tetanus /tet″ənəs/ [Gk, tetanos, extreme tension] , an acute, potentially fatal infection of the central nervous system caused by the exotoxin tetanospasmin, elaborated by the anaerobic bacillus, Clostridium tetani. The toxin is a neurotoxin and one of the most lethal poisons known. C. tetani infects only wounds that contain dead tissue. The bacillus is a common resident of the superficial layers of the soil and a normal inhabitant of the intestinal tracts of cows and horses; therefore barnyards and fields fertilized with manure are heavily contaminated. ▪ OBSERVATIONS: The bacillus may enter the body through a puncture wound, abrasion, laceration, or burn; via the uterus into the bloodstream in septic abortion or postpartum sepsis; or through the stump of the umbilical cord of the newborn. The dead tissue of the area is low in oxygen. This is the environment essential for the replication of C. tetani. The infection occurs in two clinical forms: one with an abrupt onset, high mortality, and a short incubation period (3 to 21 days); the other with less severe symptoms, a lower mortality, and a longer incubation period (4 to 5 weeks). Wounds of the face, head, and neck are the ones most likely to result in fatal infection. The disease is characterized by irritability, headache, fever, and painful spasms of the muscles resulting in lockjaw, risus sardonicus, opisthotonos, and laryngeal spasm; eventually every muscle of the body is in tonic spasm. The motor nerves transmit the impulses from the infected central nervous system to the muscles. There is no lesion; even at autopsy no organic lesion is seen and the cerebrospinal fluid is clear and normal. ▪ INTERVENTIONS: Prompt and thorough cleansing and debridement of the wound are essential for prophylaxis. A booster shot of tetanus toxoid is given to previously immunized people; tetanus immune globulin and a series of three injections of tetanus toxoid are given to those not immunized. People who are known to have been adequately immunized within 5 years do not usually require immunization. Treatment of people who have the infection includes maintenance of an airway, administration of an antitoxin as soon as possible, sedation, control of the muscle spasms, and assurance of a normal fluid balance. The room is kept quiet, and benzodiazepines may be given to reduce hypertonicity; penicillin G, metronidazole or doxycycline are antibiotics of choice administered for infection; and a tracheostomy is performed and oxygen given for ventilation. ▪ PATIENT CARE CONSIDERATIONS: The health care provider may encourage everyone to be actively immunized against the infection. The vaccine is safe and effective.
