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Tetanus, Pediatric Reviewed 6/2012

Hamid Bassiri, Joanne N. Wood (5th edition)
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BASICS

  • Description
  • Epidemiology
  • Risk Factors
  • General Prevention
  • Pathophysiology
  • Etiology

DIAGNOSIS

  • History
  • Physical Exam
  • Tests
  • Differential Diagnosis

TREATMENT

  • Medication (Drugs)
  • Additional Treatment
  • Surgery
  • In-patient Considerations

ONGOING CARE

  • Prognosis
  • Complications
The following is an excerpt....
BASICS
Description
  • Tetanus is a disease characterized by muscle rigidity and spasms due to a neurotoxin produced by Clostridium tetani in infected wounds.
  • There are 4 clinical forms of tetanus: Generalized, localized, cephalic, and neonatal.
Epidemiology
  • Tetanus remains a major problem in developing countries but is rare in the developed world because of widespread immunization.
  • Rare cases have been reported in patients with protective levels of anti-tetanus antibodies.
  • In the US 40 or fewer cases of tetanus are reported per year.
  • Generalized tetanus is the most common form of disease. Neonatal tetanus is rare in the US but common in countries in which women are not immunized and nonsterile care of the umbilical cord is practiced.
Risk Factors
  • Inadequate ...

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Clostridial diseases. Clostridia in the vegetative form inhabit the gastrointestinal tract of humans and animals. Spores pass in the feces, contaminate soil and plant materials, and are ingested or enter sites of penetrating wounds. Under anaerobic conditions they revert to vegetative forms. Plasmids in the vegetative forms elaborate toxins that cause several clostridial diseases. Food poisoning and necrotizing enteritis. Meat dishes left to cool at room temperature grow large numbers of clostridia. When contaminated meat is ingested, C. perfringens types A and C produce alpha-enterotoxin in the small intestine during sporulation, causing abdominal pain and diarrhea. Type C also produces beta-enterotoxin. Gas gangrene. Clostridia are widespread and may contaminate a traumatic wound or surgical operation. C. perfringens type A elaborates a myotoxin, a lecithinase that destroys cell membranes, alters capillary permeability, and causes severe hemolysis following intravenous injection. The toxin causes necrosis of previously healthy skeletal muscle. Tetanus. Spores of C. tetani are in soil, and enter the site of an accidental wound. Necrotic tissue at the wound site causes spores to revert to the vegetative form. Autolysis of vegetative forms releases tetanus toxin. The toxin is transported in peripheral nerves and through axons to the anterior horn cells of the spinal cord. The toxin blocks synaptic inhibition, and the accumulation of acetylcholine in damaged synapses leads to rigidity and spasms of the skeletal musculature. Botulism. Improperly canned food is contaminated by the vegetative form of C. botulinum, which proliferates under aerobic conditions and elaborates a neurotoxin. After the food is ingested, the neurotoxin is absorbed from the small intestine and eventually reaches the myoneural junction, where it inhibits the release of acetylcholine.Credit: Image from Rubin E MD and Farber JL MD. Pathology, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 1999.
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