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Tetanus microbiology
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Here's a concise breakdown of Tetanus Microbiology:
Clostridium tetani - Key Facts
The Organism
- Gram-positive, spore-forming bacillus
- Strictly anaerobic (extremely oxygen-sensitive)
- Spores are ubiquitous - found in soil, dust, GI tract of humans/animals
- "Drumstick" appearance due to terminal spore
Virulence Factor - Tetanospasmin
- Heat-labile exotoxin (neurotoxin)
- Produced only in anaerobic conditions (devitalized tissue)
- Mechanism: blocks release of inhibitory neurotransmitters (GABA & glycine) at inhibitory synapses
- Result: unopposed excitatory motor activity → spastic paralysis (muscles can't relax)
Pathogenesis
- Spores enter through wound
- Germinate in anaerobic/devitalized tissue
- Tetanospasmin travels retrograde via motor nerves to CNS
- Blocks glycine/GABA → failure of inhibitory reflex arcs
- Agonist + antagonist muscles contract simultaneously → tetanic spasms
Clinical Forms
| Type | Features |
|---|---|
| Generalized | Most common; risus sardonicus, trismus, opisthotonus, autonomic dysfunction |
| Localized | Spasms near wound site only |
| Neonatal | Via umbilical stump; very high mortality |
| Cephalic | Head/neck wounds; cranial nerve involvement |
Incubation
- Median 7 days (range 4-14 days); shorter = more severe disease
Diagnosis
- Clinical only - culture is insensitive, toxin/antibody tests unreliable
- Disease does NOT confer immunity (toxin amount too small to trigger immune response)
Treatment
- Wound debridement
- Metronidazole or penicillin
- Human anti-tetanus immunoglobulin (HTIg) - passive immunization
- Tetanus toxoid (active immunization)
- Sedation + muscle relaxants for spasms
Prevention
- Tetanus toxoid - 3 primary doses + booster every 10 years
- DTaP in children
Sources: Medical Microbiology 9e; Bailey & Love's Surgery 28e
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