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Pathology
Clostridium tetani: gram positive anaerobic spore-forming rod.
Potent exotoxin acts on synapse of motor nerves and blocks inhibitory neurone resulting in tetanic spasm.
Incubation 5-10 days.
Seldom seen in developed countries with successful vaccination uptake and good living conditions.
Aetiology
Inoculation of organism or spore via a wound or trauma causing a break in the skin.
Signs
Hypertonicity: Trismus and neck muscle spasm, followed by spasm of truncal
muscles. Lasts 2-3 months.
Reflex spasms: Violent sustained muscis.Symptoms
24 hour prodrome: restlessness and malaise. .
Investigations
Clinical diagnosis.
Treatment
Medical: IV benzylpenicillin, sedation, paralysis with tracheostomy and
ventilation.
Surgical: Wound debridement
Antitoxin: Human tetanus immunoglobulin
Prognosis
25-50% mortality. Worse with short incubation period and onset of 1st spasm < 24 hours.
Aspiration pneumonia, exhaustion and death.
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