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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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