Autonomic nervous system instability, tetanic necrosis of the heart and myocardial TNFα expression in a tetanus fatal case

Pomara, Cristoforo; Neri, Margherita; Riezzo, Irene; Turillazzi, Emanuela; Fineschi, Vittorio

doi:10.1016/j.ijcard.2008.05.007

Cited by 9 publications

(2 citation statements)

References 7 publications

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“…Circulating concentrations of noradrenaline and adrenaline, as indicated by urinary excretion, are higher in tetanus compared with those measured in other critical illnesses, and normal cardiovascular regulation is impaired 49,50. Direct catecholamine-related necrosis has been shown at autopsy and tumour necrosis factor α-associated dysfunction has also been implicated in the pathophysiology 51. Electrocardiograms of 33 patients in Dakar (Senegal) showed more than one abnormality in 93% of patients, despite normal echocardiography 52…”

Section: Clinical Featuresmentioning

confidence: 99%

Maternal and neonatal tetanus

2015

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Maternal and neonatal tetanus are important causes of maternal and neonatal mortality, claiming about 180 000 lives worldwide every year, almost exclusively in developing countries. Although easily prevented by maternal immunisation with tetanus toxoid vaccine, and aseptic obstetric and postnatal umbilical-cord care practices, maternal and neonatal tetanus persist as public-health problems in 48 countries, mainly in Asia and Africa. Survival of tetanus patients has improved substantially for those treated in hospitals with modern intensive-care facilities; however, such facilities are often unavailable where the tetanus burden is highest. The Maternal and Neonatal Tetanus Elimination Initiative assists countries in which maternal and neonatal tetanus has not been eliminated to provide immunisation with tetanus toxoid to women of childbearing age. The ultimate goal of this initiative is the worldwide elimination of maternal and neonatal tetanus. Since tetanus spores cannot be removed from the environment, sustaining elimination will require improvements to presently inadequate immunisation and health-service infrastructures, and universal access to those services. The renewed worldwide commitment to the reduction of maternal and child mortality, if translated into effective action, could help to provide the systemic changes needed for long-term elimination of maternal and neonatal tetanus. Tetanus in the first 28 days of life (neonatal tetanus) was long recognised by clinicians in resource-poor settings as an important cause of neonatal death. However, since babies affected by this disease usually are born at home and die there without registration of either event, the true burden was unknown. In the 1970s and 1980s, community-based surveys about neonatal tetanus from more than 40 countries showed that fewer than 10% of tetanus-related cases and deaths were routinely reported in most countries: in some regions, the reporting fraction was as low as 2-5%.

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Section: Clinical Featuresmentioning

confidence: 99%

Maternal and neonatal tetanus

2015

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“…Autonomic dysfunction with episodes of tachycardia, hypertension, and sweating, sometimes rapidly alternating with bradycardia and hypotension are common, especially in generalized tetanus [18,22,23]. Such symptoms are paralleled by dramatic increases in circulating adrenaline and noradrenaline [22,24], which may cause myocardial necrosis [25]. Autonomic symptoms tend to occur a week after the occurrence of motor symptoms.…”

Section: Symptomatology Of Tetanusmentioning

confidence: 99%

Tetanus: Pathophysiology, Treatment, and the Possibility of Using Botulinum Toxin against Tetanus-Induced Rigidity and Spasms

Hassel

2013

Toxins

104

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Tetanus toxin, the product of Clostridium tetani, is the cause of tetanus symptoms. Tetanus toxin is taken up into terminals of lower motor neurons and transported axonally to the spinal cord and/or brainstem. Here the toxin moves trans-synaptically into inhibitory nerve terminals, where vesicular release of inhibitory neurotransmitters becomes blocked, leading to disinhibition of lower motor neurons. Muscle rigidity and spasms ensue, often manifesting as trismus/lockjaw, dysphagia, opistotonus, or rigidity and spasms of respiratory, laryngeal, and abdominal muscles, which may cause respiratory failure. Botulinum toxin, in contrast, largely remains in lower motor neuron terminals, inhibiting acetylcholine release and muscle activity. Therefore, botulinum toxin may reduce tetanus symptoms. Trismus may be treated with botulinum toxin injections into the masseter and temporalis muscles. This should probably be done early in the course of tetanus to reduce the risk of pulmonary aspiration, involuntary tongue biting, anorexia and dental caries. Other muscle groups are also amenable to botulinum toxin treatment. Six tetanus patients have been successfully treated with botulinum toxin A. This review discusses the use of botulinum toxin for tetanus in the context of the pathophysiology, symptomatology, and medical treatment of Clostridium tetani infection.

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Clostridium tetani (Tetanus)

Brook¹

2018

Principles and Practice of Pediatric Infectious Diseases

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Autonomic nervous system instability, tetanic necrosis of the heart and myocardial TNFα expression in a tetanus fatal case

Cited by 9 publications

References 7 publications

Maternal and neonatal tetanus

Maternal and neonatal tetanus

Tetanus: Pathophysiology, Treatment, and the Possibility of Using Botulinum Toxin against Tetanus-Induced Rigidity and Spasms

Clostridium tetani (Tetanus)

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