Tetanus: Pathophysiology and Management

Ernst, Michael E.; Klepser, Michael E.; Fouts, Michelle; Marangos, Markos

doi:10.1177/106002809703101211

Cited by 56 publications

(50 citation statements)

References 40 publications

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“…Continuous infusion of diazepam or midazolam (which are GABA-agonist benzodiazepines) is also recommended to prevent the development of respiratory and cardiovascular life-threatening complications. Other drugs, such as propofol, vecuronium, pancuronium and baclofen, had been successfully used as antispasmodic agents (17,20,24).…”

Section: Discussionmentioning

confidence: 99%

A Case of Cephalic Tetanus in a Developed Country

Fusetti

Ghirotto

Ferronato

2013

Int J Immunopathol Pharmacol

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Tetanus is a potentially life-threatening infection that results from contamination of skin wound by Clostridium Tetani spores. Although, it remains an important health problem in developing countries without strict national immunization programs, this condition is rare in the developed world. The most frequent presenting symptoms are trismus and dysphagia, due to the spasmodic contraction of the masticatory muscles. Then the disease usually diffuses with a descending pattern inducing a generalized contraction of the agonist and antagonistic muscles, which characterize a tetanic spasm. Mortality usually results from respiratory failure, cardiovascular collapse, or autonomic dysfunctions. Treatment usually requires the prompt admission to the intensive care unit to avoid the development of potential life-threatening complications. We report the case of a 78-year-old farmer, who was referred to us with progressive onset of lock-jaw and muscular stiffness of the facial region, that had occurred after he had scratched himself with a rose. The recognition of the presenting signs of cephalic tetanus allowed the prompt management of the infection. However, because of the rarity of this condition, the clinicians may be unfamiliar with the clinical presentation, and be unsuspecting of the diagnosis.

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Section: Discussionmentioning

confidence: 99%

A Case of Cephalic Tetanus in a Developed Country

Fusetti

Ghirotto

Ferronato

2013

Int J Immunopathol Pharmacol

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“…The length of the illness in tetanus ranges from 3 weeks to 2 months; typically, muscle spasms subside after 2 weeks and may resolve within 1 month. 15 Treatment often requires that the patient be sedated and mechanically ventilated for long periods. Although none of the children in this series died, the reported case fatality ratio may range from 10% to 90%.…”

Section: Discussionmentioning

confidence: 99%

Philosophic Objection to Vaccination as a Risk for Tetanus Among Children Younger Than 15 Years

et al. 2002

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ABSTRACT. Objectives. Although safe and effective vaccines are available to protect against tetanus in the United States and vaccination rates are high, cases of tetanus among children continue to occur. The objectives of this article are to describe reported cases of tetanus in children in the United States and to identify the reasons for lack of protection against tetanus.Methods. We reviewed all cases of tetanus in children <15 years of age that were reported to the National Notifiable Diseases Surveillance System from 1992 through 2000. Cases were defined by physician diagnosis. We verified the information in the case reports with state and local health departments.Results. From 1992 through 2000, 15 cases of tetanus in children <15 years of age were reported from 11 states. Twelve cases were in boys. Two cases were in neonates <10 days of age; the other 13 cases were in children who ranged in age from 3 to 14 years. The median length of hospitalization was 28 days; 8 children required mechanical ventilation. There were no deaths. Twelve (80%) children were unprotected because of lack of vaccination, including 1 neonate whose mother was not vaccinated. Among all unvaccinated cases, objection to vaccination, either religious or philosophic, was the reported reason for choosing not to vaccinate.Conclusion. The majority of recent cases of tetanus among children in the United States were in unvaccinated children whose parents objected to vaccination. Parents who choose not to vaccinate their children should be advised of the seriousness of the disease and be informed that tetanus is not preventable by means other than vaccination. Pediatrics 2002;109(1). URL: http://www.pediatrics.org/cgi/content/full/109/1/e2; tetanus, vaccination, vaccine exemption, immunization law.

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“…El tétanos es una enfermedad cuyos sín-tomas son tan característicos que permiten su diagnóstico sin necesidad de aislar la bacteria (Hatheway 1990), el síntoma preponderante son las contracciones musculares muy dolorosas, con dificultad respiratoria, debido a las contracciones de los músculos involucrados con la respiración, que en última instancia llevan a la muerte por fallo respiratorio; además, los espasmos en los músculos faciales producen la mueca conocida como risa sardónica y los espasmos en los músculos de la espalda son de tal magnitud que el paciente se arquea entre los talones y la cabeza, y en todo caso, el dolor extremo es la característica preponderante (LaForce 1969, Schofield 1986, Ernst et al 1997. Los animales inoculados experimentalmente con la toxina, o sea cuando se confirma que la cepa en cuestión se trata de C. tetani, desarrollan un cuadro de tétanos mortal; esto significa, que la prueba biológica conduce al sacrificio de un número importante de animales que mueren sometidos a un estrés intenso, y si el modelo animal se comporta como en humanos, esos animales estarían sufriendo durante su agonía de un dolor extremo.…”

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Detección inmunoenzimática de la toxina de la bacteria <i>Clostridium tetani</i>: una alternativa a las pruebas biológicas con ratones

Cháves

León

Hernández‐Chavarría

2014

RBT

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Abstract. Immunoenzimatic detection of the Clostridium tetani bacterial toxin: an alternative to mice bioassays. Cell-free extracts from 20 strains of Clostridium tetani isolated from soil samples, were tested for tetanus toxin production using an enzyme immunoassay. All the extracts were classified as positive for the toxin presence, and eight of them showed absorbance values corresponding to tetanus toxin concentrations between 3.2 and 88 ng/ml; thus, they fell within the linear absorbance range (0.135-0.317). All dilutions of toxin used to obtain the calibration curve (0.0071 to 1.1 ng) were lethal for mice. Rev. Biol. Trop. 54(2): 253-256. Epub 2006 Jun 01.

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Tetanus: Pathophysiology and Management

Abstract: Despite the relative infrequency of tetanus cases, mortality among untreated patients remains significantly high. Clinicians should become knowledgeable in the pathophysiology, clinical manifestations, and management of this potentially fatal disease.

Cited by 56 publications

References 40 publications

A Case of Cephalic Tetanus in a Developed Country

A Case of Cephalic Tetanus in a Developed Country

Philosophic Objection to Vaccination as a Risk for Tetanus Among Children Younger Than 15 Years

Detección inmunoenzimática de la toxina de la bacteria <i>Clostridium tetani</i>: una alternativa a las pruebas biológicas con ratones

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