Tetanus

Still accounts for 1 million deaths worldwide each year
Etiology C. tetani: obligate anaerobic spore forming gram positive bacillus - prevalent in soil and manure
Pathogenesis Exotoxin produced tetanospasmin
- inhibits release of GABA in interneurons → excessive motor neuron activity and autonomic instability
- prevents release of glycine at Renshaw cells in spinal cord
Epidemiology Incubation: 3-14d (1-60 at the extremes)
Contaminated wounds or umbilical stump infections
Clinical presentation Time of onset: 1-7d
Trismus
Dysphagia
Tonic muscle spasm, hyperreflexia
Autonomic dysfunction
Investigations Wound swab
Serum toxin
CSF: +/- ↑ protein, but may be normal
Management penicillin is a GABA antagonist?! → metronidazole
anti-tetanus immunoglobulin: 100-300IU/kg of human Ig IM

supportive including ICU care and neuromuscular blockade

See also Tetanus prophylaxis
Tetanus Ig neutralises unbound toxin (question bank)
Toxoid immunisation produces antibodies which bind to tetanospasmin and neutralise it

#pathology

https://litfl.com/tetanus/ (NB from 2014) and https://derangedphysiology.com/main/required-reading/sepsis-and-infections/Chapter-3455/tetanus my beloved <3