infectious diseases
Tetanus
Key Points
Tetanus is caused by a toxin produced byClostridium tetaniin contaminated wounds. Tetanus toxin blocks release of inhibitory neurotransmitters, causing generalized muscle stiffness with intermittent spasms; seizures and autonomic instability may occur. Prevent further toxin release by debriding the wound and giving an antibiotic (eg,metronidazole), and neutralize unbound toxin with human tetanusimmune globulin. Give IV benzodiazepines for muscle spasm, and use neuromuscular blockade and mechanical ventilation as needed for respiratory insufficiency due to muscle spasm. Mortality is high in untreated neonates and adults. Prevent tetanus by following routine immunization recommendations. 