History
• Acute onset hypertonia, painful muscular contractions (jaw & neck) & generalized muscle spasms; lockjaw in 75% of cases
• RFs: Inadequate vaccination status, chronic wound, IVDU
Findings
• Spasms of muscles in close proximity to site of injury, cephalic, lockjaw, risus sardonicus (characteristic grimace) tetanic sz, respiratory failure
• Autonomic Dysfxn: BP ↑ or ↓, dysrhythmias, cardiac arrest
• Cx include fractures & dislocations
Evaluation
• No spec tests available; clinical Dx
Treatment
• Tx of muscle spasm w/ benzo’s, respiratory support, NG tube for feeding
• Intrathecal antitetanus immunoglobulin hastens clinical improvement
• Abx: Metronidazole, PCN G, or tetracycline
Disposition
• ICU admission
Pearls
• C. tetani is obligate gram-positive nonencapsulated spore forming bacillus, resistant to heat, desiccation, & disinfectants
• DTaP (diphtheria, tetanus, pertussis; inactivated) vaccine given at 2, 4, & 6 mo, booster given b/w 15–18 mo & at 4–6 yr; booster recommended q10y or if dirty wound
• Mortality 30–45%; if received tetanus toxoid at sometime in life mortality 6%
• Slow recovery over 2–4 mo, usually complete resolution of sxs
Prevention
• Clean & débride wound as needed
• Pts who have not completed primary immunization series should repeat Td booster in 4–8 wk & 6–12 mo