Infectious Disease Compendium

Tetanus

Diagnosis

Severe, intractable spasms with autonomic instability (it is the autonomic dysfunction that kills them).

Epidemiologic Risks

Contaminated wound esp if the patient never received the tetanus series: old folks and immigrants are at high risk.

Microbiology

C. tetani. A spore former they exist forever in the environment.

Epidemiologic Risks

Found in soil and gi tracts.

Syndromes

Clostridia tetani: tetanus aka lock jaw. Treatment: C. tetani: Human tetanus immune globulin (HTIG) 500 IU.

Active immunization must also be initiated; getting tetanus does not lead to immunity. Metronidazole (500 mg iv q 6) preferred, penicillin or imipenem but only metronidazole has been shown to help.

Patient will require intubation /tracheostomy and neuromuscular blockade to prevent spasms. A benzodiazepine intravenously (diazepam in 5-mg increments, or lorazepam in 2-mg increments) to control spasm and decrease rigidity. Transfer the patient to a quiet, dark room as external stimuli can set off spasms.

Débride any wounds. Treat sympathetic hyperactivity with labetalol (0.25-1.0 mg/min as needed for blood pressure control) or morphine (0.5-1.0 mg/kg/hr by continuous infusion; bradycardia may require a pacemaker.

High-dose intravenous Mg may help the tetany, keep levels between 3 and 4 mmol/l (Ref).

Pearls

Even after tetanus, they still need the vaccine series; the disease is not enough to cause immunity.

Rants

Vaccines work.

ICD9 Codes (Soon to be supplanted by ICD10)

Tetanus, tetanic (cephalic) (convulsions) 037; abortion 639.0; inoculation V03.7.