Infectious Disease Compendium



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.


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

Epidemiologic Risks

Found in soil and gi tracts.


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).


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


Vaccines work.

ICD9 Codes (Soon to be supplanted by ICD10)

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