HYPERLINK "http://textbookofbacteriology.net/clostridia.html" Clostridium tetani is a clinically important bacterium. It is a HYPERLINK "http://en.wikipedia.org/wiki/Gram_positive" Gram-positive, sporulating HYPERLINK "http://en.wikipedia.org/wiki/Anaerobic_organism" obligate anaerobe, notorious for producing HYPERLINK "http://en.wikipedia.org/wiki/Tetanus" Tetanus. The organism is found in soil and in the intestinal tracts and faeces of animals.

SYMPTOMS

Tetanus has been known since ancient times when the link was made between wounds and painful, fatal muscle spasm. It was once known as "Lockjaw", after the early symptoms which involve spasms of the masseter muscle. This is followed by progressive rigidity and violent spasms of the trunk and limb muscles. Death usually follows and results from interference with the respiratory muscles and breathing process.

TOXINS

Most cases of tetanus result from small puncture wounds with C. tetani spores that germinate and produce toxin. The infection remains localised, but systemic damage results from the production of HYPERLINK "http://en.wikipedia.org/wiki/Exotoxins" exotoxins, released when the spores germinate and grow. Tetanus toxin "Tetanospasmin" is one of the most potent toxins known, third only to HYPERLINK "http://en.wikipedia.org/wiki/Botulinum_toxins" botulinum toxin and HYPERLINK "http://en.wikipedia.org/wiki/Diphtheria_toxin" diphtheria toxin. This powerful neurotoxin enters peripheral nerves and travel to the Central Nervous System. Here it interferes with the release of HYPERLINK "http://en.wikipedia.org/wiki/Neurotransmitter" neurotransmitters, causing muscle contraction and spasm.

TREATMENT

Treatment of established Tetanus can be achieved with:

Human tetanus HYPERLINK "http://en.wikipedia.org/wiki/Immunoglobulin" immunoglobulin, (containing antitoxins) to neutralise the toxin.

Large doses of HYPERLINK "http://en.wikipedia.org/wiki/Antibiotics" antibiotics to halt toxin production.

IMMUNISATION

HYPERLINK "http://en.wikipedia.org/wiki/Immunisation" Immunisation is accomplished with tetanus toxoid, as part of the DPT (Diphtheria, Typhoid, Polio) vaccine. In the HYPERLINK "http://www.clinicalanswers.nhs.uk/index.cfm?question=147" UK three injections are given in the first year of life, followed by a Preschool and School Leaver boosters. Following such a schedule the individual is usually considered protected for life. However, should a wound be particularly at risk e.g. contaminated with stable manure, human tetanus immunoglobulin will give immediate additional protection.

Because of the widespread use of the tetanus toxoid the number of HYPERLINK "http://www.immunisation.org.uk/article.php?id=193" cases of tetanus in the UK is low, with an average of only six cases each year. It remains however, a significant problem world-wide, particularly the HYPERLINK "http://en.wikipedia.org/wiki/neonatal" neonatal form, where there are more than HYPERLINK "http://en.wikipedia.org/wiki/neonatal" 300,000 cases annually. Clearly there is still work to be done to eradicate this disease.