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Clostridium tetani

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1. C. tetani is a obligate anaerobic, saprophytic, rod-shaped gram-positive organisms well known for its toxin-producing ability making it one of the most dangerous of its genus.

2. It is a spore-forming organism that can withstand extreme temperature conditions in both indoor and outdoor environments.

3. The spores are distributed worldwide in soils as well as in the intestines of various livestock and companion animals.

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The spores can get into someone’s body through broken skin, usually through injuries. Tetanus bacteria are more likely to infect certain breaks in the skin. These include:

Wounds contaminated with dirt, feces, or saliva

Puncture wounds (wounds caused by an object, like a nail or needle, breaking the skin)

Burns

Crush injuries

Injuries with dead tissue

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Jaw cramping

Sudden, involuntary muscle spasms — often in the stomach

Painful muscle stiffness all over the body

Trouble swallowing

Seizures (jerking or staring)

Headache

Fever and sweating

Changes in blood pressure and heart rate

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The most important virulence factor of Clostridium tetani is tetanospasmin, a neurotoxin that blocks the release of inhibitory neurotransmitters, such as glycine and GABA in the spinal cord and brain. This leads to an increase in muscle activity, which can result in painful spasms and rigidity. Tetanospasmin can also affect the respiratory muscles, leading to difficulty breathing and death.

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The diagnosis of tetanus is clinical by asking about recent history of cuts, scrapes, punctures, and trauma, and examining someone for certain signs and symptoms. There are no hospital lab tests that can confirm tetanus.

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The main goal of treatment for tetanus is to prevent further production of tetanospasmin and to provide supportive care until the toxin is eliminated from the body.

However, Human tetanus immune globulin (HTIG) can be effective way to prevent tetanus. It is a blood product that contains antibodies to tetanospasmin. It can be used to neutralize tetanospasmin that has already bound to nerve cells.

HTIG works by binding to tetanus toxin and neutralizing it. This prevents the toxin from binding to nerve cells and causing the symptoms of tetanus.

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The sequelae of tetanus are the long-term effects of the disease.

Vocal cord spasms

Broken bones due to severe muscle spasms

Breathing problems

Pneumonia

High blood pressure or abnormal heart rhythms

Pulmonary embolism (blood clot in the lung)

Muscle weakness and stiffness

Contractures

Joint pain and deformity

Osteoporosis

Speech problems

Seizures

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The tetanus vaccine is very effective at preventing tetanus. It is estimated that the vaccine has prevented millions of cases of tetanus and deaths worldwide.

The tetanus vaccine is typically given as a combination vaccine, which also protects against diphtheria and pertussis (whooping cough). The combination vaccine is called DTaP for children and Tdap for adults.

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The figure shows reported tetanus cases in the United States during 1947–2021, according to the National Notifiable Disease Surveillance System. From 1947–2021, the number of tetanus cases reported each year, which already had decreased greatly since 1900, continued to decline, and remained low through 2021.

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Tetanus is unique among infectious diseases in that it is not transmitted from person to person. Instead, it is caused by exposure to tetanus spores, which can be found in soil and animal feces.

Tetanus spores are very resistant to the environment and can survive for many years. This means that a person can get tetanus from a wound that is many years old.

Tetanospasmin, the toxin produced by Clostridium tetani, is one of the most potent neurotoxins known. It is estimated that a lethal dose of tetanospasmin for humans is approximately 2.5 ng/kg body weight. This means that it would take a very small amount of tetanospasmin to kill a human.

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Tetanus has been known for centuries, and it was once a common cause of death. In the 1800s, tetanus was responsible for up to 50% of deaths following childbirth.

In 1890, the Japanese scientist Kitasato Shibasaburō discovered the bacteria that causes tetanus. This discovery led to the development of the tetanus vaccine in the early 1920s.

The tetanus vaccine has had a dramatic impact on the incidence and mortality of tetanus. In the United States, the number of tetanus cases reported each year has declined from over 500 cases in the 1940s to fewer than 10 cases in the 2010s.

However, tetanus is still a problem in developing countries, where vaccination rates are low. In 2018, an estimated 43,000 people died from tetanus worldwide, most of them children in developing countries.

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Brüggemann, Bäumer, S., Fricke, W. F., Wiezer, A., Liesegang, H., Decker, I., Herzberg, C., Martínez-Arias, R., Merkl, R., Henne, A., & Gottschalk, G. (2003). The Genome Sequence of Clostridium tetani, the Causative Agent of Tetanus Disease. Proceedings of the National Academy of Sciences - PNAS, 100(3), 1316–1321. https://doi.org/10.1073/pnas.0335853100

History of Tetanus - National Vaccine Information Center (NVIC). https://www.nvic.org/disease-vaccine/tetanus/history

Tetanus Disease (Lockjaw) | CDC. https://www.cdc.gov/tetanus/index.html