Tetanus

Question 1

Causative organism?

Answer 1

Clostridium tetani

Question 2

How may someone get infected?

Answer 2

Tetanus spores are present in soil and may be introduced into the body from a wound, which is often unnoticed

Question 3

What does the causative organism release?

Answer 3

Clostridium tetani releases tetanospasmin exotoxin which prevents release of GABA

Question 4

Symptoms?

Answer 4

• prodrome fever, lethargy, headache
• trismus (lockjaw)
• risus sardonicus (a highly characteristic, abnormal, sustained spasm of the facial muscles that appears to produce grinning)
• opisthotonus (arched back, hyperextended neck)
• spasms (e.g. dysphagia)

Question 5

Supportive management?

Answer 5

Ventilatory support and muscle relaxants

Question 6

Management for high risk wounds e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue)?

Answer 6

Intramuscular human tetanus immunoglobulin

Question 7

Antibiotic of choice?

Answer 7

Metronidazole

Question 8

How many doses of tetanus vaccine are given and when?

Answer 8

5 doses

• 2 months
• 3 months
• 4 months
• 3-5 years
• 13-18 years

Question 9

What type of vaccine is the tetanus vaccine?

Answer 9

Cell-free purified toxin

Question 10

What defines a clean wound?

Answer 10

Wounds less than 6 hours old, non-penetrating with negligible tissue damage

Question 11

What defines a tetanus prone wound?

Answer 11

• puncture-type injuries acquired in a contaminated environment e.g. gardening injuries
• wounds containing foreign bodies
• compound fractures
• wounds or burns with systemic sepsis
• certain animal bites and scratches

Question 12

What defines a high-risk tetanus prone wound?

Answer 12

• heavy contamination with material likely to contain tetanus spores e.g. soil, manure
• wounds or burns that show extensive devitalised tissue
• wounds or burns that require surgical intervention

Question 13

What if a patient has had a full course of tetanus vaccines, with the last dose < 10 years ago, and acquires a wound?

Answer 13

No vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

Question 14

What if a patient has had a full course of tetanus vaccines, with the last dose > 10 years ago, and acquires a tetanus prone wound?

Answer 14

Give a reinforcing dose of vaccine

Question 15

What if a patient has had a full course of tetanus vaccines, with the last dose > 10 years ago and acquired a high risk wound?

Answer 15

Give a reinforcing dose of vaccine and tetanus immunoglobulin

Question 16

What if a patient gets a wound but their vaccination history is incomplete/unknown?

Answer 16

Give a reinforcing dose of vaccine, regardless of the wound severity and if the wound is tetanus prone or high risk, then also give tetanus immunoglobulin