-Like other clostridia, it is an anaerobic, spore-forming, gram-positive rod

-it produces a deadly toxin which disrupts central inhibitory neurotransmission, resulting in increased muscle tone and spasms 

Symptoms & signs

-tonic contraction of voluntary muscles; spasms of the muscles of the jaw (trismus, lockjaw), inability to open the mouth; fully conscious patient; a characteristic grimace (risus sardonicus), exaggerated reflexes, spasms of the extensor muscles of the back resulting in a pronounced arching of the back (Opisthotonus); respiratory failure  

Tetanus vs Botulism: in tetanus spastic paralysis (strong muscle contractions) occurs, whereas in botulism, flaccid paralysis (weak or absent muscle contractions) occurs. In tetanus, bacteria inhibit glycine release, in botulism, bacteria inhibit acetylcholine release


-Tetanus is a clinical diagnosis

-Suspect it in all patients with muscle spasms and an inadequate vaccination history

-Wound culture may show bacteria with one terminal spore at the end of the rod (tennis racket shape) 


-Tetanus is a toxin mediated disease, so goals should be to eliminate current toxin production using antibiotics and vaccination and to neutralize unbound toxin with human tetanus immune globulin 

-Natural disease does not induce immunity, so immunize all recovering patients 

-Supportive care using muscle relaxants and ventilation 

  1. What is the most common cause of death in tetanus? respiratory failure