Tetanus

Disease caused by Clostridium tetani.

• Since the tetanus vaccination was carried out, there has been a marked decline
• Worldwide 300'000 - 500'000 diseases/year

• The spores of Clostriudium tetani are usually located in the ground and can penetrate the body during gardening, injuries caused by foreign bodies or bites, for example. A toxin inhibits the motoneurotic synapses, causing cramps.
• Incubation period: 2-15 days

• Uncharacteristic prodramal stage
• In the face these cramps can lead to the well-known risus sardonicus (devil's grin), with involvement of the back muscles it comes to opisthotonus. The hardening of the massetermuscles (trismus), stiff neck and increased abdominal wall tension are also typical

• Vaccine history
• Clinic
• The detection of specific antibodies is of no importance for the diagnosis. However, the vaccine titer can be determined to quantify the protective effect of the vaccination

• Wound care

• Active vaccination (toxoid vaccine) from the 3rd month of life a total of 3 vaccinations, booster vaccination every 10 years

• TD PUR vaccine with needle
• Passive vaccination (tetanus immunoglobulin): In unvaccinated persons (or where it is unclear) Postexposition: Tetagam 250 IU in combination

Mortality is around 20-50%.

1. Cohen PR. Combined Reduced-Antigen Content Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccine-Related Erythema Nodosum: Case Report and Review of Vaccine-Associated Erythema Nodosum. Dermatol Ther (Heidelb) 2013;3:191-7.
2. Cominos D, Strutton G , Busmanis I. Granulomas Associated with Tetanus Toxoid Immunization. The American Journal of Dermatopathology 1993;15:114-7. 
3. Sexton, D. (2016). Tetanus. Uptodate.com. Retrieved 24 May 2016, from http://www.uptodate.com/contents/tetanus?source=search_result&search=tetanus&selectedTitle=1%7E150 
4. Rodloff, A. (2016). RKI - RKI-Ratgeber für Ärzte - Tetanus. Rki.de. Retrieved 24 May 2016, from http://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Tetanus.html