Tetanus

Disease caused by Clostridium tetani.

• Significant decline since tetanus vaccination was introduced.
• Worldwide 300,000-500,000 cases/year.

• The spores of Clostriudium tetanie are mostly localised in the soil and can enter the body e.g. during gardening, injuries caused by foreign bodies or bites. A toxin inhibits the motoneurotic synapses, causing convulsions.
• Incubation period: 2-15 days.

• Uncharacteristic prodramal stage.
• On the face, these spasms can lead to the well-known risus sardonicus (devil's grin); if the back muscles are involved, opisthotonus occurs. Also typical are hardening of the masseter muscles (trismus), neck stiffness, and increased abdominal tension.

• Vaccine history.
• Clinical.
• Detection of spec. antibodies is of no significance for establishing the diagnosis. However, the vaccination titre can be determined to quantify the protective effect of the vaccination.

• Wonder supply.
• Active vaccination (toxoid vaccine) from 3 months of age a total of 3 vaccinations, booster vaccination every 10 years.
• TD PUR vaccine with needle
• Passive vaccination (tetanus immunoglobulin): In unvaccinated persons (or where there is uncertainty) post-exposure: Tetagam 250 IU i.m.

Lethality 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