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Tetanus 

Tetanus
Chapter:
Tetanus
DOI:
10.1093/med/9780198729228.003.0117
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date: 19 November 2019

Tetanus is rare in Western Europe. However, due to inadequate immunization coverage, tetanus remains a major public health issue worldwide. Tetanus is transmitted by direct inoculation of Clostridium tetani spores into damaged tissue. Local growth of the organism leads to the production of tetanospasmin—a potent neurotoxin which causes muscular spasm and rigidity. Two forms of tetanus exist: generalized and localized. Diagnosis is clinical, supported where possible by laboratory testing. Culture or polymerase chain reaction of samples from the wound is positive only in a few cases; detection of the neurotoxin in serum is the definitive diagnostic test. Local wound care, antibiotic, neutralization of the toxin by tetanus immunoglobulins, and supportive treatment for muscle spasm and respiratory distress are the mainstays of management. Primary prevention is through immunization with tetanus toxoid, consisting of five doses at appropriate intervals. Tetanus-prone wounds should be thoroughly cleaned. Individuals with an incomplete vaccination history or high-risk wounds should receive human tetanus immunoglobulin.

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