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Diagnosis, assessment, and management of tetanus, rabies, and botulism 

Diagnosis, assessment, and management of tetanus, rabies, and botulism
Diagnosis, assessment, and management of tetanus, rabies, and botulism

Jeffrey Lipman

and Robert J. Boots

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date: 25 June 2022

Tetanus, rabies and botulism are all infections characterized by the production of a neurotoxin, and generally do not give rise to a systemic inflammatory response. Typically tetanus result from the infection of wounds by the ubiquitious soil-borne bacteria Clostridium tetanii, botulism is most commonly due to toxin produced in food contaminated with Clostridium botulinum. Rabies usually results from an animal bite infected with the rabies virus of the Lyssavirus group. Neurological involvement by all three infections is characterized by paralysis and autonomic instability with tetanus also being associated with muscular rigidity. Importantly, the autonomic dysfunction of tetanus can be severe and may necessitate prolonged treatment in an intensive care unit (ICU). Active immunization can prevent or minimize the symptoms of tetanus and rabies, while passive immunization may slow symptom progression in botulism. Intensive care support is often required to manage respiratory failure and autonomic dysfunction. Rabies is typically fatal in the absence of prior immunization.

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