Tetanus

Clostridium tetani

Structure

Gram + Bacterium just in newly cultures. Stricter anaerobic and Spore former. Pass through different phases: during bacilli phase has movement for surface fimbriaes but when he becomes a spore (racket like) lose his fimbriaes. Spore phase is ambient resistant and expectative for normal condition to become bacilli again.

Virulence

Tetanospasmina: is a toxin that has two strains: heavy chain and light chain. The heavy can be divided by tripsine in B and C. The light chain (A) mediates the disease. Initially, there is a trauma that exposes the axon to the toxin, and links to ganglioside ; after this the toxin goes to basal nucleus of neurons in CNS by retrograde transport. Once there, spread to glicinergic and GABA-ergic terminals where clives the sinaptobrevine in the pre-sinaptic membrane and blocks the neurotransmisor fusion. This inhibition elicits an elevated stimulation by normal nervous ways that express like augmentation of muscle contraction. And the spasms is produced by incapability of inhibition afferent stimuli. These inhibitory neurons also control catecholamine release by suprarenal gland which reflects like sympathetic tone elevation.

Adhesion: Fibronectine-binding protein, int-A like protein
Hemolysin
Tetanolisine: Lyses of cholesterol membrane cells.
Collagenase: Permits interstitial spread.
Note: an infected person is not contagious, the transmission only occurs with spores present on the ambient.

Pathology

Exists four disease’s presentation ways: generalized, localized, cephalic and natal.

Generalized: Trismus, sardonic laugh, abdominal rigidity, generalized spasms (opistotonos) with conscience conservation but pain.

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Localizated: Muscles rigidity near of trauma region. Looks like inferior motor neuron lesion. It0s pro-drome of generalized.

Cephalic: muscles rigidity of cranial nerves dependent muscles. Facial hypotone and strabismus.

Natal: Due umbilical cordon infection in pregnant non-vaccinated women. Weakness and hypotonic state. Later, appears rigidity and spasms.

Dx: Clinical

Treatment: Benzodiazepins and vaccination. Don’t give penicillin cause it may work against.