Pathophysiology of Tetanus

OPEN WOUND Clostridium tetani

(spores in the anaerobic environment, multiplies in aerobic environment e.g. human body)

Toxins are produced Tetanospasmin

(potent neurotoxin)

Tetanolysin
Potentiates infection

Tetanospasmin
(potent neurotoxin)

Enters bloodstream and lymph system Passes to muscles Cannot fully cross BBB Transported back up peripheral nerves to the CNS Taken up by neuromuscular joint (3-14 days); Enters CNS by retrograde axonal transport Attaches to several sites within the central nervous system, including peripheral motor end plates, spinal cord, brain and SNS toxin blocking inhibitor impulses through neurotransmitter interference Widespread activation of motor and autonomic NS Uncontrolled catecholamine release

hyper-sympathetic state with sweating, tachycardia, and hypertension, highgrade fever

SPASMS Face, neck and jaw first because of shorter axonal pathways Activation of opposing groups = RIGIDITY (e.g., risus sardonicus) spasm of the axial muscles along the spinal column = OPISTHOTONUS

In thorax = respiratory failure

In larynx = anoxia

Grade III (severe): severe trismus, generalized spasticity, reflex and often spontaneous prolonged spasms, respiratory failure with tachypnea >40/min, apneic spells, severe dysphagia, tachycardia >120/min *growth of new axonal nerve terminals is necessary for recovery, which may take 4 to 6 weeks.