Microbiology of Clostridium Tetani and Wound Classification

Clostridium Tetani

Is the causative agent of tetanus. The organism is found in soil, feces of horses and other animals, and
normal inhabitant of the intestine of humans and animal.

A. Morphology
 Gram positive, rod shaped
 Non-capsulated and motile
 Spores are spherical, terminal and bulging,
giving characteristic appearance of a ‘drum
stick’

B. Adaptation
 Two primary life stages, sporular and
vegetative
 The latter stage is extremely anaerobic and
and bacteria of this state are unable to survive
oxygen exposure
 In contrast, the sporular form is quite hardly
and can withstand oxygen and environmental
extremes
 Utilizing anaerobic infections, such as
infiltration wounds in the skin of humans, C
tetani parasitiez its host using extracellular
excretions to degrade surrounding organic
material for fermentation
 As with majority of bacteria, clostridium tetani
reproduces via an asexual reproduction
process known as binary fision, in this process a single bacterium cell that has
reached its maximal growth stage divides into two smaller identical clone bacteria
cells.

C. Toxins
Clostridium tetani produces two distinct toxins: a hemolysin known as tetanolysin and a
powerful neurotoxin called tetanospasmin
Neurotoxin or tetanospasmin
 This toxin is reponsible for the clinical manifestation of tetanus
 Oxygen-stable and heat-labile
 On release from the bacillus the toxin is autolysed to form heterodimer consisting of
a heavy chain and a light chain linked by a disuphide bond
Hemolysin or tetanolysin
  Heat-labile, oxygen-labile toxin antigenically related to the hemolysins
 Its pathogenic role is not clear

D. Pathogenesis
 Clostridium is not an invasive organism
 Tetanus develops following the contamination of wounds with spores which may be
from soil, dust, feces, cow dung, etc
 Under favorable conditions like O – R potential, devitalized tissue and presence of
foreign bodies, germination of spores and toxin production occurs
 The toxin released from vegetative cells and initially binds to receptors on the
precynaptic membranes of motor neurons, it then migrates by the retrogrdae
axonal transport system to the cell bodies of these neurons to the spinal cord nd
brainstem.
 The toxin diffuse to terminals of inhibitory cells, including both glycirgenic
interneurons and gamma-aminobutyric acid (GABA)-secreting neurons from the
brainstem
 The toxin degrades synaptobrevin, a protein required for docking of
neurotransmitter vesicles on the presynaptic membrane.
 Release of the inhibitory glycine and GABA is blocked, and the motor neurons are
not inhibited. Hyperreflexia, muscle spasm, and spastic paralysis result
 Extremely small amount of toxin can be lethal for humans.
E. Clinical findings
 The patient is fully conscious
 The incubation period may range from 4 to 5 days to as many weeks
 Characterized by tonic contraction of voluntary muscle.
 Muscular spasm involve first in the area of injury and infection and then muscle of
jaw (trismus, lockjaw), which contract so that the mouth can not be opened
 Death usually results from interference with the mechanics of respiration
 The mortality rate in generalized tetanus is very high.

F. Treatment and prevention

 Prevention of tetanus depens on: active immunization with toxoid, proper care
wounds contaminated with soil, prophylactic use of antitoxin, administration of
penicilin or metronidazole
 The available methods of prophylaxis are: surgery, antibiotics, and immunization
 Tetanus patients are treated in hospitals in special isolated wards only to protect
them from noise and light which may provoke convulsions
 Treatment consist of controlling spasm, maintaining airway by tracheostomy and
attention to feeding
 IM administration of antitoxin gives systemic production, toneutralize unbound
toxin
  Penicilin or metronidazole is started immediately and continued for more than one
week.

Wound Classification

Wound classification system is a formula that the surgical team uses for post-operatively grading the
extent of microbial contamination

 Class I/Clean Wounds

An uninfected surgical wound, no inflammation is encountered in respiratory, alimentary,
genital, or uninfected urinary tracts are not entered.
 Class II/Clean-Contaminated Wounds
A surgical wounds in which respiratory, alimentary, genital, or urinary tract are entered under
controlled conditions and unusual contamination.
 Class III/Contaminated Wounds
Open, fresh, accidental wounds
 Class IV/Dirty or Infected Wounds
Old traumatic wounds with retained or devitalized tissue and those that involve existing clinical
infection. This definition suggest that the organism causing postoperative infection were
present in the wound before the surgical
prosedure.

National guidance on tetanus vaccination

and post-exposure prophylaxis classify te
following types of wound as tetanus
prone

 Wounds or burns that require

surgical intervention that is delayed for
more than 6 hours
 Wounds or burns that show a
significant degree of devitalized tissue or
a puncture-type injury, including animal bites, particularly where there has been contact with
soil or manure
 Wounds containing foreign bodies
 Compound of fracture
 Wounds or burns in patients who have systemic sepsis