Clostridium Tetani The bacterium kingdom possesses many different types of organism which are sometimes vital to our survival on this planet, but there are also thousands of other members of the bacteria kingdom which are very harmful when they are contracted by the human body. One of those organisms is Clostridium Tetani also known as Tetanus. This bacterium is a “Gram-positive, meaning it lacks an outer lipopolysaccharide membrane and possesses only a thick peptidoglycan cellular wall”. Tetanus is an acute, usually a fetal illness caused by Clostridium Tetani infection at a break in the skin, for example in a wound. It can also occur in burns as a complication and surgical site infection (2). During its premature stages the bacteria has a very low heat tolerance and can barely survive where oxygen is located. When formed on the human skin it takes the shape of a hard spore like infection which can withstand antiseptics and heat rising up to 249.8 degree F (121deg C.) for almost ten minutes.
History
The history of this disease dates back to the 1800’s, when the physician Arthur Nicolaier, discovered the disease, within the same year both Antonio Carle and Giorgio Rattone demonstrated how it was transmitted by using a rabbit. The rabbit was placed in a simulated area while it was injected with tetanus which later ended up killing the animal. Towards the end of the 1800’s both Kitasato Shibasaburo and French microbiologist and veterinarian Edmond Nocord prove that tetanus could be prevented or treated using antitoxin. Through the discovery made by these men the reported tetanus cases in the US has decline at a drastic rate, from “several thousand cases in the late 1940’s to 27 cases and two deaths in 2005”. Several factors have contributed to the decline in tetanus morbidity and mortality, including the widespread use of tetanus toxoid during world war II–containing vaccines since the late 1940s Although cases in the US has decline, in developing countries around the world Tetanus cases are still at a high level (5). Most of these cases occur during child birth when the umbilical stump of a new mother becomes contaminated. Other times during delivery mother who did not possess sufficient circulatory antitoxin to secure the infant’s safe passage by transplacental transfer. To reduce the effect of the infant being in danger, it will require the execution of a three-branched strategy: vaccination of women of childbearing age, clean delivery, and application of topical antimicrobials (destroy the growth of microbes) to the umbilical stump (4).
Disease
When a person is first infected with tetanus the symptoms usually takes from two to six days to appear after the wound has been infected. Some common symptoms are chills, difficulty swallowing, headache, jaw and neck stiffness, sore throat, low fever, restlessness, irritability, and stiff arms and legs. At the early stages it may seem like a regular fever but as time goes by the fever increases, and symptoms such as difficulty opening the jaw, and muscle spasms in the neck, back and abdomen may occur. The patient’s pulse is fast even though the fever is not high. Although patients with tetanus are often mentally alert, they can go into a coma unpredictably. Some mid-level symptoms are blue lips which are a sign of depressed breathing meaning there is too much carbon dioxide or very little oxygen in the blood (6).
Pathogenesis
Clostridium Tetani often enters the body through a wound and in the presence of low oxygen conditions, then the spores start to geminate and toxins are being produced. The Tetanospasmin toxin is created when the spores geminate and the organisms’ cells grow after entering the wound. The toxin then travels in the bloodstream, and then reaches the nervous system causing painful and muscular contractions. When the toxins are synthesized, it takes between 2 to 14 days to reach the spinal cord (6). The usual medical manifestations of tetanus are caused when tetanus toxin interferes with the release of neurotransmitters, blocking inhibitor impulses and this leads to unopposed muscle contraction and spasm.
Transmission
Tetanus is transmitted in many ways but it’s not transmitted from person to person. Clostridium Tetani is found in soil, human feces or intestines and animal waste. Other ways of transmissions are animal bites, dirty or rusty nails and sharp objects contaminated is another way. The most common way to get infected is through a wound because it provides an anaerobic environment for the organism to grow.
Treatment
When the infection is known, and all signs point to it being Tetanus, then steps should be taken to treat the infections before it leads to something else. It all starts with cleaning the wound/infected area. Dead tissue and other dead remains should be removed. If Tetanic spasms are occurring, supportive therapy and maintenance of an enough airway is critical. Tetanus immune globulin (TIG) is recommended for persons with tetanus. TIG can only help remove unbound tetanus toxin. It cannot affect toxin bound to nerve endings. Intravenous immune globulin (IVIG) contains tetanus antitoxin and may be used if TIG is not available. Penicillin is good also because it gets rid of the organism. Advancement in the medical field has enabled us to be able to treat and cure the disease, but sometimes it is best not to let things get that far. The best way to make sure you are not one of those who get infected by tetanus is to take the proper steps to prevent it. DPT is a mixed vaccine, which simply means that it provides immunity to different diseases. The vaccine protects you for five years, and the treatment you get depends on your vaccination status. After five years the effectiveness starts to slowly die off. Having the disease once doesn't give you lasting immunity against tetanus. People who have been vaccinated in the last ten years that have minor wounds don't need treatment. Those who were vaccinated more than ten years ago get a booster shot of the vaccine, which consists of a weakened form of the tetanus toxin. For deep or dirty wounds, people who received their last tetanus booster more than 5 years ago will need another booster shot. Those who have never been vaccinated need tetanus immune globulin (a blood product from an immune person). They also need to be vaccinated against tetanus. Five doses of diphtheria, tetanus toxiods and acellular pertussis vaccine are recommended for infants and children. You can also reduce your risk by disinfecting all wounds thoroughly. You might consider wearing knee and elbow pads during sports that are likely to involve violent contact with the ground. Avoid going barefoot while outside of your house. This will help to prevent infection from accidentally stepping on sharp, dirty objects (7).

Sources 1. P. Poudel, Budhathki S. and Manandhar S. 2009. “Tetanus”. Kathmandu Univ Med J 7(27): 315-322. 2. Brook Itzhak. 2008 “Current Concepts in the Management of Clostridium Tetani Infection”. Expert Review of Anti-infective Therapy 6(3):327-336 3. Doxey C. Andrew, Michael DJ Lynch, Kristen M. Muller, Elizabeth M Meiering, and Brendan J McConkey. 2008. “Insights Into Evolutionary Origins of Clostridial Neurotoxins From Analysis of The Clostridium Botulinum Strain A Neurotoxin Gene Cluster”. BMC Evolutionary Biology 8:316. 4. Demicheli V, Barale A, Rivetti A. 2005. “Vaccines for Women to Prevent Neonatal Tetanus”. 19(4). Cochrane Database Systematic Reviews. 5. Krestsinger Katrina, Pamela Srivastava. 2008. “Chapter 16: Tatanus”. Centers for Disease Control and Prevention. Manual for the Surveillance of VPD. 6. Paul Arnold. 2009. What is Clostridium Tetani? 7. Broder R Karen, “et al”. 2006. “Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents”. Centers for Disease Control and Prevention. ACIP 55 (3):1-34.