TETANUS - PATHOPHYSIOLOGY AND MANAGEMENT

OBJECTIVE: TO review the epidemiology, pathophysiology, clinical manif estations, diagnosis, and management of tetanus and its complications. DATA SOURCES: MEDLINE and Iowa Drug Information Services databases we re searched for literature pertaining to tetanus. Additional literatur e was obtained from the references of selected articles identified in the search. Information from all articles was considered for inclusion in the manuscript. STUDY SELECTION AND DATA EXTRACTION: Articles sele cted were those considered by the authors to assist in providing the r eader an understanding of the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of tetanus. DATA SYNTHESIS: While the number of tetanus cases has decreased markedly since data re porting for the disease began in 1947, mortality among those who acqui re the disease remains high. Elderly patients are particularly suscept ible to tetanus and its complications. Prevention of tetanus focuses o n primary immunization and scheduled boosters. Management of tetanus i nvolves initial stabilization of the patient and protection of the air way, prevention of tetanospasmin absorption by administration of human tetanus immune globulin 3000-6000 IU, and eradication of Clostridium tetani with antimicrobial therapy (metronidazole 500 mg q8h). Supporti ve measures include the administration of neuromuscular blocking agent s such as pancuronium in patients requiring artificial ventilation, as well as benzodiazepines (midazolam 5-15 mg/h) for sedation and muscle relaxation. Autonomic dysfunction should be managed with P-adrenergic blockers such as propranolol or labetalol. CONCLUSIONS: Despite the r elative infrequency of tetanus cases, mortality among untreated patien ts remains significantly high. Clinicians should become knowledgeable in the pathophysiology, clinical manifestations, and management of thi s potentially fatal disease.