Tetanus

The mechanism of action involves the irreversible blockade of inhibitory neurotransmitters glycine and GABA at the presynaptic terminals.

Clinical presentation typically begins with trismus (lockjaw) followed by risus sardonicus and opisthotonos due to sustained muscle spasms.

Diagnosis is strictly clinical, based on the patient's history of a puncture wound or contaminated injury and the presence of characteristic muscle rigidity.

Initial management requires tetanus immune globulin (TIG) to neutralize unbound toxin and the tetanus toxoid vaccine to induce active immunity.

Wound management necessitates thorough debridement and the administration of metronidazole or penicillin to eliminate the source of toxin production.

Patients with a dirty or deep wound require a tetanus booster if their last dose was more than 5 years ago, whereas clean, minor wounds require a booster only if the last dose was more than 10 years ago.