This 63-year old alcoholic was taken to the emergency room of a local hospital w

Question

This 63-year old alcoholic was taken to the emergency room of a local hospital with obvious gangrene of both feet. He was stuporous. During that evening, he had a seizure and was treated with phenutoin and barbiturates. That night he was transferred to a university hospital. At that time, he was noted to have opisthotonic posturing and to have developed increasing rigor, respiratory distress, and unresponsiveness. On examination, he had a temperature of 41.7C rectally, a blood pressure of 70/30 mm Hg, a heart rate of 110- beats per minute, and a respiratory rate of 40/min. Examination was notable for marked trismus. The neck was stiff and hyperextended. Necrotic, blackened areas were present over both feet, and several draining ulcers were noted on the heels and toes. Neurologically the patient responded to deep pain with a grimace. On the basis of these findings, specific therapy, in addition to supportive care, was initiated, and the patient ultimately recovered. In Addition to identifying this infectious disease and the infectious agent, ANSWER THE FOLLOWING QUESTIONS: What virulence factor produced by the infectious agent was responsible for his trismus? How did this patient become infected with this organism. What was the role of his gangrenous feet in the development of this infection? What is the therapy used to treat this infection? How might this infection have been prevented? Also include your interpretation of relevant history and clinical/lab findings!

Explanation / Answer

The infection is tetanus and the infectious agent is clostridium tetani.

1. Virulence factors: The virulence of tetanus is due to the release of exotoxin produced by the infectious agent i.e. clostridum tetani. C. tetani invades host tissues and release two types of toxins: Tetanolysin and Tetanospasmin. The Tetanolysin is haemolysin with no pathogenicity while the Tetanospasmin is a neurotoxin which binds with the synaptic motor neurons. The light chain of tetanospasmin prevents the release of neurotransmitters glycine and gamma aminobutyric acid form inhibitory neurons to the muscles . This results in loss of inhibition in skeletal muscles , characterized by muscle rigidity and spasms. Simultaneous and painful spasms my occur.

2. The tetanus infection may be caused when a wound becomes infected with the C.tetani. The wound may be result of surgery, animal bite, burn, laceration, injection drugs with dirty needles, tattos and body piercing.

3. Treatement for Tetanus:

1. Human Tetanus Immunoglobulin(TIG) neutralises unbound toxin

2. Treatement with Metronidazole: Kills vegetative cell, no additional toxin made. Must use with TIG (TIG binds with the toxin floating around).

3. The treatement invloves the administration of tetanus antitoxin and antibiotics.

4. Prevention:

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