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Infection of a foot ulcer
8%
21/249
Infection of the colon
4%
10/249
Intrauterine infection
Infection of the umbilical stump
76%
188/249
Dental infection
2%
4/249
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The neonate is suffering from tetanus as a result of a Clostridium tetani infection of the umbilical stump. Given the child's home birth, it is likely that the tool used to cut the umbilical cord was not properly sterilized. Additionally, if the mother had not been properly vaccinated prior to delivery, the child may not have received passive immunity in utero. C. tetani is anaerobic bacteria that can be found in wounds where the tetanus toxin is produced and can travel to the central nervous system (CNS) via retrograde transport along axons. Tetanus toxin inhibits the release of inhibitory neurotransmitters in the interneurons of the CNS by preventing vesicle-mediated exocytosis of neurotransmitters. This results in the disinhibition of motor neurons and the symptoms observed. Poudel et al. review tetanus infections. Neonatal tetanus infections are the result of either lack of maternal immunity that is passively given to the child in utero or contamination at the time of umbilical cord transection. Vaccination can completely prevent this serious condition. Sur et al. discuss the safety of vaccinations during pregnancy. The authors note that the Td vaccine is helpful in protecting the mother and child from tetanus. They advocate that pregnant women, who are not current with their Td vaccination, get vaccinated. Illustration A depicts a child suffering from tetanus. Note the presence of opisthotonos, severe hyperextension and spasticity characteristic of tetanus. Incorrect Answers: Answer 1, 2,and 5: Though C. tetani infection of foot ulcers (typically in diabetic patients), infection of the colon post-surgically, infection of skin-popping sites of IV drug uses, and dental infections are possible routes leading to tetanus, the more likely cause of neonatal tetanus consistent with the patient described above is an infection of the umbilical stump. Answer 3: Intrauterine infections are commonly from other microorganisms such as Ureaplasma urealyticum, Mycoplasma hominis, and Trichomonas amongst others.
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