Review Question - QID 212389

This patient who was cut with a rusty razor and presents with rigidity and spasms most likely has tetanus and should be treated with wound debridement, antitoxin, and a full tetanus toxoid-containing vaccine series.

Tetanus results from exposure to Clostridium tetani, which is a bacteria that produces the exotoxin tetanospasmin. This toxin cleaves SNARE proteins thereby inhibiting release of inhibitory neurotransmitters. This lack of inhibition leads to unregulated contraction and severe muscle spasms. There are 3 principal forms of treatment for this disease. Firstly, wound debridement should be performed on all patients to decrease the further production of tetanospasmin. Antitoxin should also be given to neutralize unbound toxin. Finally, a full tetanus toxoid-containing vaccine series should be given to all patients with tetanus because recovery does not confer immunity.

Incorrect Answers:
Answer 1: Antitoxin alone should only be used in patients without a visible wound through which tetanus was introduced.

Answer 2: Wound debridement alone would not be appropriate because this patient has tetanus and should, therefore, get antitoxin.

Answer 3: Wound debridement and booster vaccine would not be appropriate because this patient has tetanus and should, therefore, get antitoxin.

Answer 4: Wound debridement, antitoxin, and booster vaccine would not be appropriate because a full tetanus toxoid-containing vaccine series should be initiated upon diagnosis.

Bullet Summary:
Any patients with contaminated wounds and signs of tetanus toxicity should receive antitoxin, have the wound irrigated and debrided, and commence a full tetanus toxoid-containing vaccine series.