: 63 year old alcoholic taken to the er w/gangrene in both feet;He is stuporous;

Question

: 63 year old alcoholic taken to the er w/gangrene in both feet;He is stuporous;had a siezure during evening of transfer and was treated with phnytoin&bartituates;by nighttime he was noted to have opisthotonic posturing;developed increasing rigor,resp.distress and unresponsiveness;70/30mm Hg; HR110bpm,resp.rate40/min;rectal temp41.7 C;marked trismus;The neck was stiff and hyper extended; nectrotic blackened areas over both feet;several draining ulcers on heels and toes; neurologically the patient responded to deep pain w/a grimace. After specific therapy & supportive care was initiated the patient ultimately recovered. What is the etiology of infection?; What virulence factor produced by etiologic agent of his infection was responsible for his trismus?;How did the patient become infected with this organism?;what was the role of his gangrenous feet in the development of this infection?;What is the specific therapy used to reat this infection?;How might this infection have been prevented?

Explanation / Answer

a) The infection caused is TETANUS. b) Trismus or lockjaw and the facial spasms called as Risus sardonicus is the first sign of the this infection. It results due to the neurotoxin tetanospasmin or tetanus toxin, produced by Clostridium tetani (disease causing agent). The released toxin enters neuromuscular junctinos of motor neurons and carried to cell bodies in the spinal cord and brain stem through retrograde axonal transport and bind irrreversibly to receptors at these sites. It blocks neurotransmission by cleaving membrane proteins of neuroexocytosis, leading to damage in upper motor neurons that can no longer inhibit lower motor neurons and cannot control reflex responses to afferent sensory stimuli. c) The patient might be infected by placing his hands on any rough surface of rusty metal that merely contains C. tetani endospores. The another mode might be through a nail that affords a means to puncture skin and deliver endospore into the wound. d) Gangrene feet is described as the death of muscle tissue of the foot. It develops when the blood supply is cut off to the affected part as a result of infection. So, it plays a prominent role in development of the infection by giving enough space for bacteria to grow. e) Tetanus can be treated by administring the patient with antibiotic metronidazole that decrease the bacterial number but have no effect on bacterial toxin. Passive immunization might help in another way of treatment. f) Tetanus can be prevented by vaccination with tetanus toxoid.

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