LAUSR

1. Elizabeth Rhinesmith, MD* 2. Linda Fu, MD, MS* 1. *Children’s National Health System, Washington, DC Tetanus is a life-threatening disease caused by the spore-forming, obligate anaerobic bacterium Clostridium tetani . This bacterium is abundant worldwide, mainly found in soil and the gastrointestinal tracts of humans and other animals. Disease is caused by the introduction of bacteria through a skin break, most commonly from a contaminated wound, or poor perinatal hygiene and improper cord care in the neonate, with most cases being birth related. Under anaerobic conditions, dormant C tetani spores germinate into bacilli. Bacilli produce the endotoxin tetanospasmin, which prevents the presynaptic release of neurotransmitters that inhibit muscle contraction, leading to uncontrolled muscle contraction and clinical spasms. The incidence of tetanus has dramatically decreased worldwide since the mid-20th century, largely due to the development and implementation of the tetanus toxoid vaccine. Nonetheless, tetanus remains a significant cause of mortality in the developing world, causing an estimated 56,000 deaths annually worldwide (2015 estimate), approximately 20,000 of them in neonates. The majority of tetanus cases occur in South Asia and sub-Saharan Africa. In the United States, incidence is 0.01 per 100,000, with approximately 10% of cases occurring in patients younger than 20 years. Tetanus has 4 clinical presentations: neonatal, localized, cephalic, and generalized. Neonatal tetanus generally occurs 3 to 7 days after delivery. Difficulty feeding, poor suck/swallow, and excessive crying often precede overt spasms. Localized tetanus involves muscle contraction limited to the area of injury. Cephalic tetanus, while quite rare, can be associated with head lesions or chronic otitis media; it generally presents with cranial nerve palsy 1 to …