Abstract
Tetanus toxin, the product of Clostridium tetani, is the cause of tetanus symptoms. Tetanus toxin is taken up into terminals of lower motor neurons and transported axonally to the spinal cord and/or brainstem. Here the toxin moves trans-synaptically into inhibitory nerve terminals, where vesicular release of inhibitory neurotransmitters becomes blocked, leading to disinhibition of lower motor neurons. Muscle rigidity and spasms ensue, often manifesting as trismus/lockjaw, dysphagia, opistotonus, or rigidity and spasms of respiratory, laryngeal, and abdominal muscles, which may cause respiratory failure. Botulinum toxin, in contrast, largely remains in lower motor neuron terminals, inhibiting acetylcholine release and muscle activity. Therefore, botulinum toxin may reduce tetanus symptoms. Trismus may be treated with botulinum toxin injections into the masseter and temporalis muscles. This should probably be done early in the course of tetanus to reduce the risk of pulmonary aspiration, involuntary tongue biting, anorexia and dental caries. Other muscle groups are also amenable to botulinum toxin treatment. Six tetanus patients have been successfully treated with botulinum toxin A. This review discusses the use of botulinum toxin for tetanus in the context of the pathophysiology, symptomatology, and medical treatment of Clostridium tetani infection.
Highlights
The muscular rigidity and spasms of tetanus are caused by tetanus toxin, which is produced by Clostridium tetani, an anaerobic bacillus, whose spores survive in soil and cause infection by contaminating wounds [1]
This review discusses the possibility of using botulinum toxin for tetanus-induced rigidity and spasms in the context of the pathophysiology, symptomatology, and medical treatment of Clostridium tetani infection
The treatment of trismus with botulinum toxin is probably a fairly safe procedure, since injection into the masseter and temporalis muscles can be achieved without endangering neighboring vital structures
Summary
The muscular rigidity and spasms of tetanus are caused by tetanus toxin (tetanospasmin), which is produced by Clostridium tetani, an anaerobic bacillus, whose spores survive in soil and cause infection by contaminating wounds [1]. The global incidence of tetanus has been estimated at approximately one million cases annually [1,2]. Mortality rates from tetanus vary greatly across the world, depending on access to healthcare, and approach 100% in the absence of medical treatment [3]. This review discusses the possibility of using botulinum toxin for tetanus-induced rigidity and spasms in the context of the pathophysiology, symptomatology, and medical treatment of Clostridium tetani infection
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