Article Sections

Introduction

Tetanus is an acute, life-threatening neuromuscular disease caused by the neurotoxin tetanospasmin, which is produced by Clostridium tetani.

Pathophysiology

Clostridium tetani is a spore-forming, gram-positive anaerobic bacteria normally found in soil.  The disease develops when spores enter the body through a break in the skin.  The spores germinate in anaerobic conditions (like that of a puncture wound) and subsequently produce a potent metalloprotease exotoxin (tetanospasmin or tetanus toxin).  Using retrograde axonal transport ( Figure 1), the toxin migrates through lower motor neurons to inhibitory interneurons in the CNS at the level of the spinal cord and brainstem; there, it acts on the anterior horn cells, blocking the release of inhibitory neurotransmitters (glycine, GABA).  This action leads to uncontrolled firing of alpha motor neurons and subsequent tonic muscle contraction.

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