DR Medhat MRCP

C. Clostridium
- G+ve anaerobic bacilli.
- Include clostridium ( Tetani ,Botulinium,perfringens,difficile)
Tetanus (clostridium tetani)
- Is caused by the tetanospasmin exotoxin released from Clostridium tetani.
- Tetanus spores are present in soil and may be introduced into the body from a
wound, which is often unnoticed.
- Tetanospasmin prevents release of GABA
• Features
Prodrome fever, lethargy, headache
Trismus (lockjaw).
Risus sardonicus
Opisthotonus (arched back, hyperextended neck)
Spasms (e.g. Dysphagia).
• Management
Supportive therapy including ventilatory support and muscle relaxants.
I.M human tetanus immunoglobulin for high-risk wounds (e.g. Compound fractures,
delayed surgical intervention, significant degree of devitalised tissue).
Metronidazole is now preferred to benzylpenicillin as the antibiotic of choice.
Clostridium botulinum (botulism)
- Found in contaminated canned or smoked food.
• Features (5D +ms weakness) : 36 hrs after ingestion of contaminated canned food
1) Diplopia.
2) Dry mouth.
3) Dysphagia.
4) Dysphonia.
5) Dilated fixed pupils
6) Muscle weakness.
• TTT :
1) Gastric lavage + I.V fluids.
2) Botulinum anti-toxin as soon as possible (within 24 hrs).
3) Mechanical ventilation if required.
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