Tetanus Infection: Symptoms, Causes, And Treatment

The organism that causes tetanus is Clostridium tetani. This bacterium can infect through a wound or cut that has been contaminated with soil or manure. In Mary's case, the wound was contaminated with dirt and at age 50years, the likelihood of the tetanus antibodies being reduced is high.  

A booster dose of the tetanus vaccine can restore the antibodies to a concentration higher than the 0.01 IU/ml required to counter a possible infection with Clostridium tetani. The booster dose is a safeguard against the possibility of low antibody concentration due to the many years that may have lapsed after the last vaccine was taken. Once the booster vaccine is given, it restores high concentration of the antibody and the body is equipped to fight a possible infection.

The bacterium can enter the blood stream through a seemingly innocuous wound. So even before a patient complains of any symptoms, the dressing and cleaning of the wound is usually accompanied by a tetanus vaccine as a preventive measure. Symptoms associated with an infection are caused due to neurotoxins produced by the bacteria. Muscle spasms, difficulty in breathing, trismus- which makes talking difficult, stiff shoulders, neck and back are also observed. The infection can prove to be fatal in some cases (Immunise, 2016). Tetanus remains an expensive to treat disease and a patient may often take weeks of treatment before recovering completely. So, a tetanus booster vaccine is completely justified in Mary's case.

The normal process of wound healing involves the four stages of homeostasis, inflammation, proliferation of new cells and remodelling. Wound edges are hot to touch and red due to flow of blood into the area. The surrounding tissue is swollen due to inflammation. Several cytokines are secreted at the site due to inflammation, the permeability of the blood vessels is increased. Macrophages and leukocytes reach the wound and protect the site from possible infectious pathogens that could be endogenous or exogenous in origin.  Purulent and odorous discharge is a symptom that infection has occurred and the wound exudate is likely to contain pus cells. The accompanying fever indicates that an antibiotic may be required to treat the infection. An exudate helps because it keeps the wound moist and speeds up the process of tissue repair.

Surrounding tissues swollen

Inflammation occurs and several cells of the immune system are recruited at the wound site. The macrophages play several roles at the wound site. They release cytokines so that the inflammatory response can begin through the recruitment and activation of leukocytes (Guo & DiPietro, 2010). The main function of the immune cells is to protect the wound from pathogens. The T cells help in maintenance of tissue integrity and inflammation. Hypoxia at the wound site in the initial stages helps in the process of healing. It helps in the induction of cytokines and growth factor production.

Purulent and odorous discharge is a sign that the wound is infected. Other symptoms associated with an infected wound are edema, warmth, pain, purulent exudate, wound exudate and erythema. Malodour from the wound site is also a symptom of the infection. Fever and chills are systemic signs of the infection and may signify a progression to bacteremia or septicemia. This requires the administration of a systemic antibiotic after a culture sensitivity test is carried out (Dabiri, Damstetter, & Phillips, 2016), so that the correct antibiotic can be prescribed to the patient.

 Mary's fever developed s an inflammatory response that affects the whole body. Bacterial infections can cause the release of pyrogens that alter the temperature regulation process of the hypothalamus. The skin becomes pale during fever due to vasoconstriction since the blood flow is diverted away from the extremities. This reduces the loss of heat to a minimum and raises the core temperature  of the body. The hypothalamus causes the stimulation of muscles, so that shivering occurs and raises the core temperature of the body further. The fever breaks and the body temperature reduces when the body begins to sweat and the hypothalamus reverses the changes that led to an increase in the body temperature (Craft & Gordon, 2015).

Fever is known to induce the innate immune response that helps in stimulation of leukocytes that help in killing pathogens. In Mary's case the infection is caused by Staphylococcus, so the leukocytes will help in killing the bacteria. Most human pathogens are mosophiles and the optimum temperature for their growth is 35⁰C, so a rise in body temperature during fever can inhibit the growth of pathogens. Thus, fever helps the body in fighting against the infectious pathogen and is a vital part of the body's defence mechanism (Lumen).

Endogenous source of contamination could be the skin in case of Mary because Staphylococcus is a natural microflora that resides on the skin. The cut or wound breaks the skin barrier and can get infected with the skin resident bacteria which often get enveloped in a biofilm and become resistant to several antibiotics. The skin has a natural capacity to resist infection from the commensal microbes that reside on its surface. This ability is conferred due to a hostile pH, synthesis of antimicrobial peptides, proteases chemokines, cytokines and lysozymes. So, a cut or wound tilts the balance in favour of the pathogen and thus infection occurs (Cogen, Nizet, & Gallo, 2008).

Since Mary's wound had come in contact with soil and manure, her wound infection could have originated in an exogenous manner. The mode of transmission could be a possible contact of the pathogen in the soil with the tissue that was exposed due to breakage of the skin barrier.

It is important in case of an infected wound to treat the infection with an antibiotic that the pathogenic bacterium is sensitive to. Staphylococcus aureus is known to have antibiotic resistance against several antibiotics. Augmentin is an appropriate prescription for Staphylococcus aureus because augmentin is a combination of amoxycillin and clavulenic acid which. Amoxycillin is a penicillin analogue and clavulenic acid is a beta lactam and has the ability to block the activity of beta lactamases. Augmentin is known to be effective against Staphylococcus aureus.

The major ingredients of Augmentin are Amoxycillin and clavulenic acid. Amoxycillin is a derivative of penicillin and belongs to the class of antibiotics that have a beta lactam ring. Several bacterial species have become resistant to beta lactam antibiotics due to the production of the enzyme beta lactamase. To counter this mechanism of bacterial resistance, amoxycillin has been combined with clavulenic acid which is a beta lactamase inhibitor and does not render amoxycillin to be degraded by the bacterial beta lactamase. On giving a dosage of Augmentin for a specific duration to Mary, the infection in her wound can be cured and symptom of fever can also be treated (Bullock & Manias, 2017).