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77-407: C. tetani is commonly found in soil, saliva, dust, and manure. The bacteria generally enter through a break in the skin, such as a cut or puncture wound caused by a contaminated object. They produce toxins that interfere with normal muscle contractions. Diagnosis is based on the presenting signs and symptoms. The disease does not spread between people. Tetanus can be prevented by immunization with

154-470: A bee sting ) to potentially fatal even at extremely low doses (such as botulinum toxin ). Toxins are often distinguished from other chemical agents strictly based on their biological origin. Less strict understandings embrace naturally occurring inorganic toxins, such as arsenic . Other understandings embrace synthetic analogs of naturally occurring organic poisons as toxins, and may or may not embrace naturally occurring inorganic poisons. It

231-437: A booster vaccine every ten years, and standard care practice in many places is to give the booster to any person with a puncture wound who is uncertain of when they were last vaccinated, or if they have had fewer than three lifetime doses of the vaccine. The booster may not prevent a potentially fatal case of tetanus from the current wound, however, as it can take up to two weeks for tetanus antibodies to form. In children under

308-408: A fetus or infant by its mother. Naturally acquired passive immunity can be provided during pregnancy, and through breastfeeding . In humans, maternal antibodies (MatAb) are passed through the placenta to the fetus by an FcRn receptor on placental cells. This occurs predominately during the third trimester of pregnancy, and thus is often reduced in babies born prematurely. Immunoglobulin G (IgG)

385-414: A 15–30% case fatality rate. Tetanus is caused by the tetanus bacterium, Clostridium tetani . The disease is an international health problem, as C. tetani endospores are ubiquitous. Endospores can be introduced into the body through a puncture wound ( penetrating trauma ). Due to C. tetani being an anaerobic bacterium, it and its endospores thrive in environments that lack oxygen , such as

462-441: A immune system disorder that prevents them from making antibodies in response to a vaccine. In addition to conferring passive immunities, breastfeeding has other lasting beneficial effects on the baby's health, such as decreased risk of allergies and obesity. A disadvantage to passive immunity is that producing antibodies in a laboratory is expensive and difficult to do. In order to produce antibodies for infectious diseases, there

539-423: A major public health effort, Uganda was certified as having eliminated maternal and neonatal tetanus in 2011. Tetanus toxoid can be given in case of suspected exposure to tetanus. In such cases, it can be given with or without tetanus immunoglobulin (also called tetanus antibodies or tetanus antitoxin ). It can be given as intravenous therapy or by intramuscular injection . The guidelines for such events in

616-434: A mechanical ventilator. To survive a tetanus infection, the maintenance of an airway and proper nutrition are required. An intake of 3,500 to 4,000 calories (15,000 to 17,000 kJ) and at least 150 g of protein per day is often given in liquid form through a tube directly into the stomach ( percutaneous endoscopic gastrostomy ), or through a drip into a vein ( parenteral nutrition ). This high-caloric diet maintenance

693-400: A more generalized form of the disease. Due to its rarity, clinicians may be unfamiliar with the clinical presentation, and may not suspect tetanus as the illness. Treatment can be complicated, as symptoms may be concurrent with the initial injury that caused the infection. Cephalic tetanus is more likely than other forms of tetanus to be fatal, with the progression to generalized tetanus carrying

770-468: A person's breathing is affected. Tetanus occurs in all parts of the world, but is most frequent in hot and wet climates where the soil has a high organic content. In 2015, there were about 209,000 infections and about 59,000 deaths globally. This is down from 356,000 deaths in 1990. In the US, there are about 30 cases per year, almost all of which were in people who had not been vaccinated. An early description of

847-486: A puncture wound. With the changes in oxygen levels, the turkey drumstick-shaped endospore can quickly spread. The disease occurs almost exclusively in people who are inadequately immunized. It is more common in hot, damp climates with soil rich in organic matter . Manure -treated soils may contain spores, as they are widely distributed in the intestines and feces of many animals, such as horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. In agricultural areas,

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924-530: A safe level. In Europe, the European Food Safety Authority produced risk assessments for more than 4,000 substances in over 1,600 scientific opinions and they provide open access summaries of human health, animal health and ecological hazard assessments in their OpenFoodTox database. The OpenFoodTox database can be used to screen potential new foods for toxicity. The Toxicology and Environmental Health Information Program (TEHIP) at

1001-526: A significant number of human adults may harbor the organism. The spores can also be found on skin surfaces and in contaminated heroin . Rarely, tetanus can be contracted through surgical procedures, intramuscular injections, compound fractures, and dental infections. Animal bites can transmit tetanus. Tetanus is often associated with rust , especially rusty nails. Although rust itself does not cause tetanus, objects that accumulate rust are often found outdoors or in places that harbor soil bacteria. Additionally,

1078-425: A toxin delivered via a bite, sting, etc.). Poison is a related but broader term that encompasses both toxins and toxicants; poisons may enter the body through any means - typically inhalation , ingestion , or skin absorption . Toxin, toxicant, and poison are often used interchangeably despite these subtle differences in definition. The term toxungen has also been proposed to refer to toxins that are delivered onto

1155-528: A treatment was discovered recently in the 2013 Ebola epidemic in Africa. Only one of the eight infected patients died, compared to a typical 80% Ebola mortality, which suggested that antibody treatment may contribute to survival. Immune globulin or immunoglobulin has been used to both prevent and treat reactivation of the herpes simplex virus (HSV), varicella zoster virus , Epstein-Barr virus (EBV), and cytomegalovirus (CMV). The following immunoglobulins are

1232-452: A year. Passive immunity is also provided through colostrum and breast milk, which contain IgA antibodies that are transferred to the gut of the infant, providing local protection against disease causing bacteria and viruses until the newborn can synthesize its own antibodies. Protection mediated by IgA is dependent on the length of time that an infant is breastfed, which is one of the reasons

1309-574: Is a naturally occurring poison produced by metabolic activities of living cells or organisms . They occur especially as proteins , often conjugated . The term was first used by organic chemist Ludwig Brieger (1849–1919), derived from toxic . Toxins can be small molecules , peptides , or proteins that are capable of causing disease on contact with or absorption by body tissues interacting with biological macromolecules such as enzymes or cellular receptors . They vary greatly in their toxicity , ranging from usually minor (such as

1386-537: Is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a soft-tipped instrument and observing the effect. A positive test result is the involuntary contraction of the jaw (biting down on the "spatula"), and a negative test result would normally be a gag reflex attempting to expel the foreign object. A short report in The American Journal of Tropical Medicine and Hygiene states that, in an affected subject research study,

1463-400: Is a need for possibly thousands of human donors to donate blood or immune animals' blood would be obtained for the antibodies. Patients who are immunized with the antibodies from animals may develop serum sickness due to the proteins from the immune animal and develop serious allergic reactions. Antibody treatments can be time-consuming and are given through an intravenous injection or IV, while

1540-451: Is a short-term immunization achieved by the transfer of antibodies, which can be administered in several forms; as human or animal blood plasma or serum , as pooled human immunoglobulin for intravenous ( IVIG ) or intramuscular (IG) use, as high-titer human IVIG or IG from immunized donors or from donors recovering from the disease, and as monoclonal antibodies (MAb). Passive transfer is used to prevent disease or used prophylactically in

1617-468: Is already affected by tetanospasmin. In 2013, it caused about 59,000 deaths—down from 356,000 in 1990. Tetanus, notably the neonatal form, remains a significant public health problem in non-industrialized countries, with 59,000 newborns dying worldwide in 2008 as a result of neonatal tetanus. In the United States, from 2000 through 2007, an average of 31 cases were reported per year. Nearly all of

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1694-418: Is due to asphyxiation, secondary to respiratory paralysis. Tetanus was well known to ancient civilizations, who recognized the relationship between wounds and fatal muscle spasms. In 1884, Arthur Nicolaier isolated the strychnine -like toxin of tetanus from free-living, anaerobic soil bacteria. The etiology of the disease was further elucidated in 1884 by Antonio Carle and Giorgio Rattone, two pathologists of

1771-513: Is further from the Ancient Greek : τείνειν , romanized :  teinein , lit.   'to stretch'. There is insufficient evidence that tetanus can be treated or prevented by vitamin C . This is at least partially due to the fact that the historical trials that were conducted in attempts to look for a possible connection between vitamin C and alleviating tetanus patients were of poor quality. Toxin A toxin

1848-484: Is higher in unvaccinated individuals, and in people over 60 years of age. The incubation period of tetanus may be up to several months, but is usually about ten days. In general, the farther the injury site is from the central nervous system , the longer the incubation period. However, shorter incubation periods will have more severe symptoms. In trismus nascentium (i.e. neonatal tetanus), symptoms usually appear from 4 to 14 days after birth, averaging about 7 days. On

1925-461: Is important to confirm usage if a common understanding is critical. Toxins are a subset of toxicants . The term toxicant is preferred when the poison is man-made and therefore artificial. The human and scientific genetic assembly of a natural-based toxin should be considered a toxin as it is identical to its natural counterpart. The debate is one of linguistic semantics . The word toxin does not specify method of delivery (as opposed to venom ,

2002-434: Is most often used in a laboratory setting in the field of immunology , to transfer immunity between " congenic ", or deliberately inbred mouse strains which are histocompatible. Passive immunity starts working faster than vaccines do, as the patient's immune system does not need to make its own antibodies: B cells take time to activate and multiply after a vaccine is given. Passive immunity works even if an individual has

2079-471: Is often treated immuno-prophylactically upon exposure. Prevention of rabies infection still requires the use of both vaccine and immunoglobulin treatments. During a 1995 Ebola virus outbreak in the Democratic Republic of Congo , whole blood from recovering patients, and containing anti-Ebola antibodies, was used to treat eight patients, as there was no effective means of prevention, though

2156-549: Is referred to as failure of passive transfer. It can be diagnosed by measuring the amount of IgG in a newborn's blood, and is treated with intravenous administration of immunoglobulins. If not treated, it can be fatal. A preprint suggested that (SARS-CoV-2) antibodies in or transmitted through the air are an unrecognized mechanism by which, transferred, passive immune protection occurs. Antibodies from vaccination can be present in saliva and thereby may have utility in preventing infection. Artificially acquired passive immunity

2233-434: Is required because of the increased metabolic strain brought on by the increased muscle activity. Full recovery takes 4 to 6 weeks, because the body must regenerate destroyed nerve axon terminals. The antibiotic of choice is metronidazole . It can be given as intravenously, by mouth, or by rectum. Of likewise efficiency is penicillin , but some raise the concern of provoking spasms because it inhibits GABA receptor , which

2310-416: Is the only antibody isotype that can pass through the human placenta, and is the most common antibody of the five types of antibodies found in the body. IgG antibodies protects against bacterial and viral infections in fetuses. Immunization is often required shortly following birth to prevent diseases in newborns such as tuberculosis , hepatitis B , polio , and pertussis , however, maternal IgG can inhibit

2387-528: Is the transfer of active humoral immunity of ready-made antibodies . Passive immunity can occur naturally, when maternal antibodies are transferred to the fetus through the placenta , and it can also be induced artificially, when high levels of antibodies specific to a pathogen or toxin (obtained from humans , horses , or other animals ) are transferred to non- immune persons through blood products that contain antibodies, such as in immunoglobulin therapy or antiserum therapy. Passive immunization

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2464-414: Is transported back through the axon until it reaches the central nervous system . Here, it selectively binds to and is transported into inhibitory neurons via endocytosis . It then leaves the vesicle for the neuron cytosol, where it cleaves vesicle associated membrane protein (VAMP) synaptobrevin , which is necessary for membrane fusion of small synaptic vesicles (SSV's). SSV's carry neurotransmitter to

2541-486: Is used when there is a high risk of infection and insufficient time for the body to develop its own immune response, or to reduce the symptoms of ongoing or immunosuppressive diseases. Passive immunization can be provided when people cannot synthesize antibodies, and when they have been exposed to a disease that they do not have immunity against. Maternal passive immunity is a type of naturally acquired passive immunity, and refers to antibody -mediated immunity conveyed to

2618-483: The United States National Library of Medicine (NLM) maintains a comprehensive toxicology and environmental health web site that includes access to toxins-related resources produced by TEHIP and by other government agencies and organizations. This web site includes links to databases, bibliographies, tutorials, and other scientific and consumer-oriented resources. TEHIP also is responsible for

2695-504: The University of Turin , who demonstrated the transmissibility of tetanus for the first time. They produced tetanus in rabbits by injecting pus from a person with fatal tetanus into their sciatic nerves, and testing their reactions while tetanus was spreading. In 1891, C. tetani was isolated from a human victim by Kitasato Shibasaburō , who later showed that the organism could produce disease when injected into animals, and that

2772-455: The tetanus vaccine . In those who have a significant wound and have had fewer than three doses of the vaccine, both vaccination and tetanus immune globulin are recommended. The wound should be cleaned, and any dead tissue should be removed. In those who are infected, tetanus immune globulin, or, if unavailable, intravenous immunoglobulin (IVIG) is used. Muscle relaxants may be used to control spasms. Mechanical ventilation may be required if

2849-681: The Toxicology Data Network (TOXNET), an integrated system of toxicology and environmental health databases that are available free of charge on the web. TOXMAP is a Geographic Information System (GIS) that is part of TOXNET. TOXMAP uses maps of the United States to help users visually explore data from the United States Environmental Protection Agency 's (EPA) Toxics Release Inventory and Superfund Basic Research Programs . Passive immunity In immunology , passive immunity

2926-441: The United States for people at least 11 years old (and not pregnant) are as follows: Mild cases of tetanus can be treated with: Severe cases will require admission to intensive care . In addition to the measures listed above for mild tetanus: Drugs, such as diazepam or other muscle relaxants , can be given to control the muscle spasms. In extreme cases, it may be necessary to paralyze the person with curare -like drugs, and use

3003-530: The World Health Organization recommends breastfeeding for at least the first two years of life. Other species besides humans transfer maternal antibodies before birth, including primates and lagomorphs (which includes rabbits and hares). In some of these species IgM can be transferred across the placenta as well as IgG. All other mammalian species predominantly or solely transfer maternal antibodies after birth through milk. In these species,

3080-593: The above-mentioned deregulation of motor neurons and muscle tension. There are currently no blood tests for diagnosing tetanus. The diagnosis is based on the presentation of tetanus symptoms, and does not depend upon isolation of the bacterium, which is recovered from the wound in only 30% of cases, and can be isolated from people without tetanus. Laboratory identification of C. tetani can be demonstrated only by production of tetanospasmin in mice. Having recently experienced head trauma may indicate cephalic tetanus if no other diagnosis has been made. The "spatula test"

3157-722: The age of seven, the tetanus vaccine is often administered as a combined vaccine, DPT/DTaP vaccine , which also includes vaccines against diphtheria and pertussis . For adults and children over seven, the Td vaccine (tetanus and diphtheria) or Tdap (tetanus, diphtheria, and acellular pertussis) is commonly used. The World Health Organization certifies countries as having eliminated maternal or neonatal tetanus . Certification requires at least two years of rates of less than 1 case per 1,000 live births. In 1998 in Uganda , 3,433 tetanus cases were recorded in newborn babies; of these, 2,403 died. After

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3234-612: The basis of clinical findings, four different forms of tetanus have been described. Generalized tetanus is the most common type of tetanus, representing about 80% of cases. The generalized form usually presents with a descending pattern. The first sign is trismus or lockjaw, then facial spasms (called risus sardonicus ), followed by stiffness of the neck, difficulty in swallowing, and rigidity of pectoral and calf muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure , and episodic rapid heart rate. Spasms may occur frequently and last for several minutes, with

3311-689: The biological origin as opposed to environmental or anthropogenic origins. Biotoxins can be classified by their mechanism of delivery as poisons (passively transferred via ingestion, inhalation, or absorption across the skin), toxungens (actively transferred to the target's surface by spitting, spraying, or smearing), or venoms (delivered through a wound generated by a bite, sting, or other such action). They can also be classified by their source, such as fungal biotoxins , microbial toxins , plant biotoxins , or animal biotoxins. Toxins produced by microorganisms are important virulence determinants responsible for microbial pathogenicity and/or evasion of

3388-466: The bloodstream, where it binds to the presynaptic membrane of a motor neuron . The heavy chain C-terminal domain aids in the binding to the correct site, recognizing and binding to the correct glycoproteins and glycolipids in the presynaptic membrane. The toxin binds to a site that will be taken into the neuron as an endocytic vesicle that will travel down the axon, past the cell body, and down

3465-462: The body does not develop memory; therefore, the patient is at risk of being infected by the same pathogen later unless they acquire active immunity or vaccination. In 1888 Emile Roux and Alexandre Yersin showed that the clinical effects of diphtheria were caused by diphtheria toxin and, following the 1890 discovery of an antitoxin -based immunity to diphtheria and tetanus by Emil Adolf von Behring and Kitasato Shibasaburō , antitoxin became

3542-467: The body shaped into a characteristic form called opisthotonos . Spasms continue for up to four weeks, and complete recovery may take months. Neonatal tetanus ( trismus nascentium ) is a form of generalized tetanus that occurs in newborns, usually those born to mothers who themselves have not been vaccinated. If the mother has been vaccinated against tetanus, the infants acquire passive immunity , and are thus protected. It usually occurs through infection of

3619-428: The body surface of another organism without an accompanying wound . A rather informal terminology of individual toxins relates them to the anatomical location where their effects are most notable: On a broader scale, toxins may be classified as either exotoxins , excreted by an organism, or endotoxins , which are released mainly when bacteria are lysed . The term "biotoxin" is sometimes used to explicitly confirm

3696-458: The case of immunodeficiency diseases, such as hypogammaglobulinemia . It is also used in the treatment of several types of acute infection, and to treat poisoning . Immunity derived from passive immunization lasts for a few weeks to three to four months. There is also a potential risk for hypersensitivity reactions, and serum sickness , especially from gamma globulin of non-human origin. Passive immunity provides immediate protection, but

3773-618: The cases in the United States occur in unimmunized individuals, or individuals who have allowed their inoculations to lapse. Tetanus is found primarily in goats and sheep. The following are clinical symptoms found in affected goats and sheep. Extended head and neck, tail rigors (tail becomes rigid and straight), abnormal gait (walking becomes stiff and abnormal), arched back, stiffness of the jaw muscles, lockjaw, twitching of eyes, drooping eyelids, difficulty swallowing, difficulty or inability to eat and drink, abdominal bloat, spasms (uncontrolled muscular contractions) before death. Death sometimes

3850-426: The dendrites to the dendritic terminal at the spine and central nervous system. Here, it will be released into the synaptic cleft , and allowed to bind with the presynaptic membrane of inhibitory neurons in a similar manner seen with the binding to the motor neuron. Tetanus toxin is then internalized again via endocytosis , this time, in an acidic vesicle. In a mechanism not well understood, depolarization caused by

3927-425: The disease had been largely eliminated from all but 25 countries. Neonatal tetanus is rare in developed countries . Local tetanus is an uncommon form of the disease, in which people have persistent contraction of muscles in the same anatomic area as the injury. The contractions may persist for many weeks before gradually subsiding. Local tetanus is generally milder; only about 1% of cases are fatal, but it may precede

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4004-600: The disease was made by Hippocrates in the 5th century BC. The cause of the disease was determined in 1884 by Antonio Carle and Giorgio Rattone at the University of Turin , and a vaccine was developed in 1924. Tetanus often begins with mild spasms in the jaw muscles —also known as lockjaw. Similar spasms can also be a feature of trismus . The spasms can also affect the facial muscles , resulting in an appearance called risus sardonicus . Chest, neck, back, abdominal muscles, and buttocks may be affected. Back muscle spasms often cause arching, called opisthotonus . Sometimes,

4081-413: The firing of the inhibitory neuron causes the toxin to be pulled into the neuron inside vesicles. The toxin then needs a way to get out of the vesicle and into the neuron cytosol for it to act on its target. The low pH of the vesicle lumen causes a conformational change in the toxin, shifting it from a water-soluble form to a hydrophobic form. With the hydrophobic patches exposed, the toxin can slide into

4158-419: The first major success of modern therapeutic immunology. Shibasaburo and von Behring immunized guinea pigs with the blood products from animals that had recovered from diphtheria and realized that the same process of heat treating blood products of other animals could treat humans with diphtheria. By 1896, the introduction of diphtheria antitoxin was hailed as "the most important advance of the [19th] Century in

4235-459: The host immune response . Biotoxins vary greatly in purpose and mechanism, and can be highly complex (the venom of the cone snail can contain over 100 unique peptides , which target specific nerve channels or receptors). Biotoxins in nature have two primary functions: Some of the more well known types of biotoxins include: Many living organisms employ toxins offensively or defensively. A relatively small number of toxins are known to have

4312-673: The immunoglobulins currently approved for use for infectious disease prophylaxis and immunotherapy , in the United States. The one exception to passive humoral immunity is the passive transfer of cell-mediated immunity , also called adoptive immunization which involves the transfer of mature circulating lymphocytes. It is rarely used in humans, and requires histocompatible (matched) donors, which are often difficult to find, and carries severe risks of graft-versus-host disease . This technique has been used in humans to treat certain diseases including some types of cancer and immunodeficiency . However, this specialized form of passive immunity

4389-444: The induction of protective vaccine responses throughout the first year of life. This effect is usually overcome by secondary responses to booster immunization. Maternal antibodies protect against some diseases, such as measles, rubella, and tetanus, more effectively than against others, such as polio and pertussis. Maternal passive immunity offers immediate protection, though protection mediated by maternal IgG typically only lasts up to

4466-481: The introduction of vaccines; however, it is still indicated following exposure and prior to travel to areas of endemic infection. In 1953, human vaccinia immunoglobulin (VIG) was used to prevent the spread of smallpox during an outbreak in Madras, India , and continues to be used to treat complications arising from smallpox vaccination. Although the prevention of measles is typically induced through vaccination, it

4543-429: The low pH environment) to leave through the toxin pore, or that the pore could alter the electrochemical gradient enough, by letting in or out ions, to cause osmotic lysis of the vesicle, spilling the vesicle's contents. The light chain of the tetanus toxin is zinc-dependent protease . It shares a common zinc protease motif (His-Glu-Xaa-Xaa-His) that researchers hypothesized was essential for target cleavage, until this

4620-411: The low-oxygen (anaerobic) environment may exist under the skin, and the puncturing object can deliver endospores to a suitable environment for growth. It is a common misconception that rust itself is the cause; a related misconception is that a puncture from a rust-free nail is not a risk. Tetanus neurotoxin (TeNT) binds to the presynaptic membrane of the neuromuscular junction , is internalized, and

4697-407: The medical treatment of acute infective disease". Prior to the advent of vaccines and antibiotics , specific antitoxin was often the only treatment available for infections such as diphtheria and tetanus. Immunoglobulin therapy continued to be a first line therapy in the treatment of severe respiratory diseases until the 1930s, even after sulfonamides were introduced. In 1890 antibody therapy

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4774-499: The membrane for release, so inhibition of this process blocks neurotransmitter release. Tetanus toxin specifically blocks the release of the neurotransmitters GABA and glycine from inhibitory neurons. These neurotransmitters keep overactive motor neurons from firing, and also play a role in the relaxation of muscles after contraction. When inhibitory neurons are unable to release their neurotransmitters, motor neurons fire out of control, and muscles have difficulty relaxing. This causes

4851-402: The muscle spasms and spastic paralysis seen in tetanus infection. The tetanus toxin, tetanospasmin , is made up of a heavy chain and a light chain. There are three domains, each of which contributes to the pathophysiology of the toxin. The heavy chain has two of the domains. The N-terminal side of the heavy chain helps with membrane translocation, and the C-terminal side helps the toxin locate

4928-414: The neonatal gut is able to absorb IgG for hours to days after birth. However, after a period of time the neonate can no longer absorb maternal IgG through their gut, an event that is referred to as "gut closure". If a neonatal animal does not receive adequate amounts of colostrum prior to gut closure, it does not have a sufficient amount of maternal IgG in its blood to fight off common diseases. This condition

5005-696: The only specific pharmacologic treatment available for botulism . Antitoxin also known as heterologous hyperimmune serum is often also given prophylactically to individuals known to have ingested contaminated food. IVIG treatment was also used successfully to treat several patients with toxic shock syndrome , during the 1970s tampon scare . Antibody therapy is also used to treat viral infections. In 1945, hepatitis A infections, epidemic in summer camps, were successfully prevented by immunoglobulin treatment. Similarly, hepatitis B immune globulin (HBIG) effectively prevents hepatitis B infection. Antibody prophylaxis of both hepatitis A and B has largely been supplanted by

5082-562: The onset of generalized tetanus. Cephalic tetanus is the rarest form of the disease (0.9–3% of cases), and is limited to muscles and nerves in the head. It usually occurs after trauma to the head area, including: skull fracture , laceration, eye injury, dental extraction , and otitis media , but it has been observed from injuries to other parts of the body. Paralysis of the facial nerve is most frequently implicated, which may cause lockjaw, facial palsy , or ptosis , but other cranial nerves can also be affected. Cephalic tetanus may progress to

5159-714: The potential to cause widespread sickness or casualties. They are often inexpensive and easily available, and in some cases it is possible to refine them outside the laboratory. As biotoxins act quickly, and are highly toxic even at low doses, they can be more efficient than chemical agents. Due to these factors, it is vital to raise awareness of the clinical symptoms of biotoxin poisoning, and to develop effective countermeasures including rapid investigation, response, and treatment. The term "environmental toxin" can sometimes explicitly include synthetic contaminants such as industrial pollutants and other artificially made toxic substances. As this contradicts most formal definitions of

5236-416: The rough surface of rusty metal provides crevices for dirt containing C. tetani , while a nail affords a means to puncture skin and deliver endospores deep within the body at the site of the wound. An endospore is a non-metabolizing survival structure that begins to metabolize and cause infection once in an adequate environment. Hence, stepping on a nail (rusty or not) may result in a tetanus infection, as

5313-569: The spasms affect muscles utilized during inhalation and exhalation , which can lead to breathing problems. Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups, called tetany . These episodes can cause fractures and muscle tears. Other symptoms include fever , headache , restlessness, irritability , feeding difficulties, breathing problems , burning sensation during urination , urinary retention , and loss of stool control . Even with treatment, about 10% of people who contract tetanus die. The mortality rate

5390-519: The spatula test had a high specificity (zero false-positive test results) and a high sensitivity (94% of infected people produced a positive test). Unlike many infectious diseases, recovery from naturally acquired tetanus does not usually result in immunity . This is due to the extreme potency of the tetanospasmin toxin. Tetanospasmin will likely be lethal before it will provoke an immune response. Tetanus can be prevented by vaccination with tetanus toxoid . The CDC recommends that adults receive

5467-450: The specific receptor site on the correct neuron. The light chain domain cleaves the VAMP protein once it arrives in the inhibitory neuron cytosol. There are four main steps in tetanus's mechanism of action: binding to the neuron, internalization of the toxin, membrane translocation, and cleavage of the target VAMP. The toxin travels from the wound site to the neuromuscular junction through

5544-449: The term "toxin", it is important to confirm what the researcher means when encountering the term outside of microbiological contexts. Environmental toxins from food chains that may be dangerous to human health include: In general, when scientists determine the amount of a substance that may be hazardous for humans, animals and/or the environment they determine the amount of the substance likely to trigger effects and if possible establish

5621-495: The toxin could be neutralized by specific antibodies . In 1897, Edmond Nocard showed that tetanus antitoxin induced passive immunity in humans, and could be used for prophylaxis and treatment. Tetanus toxoid vaccine was developed by P. Descombey in 1924, and was widely used to prevent tetanus induced by battle wounds during World War II . The word tetanus comes from the Ancient Greek : τέτανος , romanized :  tetanos , lit.   'taut', which

5698-441: The unhealed umbilical stump , particularly when the stump is cut with a non-sterile instrument. As of 1998, neonatal tetanus was common in many developing countries , and was responsible for about 14% (215,000) of all neonatal deaths. In 2010, the worldwide death toll was approximately 58,000 newborns. As the result of a public health campaign, the death toll from neonatal tetanus was reduced by 90% between 1990 and 2010, and by 2013,

5775-427: The vesicle membrane. The toxin forms an ion channel in the membrane that is nonspecific for Na, K, Ca, and Cl ions. There is a consensus among experts that this new channel is involved in the translocation of the toxin's light chain from the inside of the vesicle to the neuron cytosol, but the mechanism is not well understood or agreed upon. It has been proposed that the channel could allow the light chain (unfolded from

5852-399: Was more recently confirmed by experiment: when all zinc was removed from the neuron with heavy metal chelators , the toxin was inhibited, only to be reactivated when the zinc was added back in. The light chain binds to VAMP, and cleaves it between Gln and Phe. Without VAMP, vesicles holding the neurotransmitters needed for motor neuron regulation ( GABA and glycine) cannot be released, causing

5929-473: Was used to treat tetanus , when serum from immunized horses was injected into patients with severe tetanus in an attempt to neutralize the tetanus toxin, and prevent the dissemination of the disease. Since the 1960s, human tetanus immune globulin (TIG) has been used in the United States in unimmunized, vaccine-naive or incompletely immunized patients who have sustained wounds consistent with the development of tetanus. The administration of horse antitoxin remains

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