Tétanos y botulismo

  1. Reina González, G.
  2. Leiva, J.
  3. Rubio, M.
  4. Fernández-Alonso, M.
Journal:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Year of publication: 2018

Issue Title: Enfermedades infecciosas (III) Infecciones por bacilos Gram negativos

Series: 12

Issue: 51

Pages: 3000-3009

Type: Article

DOI: 10.1016/J.MED.2018.03.002 DIALNET GOOGLE SCHOLAR

More publications in: Medicine: Programa de Formación Médica Continuada Acreditado

Abstract

Introduction. Tetanus and botulism constitute two life-threating infections caused by spore-forming bacteria, Clostridium tetani and Clostridium botulinum, respectively. Tetanus. Tetanus is caused by tetanospasmine toxin, which inhibits GABA and glicine neurotransmitters release, causing spastic paralysis followed by respiratory failure and severe impairment of autonomic nervous system. Mortality rate is approximately 8-60%, therefore a prompt clinical diagnosis is essential to transfer the patient to intensive care unit and establish supportive care. In addition, the toxin must be neutralized with specific immunoglobulin, spasms must be controlled with benzodiazepines and cardiovascular instability must be managed with labetalol and magnesium sulphate. Botulism. Botulism is caused by a thermolabile neurotoxin resulting in flaccid paralysis and respiratory failure, with an observed mortality of 5-10%. There are eight different toxins (A-H) produced by several Clostridium specie, responsible for botulism. Infection can occur following food poisoning with preformed toxin (food-borne botulism), by ingestion of food contaminated with Clostridium botulinum spores (infant botulism), by wound contamination or bacteria inhalation if used as a bioweapon. Early respiratory and airway support must be established together with additional measures (antitoxin and antibiotic).

Bibliographic References

  • Ergonul O, Egeli D, Kahyaoglu B, Bahar M, Etienne M, Bleck T. An unexpected tetanus case. Lancet Infect Dis. 2016;16(6):746-52.
  • Kyu HH, Mumford JE, Stanaway JD, Barber RM, Hancock JR, Vos T. Mortality from tetanus between 1990 and 2015: findings from the global burden of disease study 2015. BMC Public Health. 2017;17(1):179.
  • European Centre for Disease Prevention and Control. Annual Epidemiological Report 2016-Tetanus. Stockholm: ECDC: 2016.
  • Thwaites CL, Beeching NJ, Newton CR. Maternal and neonatal tetanus. Lancet. 2015;385(9965):362-70.
  • Stevens DL, Bryant AE, Berger A, von Eichel-Streiber C. Clostridium. Manual of clinical microbiology. 10ª ed. Washington DC: ASM Press; 2011. p. 834-57.
  • Reddy P, Bleck TP. Clostridium tetani (tétanos). Enfermedades Infecciosas. Principios y práctica. 7ª Ed. Barcelona: Elsevier; 2012: 3091-6.
  • Brook I. Current concepts in the management of Clostridium tetani infection. Expert Rev Anti Infect Ther. 2008;6:327-36
  • Thwaites CL. Botulism and tetanus. Medicine. 2014:11-3.
  • Farrar JJ, Yen LM, Cook T, Fairweather N, Binh N, Parry J. Tetanus. J Neurol Neurosurg Psychiatry. 2000;69(3):292-301.
  • Bleck TP. Intravenous immune globulin for passive tetanus prophylaxis. J Infect Dis. 1993;167(2):498-9.
  • Ataro P, Mushatt D, Ahsan S. Tetanus: a review. South Med J. 2011; 104(8):613-7.
  • Edmondson RS, Flowers MW. Intensive care in tetanus: management, complications, and mortality in 100 cases. Br Med J. 1979;1(6175):1401-4.
  • Ablett JJ. Analyses and main experiences in 82 patients treated in the Leeds Tetanus Unit. Symposium on tetanus in Great Britain. Boston Spa, United Kingdom: Leeds General Infirmary; 1967. p. 1-10.
  • Afshar M, Raju M, Ansell D, Bleck TP. Narrative review: tetanus : a health threat after natural disasters in developing countries. Ann Intern Med. 2011;154(5):329-35.
  • Thwaites CL, Yen LM, Loan HT, Thuy TT, Thwaites GE, Stepniewska K. Magnesium sulphate for treatment of severe tetanus: a randomised controlled trial. Lancet. 2006;368(9545):1436-43.
  • Carter AT, Peck MW. Genomes, neurotoxins and biology of Clostridium botulinum Group I and Group II. Res Microbiol. 2015;166(4):303-17.
  • Reddy P, Bleck TP. Clostridium botulinum (botulismo). Enfermedades infecciosas. Principios y práctica. 7ª ed. Barcelona: Elsevier; 2012. p. 3097-102.
  • Adalja AA, Toner E, Inglesby TV. Clinical management of potential bioterrorism related conditions. N Engl J Med. 2015;372(10):954-62.
  • European Centre for Disease Prevention and Control. Annual Epidemiological Report 2016– Botulism. Stockholm: ECDC– 2016.
  • Barash JR, Arnon SS. A novel strain of Clostridium botulinum that produces type B and type H botulinum toxins. J Infect Dis. 2014;209:183e91.
  • Health Protection Agency. Guidelines for action in the event of a deliberate release: botulism. Versión 4.5.1.
  • Domingo RM, Haller JS, Gruenthal M. Infant botulism: two recent cases and literature review. J Child Neurol. 2008;23(11):1336-46.
  • Arnon SS, Schechter R, Inglesby TV, Henderson DA, Bartlett JG, Ascher MS. Botulinum toxin as a biological weapon: medical and public health management. JAMA. 2001;285(8):1059-70.
  • Cherington M. Electrophysiologic methods as an aid in diagnosis of botulism: A review. Muscle Nerve. 1982;6:528-9.
  • Chalk CH , Benstead TJ, Keezer M. Medical treatment for botulism. Cochrane Database Syst Rev. 2014;2:CD008123.
  • Castor C, Mazuet C, Saint-Leger M, Vygen S, Coutureau J, Durand M. Cluster of two cases of botulism due to Clostridium baratii type F in France, November 2014. Euro Surveill. 2015;20(6):pii=21031.
  • Kull S, Schulz KM, Weisemann J, Kirchner S, Schreiber T, Bollenbach A. Isolation and functional characterization of the novel Clostridium botulinum neurotoxin A8 subtype. PLoS One. 2015;10(2): e0116381.