[Changes in lipid metabolism, oxygen balance and muscle ultrastructure in tetanus in an experiment]

Dogs and white rats with experimental tetanus were examined for blood plasma lipids and red cells, their acid resistance, oxygen balance, cytochrome oxidase and aspartate transaminase activity and muscle ultrastructure. The amount of blood plasma lipids was found to be increased, the lipid content in red cells was lowered because of phospholipid washing out. The red cell resistance was lowered, their sedimentation rate was accelerated. Oxygen metabolism in muscles was first enhanced to form excess lipid peroxides, disturbing the integrity of cell membranes and myocyte ultrastructure, and then it was suppressed because of depletion of the compensatory mechanisms and eventuated in the destruction of part of cells and later on in the death of animals.

Changes in blood chemistry and liver histopathology of rabbits during experimental tetanus toxicity

Changes in blood chemistry, especially blood glucose, were studied in rabbits developing tetanus after injection of tetanus toxin. Blood glucose levels increased significantly above control values after the animals developed tetanus. The increase in glucose level paralleled the depletion of liver glycogen, detected by means of PAS staining. The observed changes were not affected by adrenergic receptor block or catecholamine depletion by reserpine, suggesting non-mediation of the sympathetic nervous system in the response. A direct action of the toxin on the liver, initiating glycogen depletion, is being postulated.

The metabolic response and problems with nutritional support in acute tetanus

Thirteen patients with severe tetanus were studied in the first and second week of illness in order to assess metabolic changes and nutritional requirements. Nine required muscular paralysis and subsequent assisted ventilation in order to control spasms. Symptoms and signs of sympathetic overactivity were especially common in the latter groups with a fourfold increase in urinary adrenaline and noradrenaline excretion. Other hormonal and metabolic abnormalities included hyperglycemia, mildly elevated insulin concentrations with no significant rise in cortisol, and glucagon. Evidence of excessive protein catabolism was obtained particularly during the second week of illness, mean urinary nitrogen excretion being 20.5 +/- 13.8 g/d. Maintenance of nutrient homeostasis proved impossible with conventional enteral-feeding techniques: high-density feeds exacerbated hyperglycemia and diarrhea; low-density feeds were unable to maintain nitrogen balance (-12.34 g/d in ventilated patients, second week). The results indicate that loss of lean body mass is inevitable in such patients unless the metabolic response can be suppressed or more aggressive forms of nutritional support (eg, total parenteral nutrition including sufficient insulin to maintain normoglycemia) are employed.

[Tetanus. Apropos a case]

The authors report a case of tetanus in a 19 months infant who has only received BCG. After a four days period during which two laryngeal spasms occurred, the infant presents a generalized tetanus. The outcome was favorable with specific serotherapy myorelaxants and assisted ventilation of four weeks duration.

Chronic tetanus: clinical report and histochemistry of muscle

A patient who was partially immune to tetanus developed nonfulminant tetanus after a minor injury. Manifestations of the disease persisted for over 17 months. Electrophysiologic studies revealed an absent silent period in the masseter muscle, large-amplitude F-responses, and denervation. A muscle biopsy showed neurogenic atrophy with reinnervation. This observation supports the existence of chronic tetanus and provides morphologic evidence for a peripheral action of tetanus toxin in humans.

Permanent tetraplegia as a consequence of tetanus neonatorum. Evidence for widespread lower motor neuron damage

It is generally believed that no permanent neurological damage is found among survivors of tetanus neonatorum. Newborns dying shortly after the onset of tetanus also lack significant neurological abnormalities. In adults a variety of neuromuscular lesions have been reported; however, a uniform pathological picture is absent. We report a case of a newborn with severe tetanus in whom striking evidence of anterior horn neuronal damage was documented, causing permanent nonprogressive tetraplegia. We suggest that the mechanism responsible for this lesion involves the retrograde axoplasmic flow of tetanus toxin reaching the spinal cord via nerve endings in the infected umbilical cord stump.

The action of tetanus toxin: a case report

A case of neonatal tetanus in an infant with myelomeningocele is described, and the possible action of tetanus toxin is discussed.

Toxin-neutralizing effect of antibody against subtilisin-digested tetanus toxin

A form of systemic tetanus with atypical symptoms was observed in mice injected in the left thigh with a mixture of tetanus toxin and antibody produced in guinea pigs against a fragment of toxin obtained from a subtilisin digest of the crystallized toxin. The mice did not show typical symptoms of the local tetanus such as convulsions or spastic paralysis of the injected limb.

Decrease of muscle extensibility and reduction of sarcomere number in soleus muscle following a local injection of tetanus toxin

Slow soleus muscle in guinea pig developed within 4--6 days after local injection of a sublethal dose of tetanus toxin and 2--4 days after the first signs of local tetanus, a myostatic contracture characterized by a change in the passive tension--lengthening curve associated with a considerable decrease of the sarcomere number. It was demonstrated by clinical and EMG investigations that the soleus did have a tetanic spasm at least within the 2--4 day period of observation. When local tetanus was confined to slow soleus by functional suppression of rapid gastrocnemius and ankle flexor muscles, the decrease of the sarcomere number still persisted. This decrease failed to occur after section of the nerve supplying the soleus when associated with an injection of the tetanus toxin, and was much greater than when the soleus was passively shortened for the same period of time by plaster cast.

Histoautoradiography of central nervous system in rats with generalized tetanus due to 125I-toxin

Rats were injected i.v. with 125I-tetanus toxin. In autoradiographs of the spinal cord radioactivity was found over the pericarya and in the surroundings of the motoneurones whereas grain density was less over their nuclear region. In addition, pericarya in the lateral horn of the thoracic region and also the bipolar cells of the spinal ganglia contained radioactivity. The central part and the dorsal horns of spinal cord, and the white substance did not show any appreciable radioactivity. Within the medulla oblongata, clusters of large cells representing motor nuclei, as well as some fibre tracts close to them, contained 125I. Forebrain and cerebellum remained free. According to its histoautoradiographic appearance, generalized tetanus can be described best as a combination of multiple local tetani.

Tetanus antibody production in serum and cerebrospinal fluid in the rabbit and correlated histopathological features of the central nervous system

The histopathological features in the central nervous system (CNS) developing during the active phase of tetanus antibody formation in the cerebrospinal fluid (CSF) as induced in 15 rabbits were studied. The measurement of antibody titres in serum and CSF by electroimmunodiffusion and histological examination were done sequentially at the 1st, 3rd, 5th, 7th and 9th days after cisternal secondary inoculation with fluid tetanus toxoid. Tetanus antibodies appeared in serum after the 1st and in CSF after the 5th day. Decreasing values of CSF total protein were found. The meaning of an elevated Q ratio as observed in this situation of strong antibody formation in the CSF was enhanced. The histopathological features in the central nervous system consisted of perivascular inflammatory infiltration, at first polymorphic and then composed almost exclusively of mononuclear cells with a predominantly leptomeningeal and subpial localization, which might represent the origin of CSF tetanus antibodies. The localization was related to the contact zone between the antigen- and antibody-containing compartments, respectively the subarachnoid space and vascularized structures of the brain and spinal cord. Four control rabbits presented neither tetanus antibodies in the CSF nor perivascular inflammatory infiltration in the CNS. Similarity between the present experimental results and the immunopathological features of the primary demyelinating diseases provides some useful information about the immunological inflammatory events in these diseases.