Epidemiology and Etiology

Because neonatal tetanus is usually caused by an infection of the umbilicus (though circumcision leads to a few cases), it does not occur as an epidemic. It strikes individuals rather than communities and, therefore, is difficult to study and does not generate the kind of public interest that epidemics do. Consequently, the disease has not yet received the attention it deserves.

C. tetani is an obligate anaerobe (a microorganism that can grow only in the complete absence of molecular oxygen), a gram-positive, nonencapsulated, slender, motile rod. It is introduced into an injured area as spores. The disease develops if the spores are converted to vegetative organisms, producing the potent toxin, tetanospasmin. The toxin reaches the nervous system via the bloodstream or by traveling along the axon cylinders of motor nerves, eventually becoming fixed in the spinal cord and cranial nerves. Reflex convulsive activity follows.

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