Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Tetanus is an acute, often-fatal disease of the nervous system that is caused by nerve toxins produced by the bacterium Clostridium tetani. This bacterium is found throughout the world in the soil and in animal and human intestines. The bacterium can also lay dormant in its spore form for years before becoming activated and developing into a regularly reproducing bacterium.
Where do tetanus bacteria grow in the body?
Contaminated wounds are sites where tetanus bacteria multiply. Deep wounds or those with dead tissue are particularly prone to tetanus infection.
Puncture wounds, such as those caused by nails, splinters, or insect bites, are favorite locations of entry for the bacteria. The bacteria can also be introduced through burns, any break in the skin, and injection-drug sites. Tetanus can also be a hazard to both the mother and newborn child (by means of the uterus after delivery and through the umbilical cord stump).
The potent toxin that is produced when the tetanus bacteria multiply is the major cause of harm from tetanus.
How does the tetanus toxin cause damage to the body?
The tetanus toxin affects the interaction between the nerve and the muscle that it stimulates, specifically at the neuromuscular junction. The tetanus toxin amplifies the chemical signal from the nerve to the muscle, which causes the muscles to tighten up in a continuous ("tetanic" or "tonic") contraction or spasm. This results in either localized or generalized muscle spasms. Tetanus toxin can affect neonates to cause muscle spasms, inability to nurse, and seizures. This typically occurs within the first two weeks after birth and can be associated with poor sanitation methods in caring for the umbilical cord stump of the neonate. Of note, because of tetanus vaccination programs, first introduced in the late 1940s, tetanus infection rates have dropped substantially. In fact, according to the World Health Organization, there have only been three cases of neonatal tetanus reported in the U.S. since 2000. In each of these cases, the mothers were incompletely immunized. Unfortunately, throughout the world, tetanus is still common. In 2014, there were over 2,000 cases of neonatal tetanus and over 9,000 cases of non-neonatal tetanus. In comparison, there were 114,000 overall cases reported in 1980.
The bacteria that cause tetanus can be found in soil,
manure, or dust. They infect humans by entering the body through cuts or
puncture wounds, particularly when the wound area is dirty. Animal bites, burns,
and non-sterile injection of drugs can also lead to infection with Clostridium