図：SMB.260
芽胞形成
嫌気性菌
グラム陽性桿菌
形状：太鼓のバチ状(円形で端在性の芽胞)
棲息場所　土壌中に広く分布
運動性：寒天平板上で遊走し､辺縁は樹枝状
病原性：創傷感染(特に土壌で汚染された挫滅創)により感染。受傷後6時間で毒素(破傷風毒素)を産生し始める。
毒素：外毒素(神経毒：テタノスパスミン(破傷風毒素)、破傷風溶血毒：テタノリジン)
感染症：破傷風

WordNet

spindle-shaped bacterial cell especially one swollen at the center by an endospore (同)clostridia

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/02/25 17:22:09」(JST)

wiki en

Clostridium tetani is a box-car shaped, anaerobic bacterium of the genus species Clostridium. Like other Clostridium genus species, it is Gram-positive, and its appearance on a gram stain resembles tennis rackets or drumsticks.^[1] C. tetani is found as spores in soil or in the gastrointestinal tract of animals. C. tetani produces a potent biological toxin, tetanospasmin, and is the causative agent of tetanus, a disease characterized by painful muscular spasms that can lead to respiratory failure and, in up to 40% of cases, death.

History

Tetanus was known to ancient people, 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 1890 by Antonie Carl and Giorgio Rattone, who demonstrated the transmissibility of tetanus for the first time. They produced tetanus in rabbits by injecting their sciatic nerve with pus from a fatal human tetanus case in that same year. In 1889, 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 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.^[2]

Characteristics

C. tetani is a rod-shaped, obligate anaerobe which stains Gram positive in fresh cultures; established cultures may stain Gram negative.^[1] During vegetative growth, the organism cannot survive in the presence of oxygen, is heat-sensitive and exhibits flagellar motility. As the bacterium matures, it develops a terminal spore, which gives the organism its characteristic appearance. C. tetani spores are extremely hardy as they are resistant to heat and most antiseptics.^[3] The spores are distributed widely in manure-treated soils and can also be found on human skin and in contaminated heroin.^[2]

Vaccination

Tetanus can be prevented through the highly effective tetanus vaccine, which is a tetanus toxin inactivated with formaldehyde to be immunogenic but not pathogenic. The vaccine can be formulated as simple or adsorbed tetanus vaccine, combined tetanus and killed polio vaccine, or the older (diphtheria, tetanus, pertussis) (DPT) vaccine. Side effects are rare, but if they do occur, include fever, pain at the injection site, unexplained crying in infants, and irritability in older children or adults. Severe reactions are extremely rare and include anaphylaxis, seizures and encephalopathy. All infants are recommended to receive the vaccine at 2, 4, 6, and 15 months of age. A fifth booster dose should be given at 4–6 years of age. After that, it should be given every 10 years. However, if a bite, scratch, or puncture occurs more than five years after the last dose of vaccine, the patients should receive another dose of vaccine.

Toxicity

C. tetani usually enters a host through a wound to the skin, then it replicates. High risk individuals are people exposed to soil or animal feces. The spores are widely distributed in soil and in the intestines and feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. Manure-treated soil may contain large numbers of spores. In agricultural areas, a significant number of human adults may harbor the organism. The spores can also be found on skin surfaces and in contaminated heroin.^[2] Once an infection is established, C. tetani produces two exotoxins, tetanolysin and tetanospasmin. Eleven strains of C. tetani have been identified, which differ primarily in flagellar antigens and in their ability to produce tetanospasmin. The genes for toxin production are encoded on a plasmid which is present in all toxigenic strains, and all strains that are capable of producing toxin produce identical toxins.^[4]

Tetanolysin serves no known benefit to C. tetani. Tetanospasmin is a neurotoxin that causes the clinical manifestations of tetanus. Tetanus toxin is generated in living bacteria, and is released when the bacteria lyse, such as during spore germination or vegetative growth. A minimal amount of spore germination and vegetative cell growth are required for toxin production.^[4]

On the basis of weight, tetanospasmin is one of the most potent toxins known (based on tests conducted on mice). The estimated minimum human lethal dose is 2.5 nanograms per kilogram of body weight, or 175 nanograms in a 70 kg (154 lb) human.^[2] The only toxins more lethal to mice are botulinum toxin, produced by close relative Clostridium botulinum and the exotoxin produced by Corynebacterium diphtheriae, the causative agent of diphtheria. Exotoxic is a potent neurotoxin. Once spasms start, cannot stop. that is one of the distinguishing factor of Clostridium tetani. It should be noted, however, that humans and other animals may react to specific toxins differently from mice, and that the overall lethality of a specific toxin likely varies between different animals.

Tetanospasmin is a zinc-dependent metalloproteinase that is structurally similar to botulinum toxin, but with different effects. C. tetani synthesizes tetanospasmin as a single 150kDa polypeptide progenitor toxin that is then cleaved by a protease into two fragments; fragment A (a 50kDa "light chain") and fragment B (a 100 kDa "heavy chain") which remain connected via a disulfide bridge. Cleavage of the progenitor toxin into A and B fragments can be induced artificially by trypsin.^[4]

Toxin action

Tetanospasmin released in the wound is absorbed into the circulation and reaches the ends of motor neurons all over the body. The toxin acts at several sites within the central nervous system, including nerve terminals, the spinal cord, and brain, and within the sympathetic nervous system. By binding to peripheral motor neuron terminals, the toxin enters the nerve axons, and is transported across synaptic junctions to the nerve-cell body in the brain stem and spinal cord by retrograde intraneuronal transport, until it reaches the central nervous system, where it rapidly binds to gangliosides at the presynaptic membrane of inhibitory motor nerve endings.^[2]

The clinical manifestations of tetanus are caused when tetanus toxin blocks inhibitory impulses, by interfering with the release of neurotransmitters, including glycine and gamma-aminobutyric acid. These inhibitory neurotransmitters inhibit the alpha motor neurons. With diminished inhibition, the resting firing rate of the alpha motor neuron increases, producing rigidity, unopposed muscle contraction and spasm. Characteristic features are risus sardonicus (a rigid smile), trismus (commonly known as "lock-jaw"), and opisthotonus (rigid, arched back). Seizures may occur, and the autonomic nervous system may also be affected. Tetanospasmin appears to prevent the release of neurotransmitters by selectively cleaving a component of synaptic vesicles called synaptobrevin II.^[4] Loss of inhibition also affects preganglionic sympathetic neurons in the lateral gray matter of the spinal cord and produces sympathetic hyperactivity and high circulating catecholamine levels. Hypertension and tachycardia alternating with hypotension and bradycardia may develop.^[5]^[6]

Genome structure

Clostridium tetani has a genome that contains 2.80 Mbp with 2,373 protein coding genes.^[7]

References

^ ^a ^b Ryan, KJ; Ray, CG, eds. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 0-8385-8529-9.
^ ^a ^b ^c ^d ^e Centers for Disease Control and Prevention (2006). "Tetanus". In Atkinson, W; Hamborsky, J; McIntyre, L et al. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book) (10th ed.). Public Health Foundation. |displayeditors= suggested (help)
^ Madigan, M; Martinko, J, eds. (2005). Brock Biology of Microorganisms (11th ed.). Prentice Hall. ISBN 0-13-144329-1.
^ ^a ^b ^c ^d Todar, Ken (2005) Pathogenic Clostridia, Ken Todar's Microbial World, University of Wisconsin - Madison.
^ Loscalzo, Joseph; Fauci, Anthony S.; Braunwald, Eugene; Dennis L. Kasper; Hauser, Stephen L; Longo, Dan L. (2008). Harrison's principles of internal medicine. McGraw-Hill Medical. ISBN 0-07-146633-9.
^ "Tetanus in Emergency Medicine". Emedicine. Retrieved 2011-09-01.
^ Bruggemann, H.; Baumer, S.; Fricke, WF.; Wiezer, A.; Liesegang, H.; Decker, I.; Herzberg, C.; Martinez-Arias, R. et al. (Feb 2003). "The genome sequence of Clostridium tetani, the causative agent of tetanus disease". Proc Natl Acad Sci U S A 100 (3): 1316–21. doi:10.1073/pnas.0335853100. PMC 298770. PMID 12552129.

External links

Pathema-Clostridium Resource
Centers for Disease Control and Prevention (2012). "Ch. 20: Tetanus". In Atkinson, W; Wolfe, S; Hamborsky, J. Epidemiology and Prevention of Vaccine-Preventable Diseases (12th ed.). Washington DC: Public Health Foundation. pp. 291–300.

UpToDate Contents

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1. 破傷風 tetanus
2. 成人における破傷風-ジフテリアトキソイドワクチン tetanus diphtheria toxoid vaccination in adults
3. 刺創の概要 overview of puncture wounds
4. Diphtheria, tetanus, and pertussis immunization in children 7 through 18 years of age
5. 0～6歳の乳児および小児におけるジフテリア、破傷風、および百日咳ワクチン diphtheria tetanus and pertussis immunization in infants and children 0 through 6 years of age

English Journal

Urocanate reductase: Identification of a novel anaerobic respiratory pathway in Shewanella oneidensis MR-1.

Bogachev AV, Bertsova YV, Bloch DA, Verkhovsky MI.SourceDepartment of Molecular Energetics of Microorganisms, A.N. Belozersky Institute of Physico-Chemical Biology, Moscow State University, Moscow, 119992, Russia.
Molecular microbiology.Mol Microbiol.2012 Oct 18. doi: 10.1111/mmi.12067. [Epub ahead of print]
Interpretation of the constantly expanding body of genomic information requires that the function of each gene be established. Here we report the genomic analysis and structural modeling of a previously uncharacterized redox-metabolism protein UrdA (SO_4620) of Shewanella oneidensis MR-1, which led
PMID 23078170

Tetanus following replantation of an amputated finger: a case report.

Hayashida K, Murakami C, Fujioka M.AbstractABSTRACT: INTRODUCTION: Tetanus is an infectious disease caused by tetanus toxin produced by Clostridium tetani and induces severe neurological manifestations. We treated a patient who developed tetanus during hospitalization for replantation of an amputated finger. To the best of our knowledge, this is the first published case report of such an entity.
Journal of medical case reports.J Med Case Rep.2012 Oct 8;6(1):343. [Epub ahead of print]
ABSTRACT: INTRODUCTION: Tetanus is an infectious disease caused by tetanus toxin produced by Clostridium tetani and induces severe neurological manifestations. We treated a patient who developed tetanus during hospitalization for replantation of an amputated finger. To the best of our knowledge, thi
PMID 23043848

Identification of a novel linear epitope in tetanus toxin recognized by a protective monoclonal antibody: Implications for vaccine design.

Luo P, Qin L, Mao X, Chen L, Yu S, Li Q, Liu W, Zhang W, Gu J, Zou Q.SourceDepartment of Clinical Microbiology and Immunology, College of Medical Laboratory, Third Military Medical University, Chongqing 400038, China.
Vaccine.Vaccine.2012 Oct 5;30(45):6449-55. doi: 10.1016/j.vaccine.2012.08.002. Epub 2012 Aug 10.
Tetanus, a severe infectious disease, is caused by tetanus toxin (TT) from Clostridium tetani, which remains one of the most critical unsolved health problems despite preventive strategies. The carboxyl terminal of TT (TTC) is responsible for the binding of TT to neurons and for its toxicity and has
PMID 22889825

Japanese Journal

臨床情報による的確な検体処理で Clostridium tetani の分離に成功した破傷風の一症例

大橋一孝,河合裕美,渡邉美菜子,山本詩子,岡崎恵美,高野由喜子,早川希威,佐藤敏夫,大花昇,山本夏男,今福裕司,塚田泰彦,須釜久美子,小黒祐子,山本明彦,高橋元秀,金光敬二
日本臨床微生物学雑誌 = The journal of the Japanese Society for Clinical Microbiology 21(1), 35-39, 2011-03-25
NAID 10028122511

Disinfection Methods for Spores of Bacillus atrophaeus, B. anthracis, Clostridium tetani, C. botulinum and C. difficile

Oie Shigeharu,Obayashi Akiko,Yamasaki Hirofumi,Furukawa Hiroyuki,Kenri Tsuyoshi,Takahashi Motohide,Kawamoto Keiko,Makino Sou-ichi
Biological & Pharmaceutical Bulletin 34(8), 1325-1329, 2011
… anthracis, Clostridium botulinum and Clostridium tetani, and Clostridium difficile. …
NAID 130000936607

非ウイルス性感染症破傷風菌 (広範囲血液・尿化学検査免疫学的検査(第7版・3)その数値をどう読むか) -- (免疫学的検査感染症関連検査(抗原および抗体を含む))

山本明彦,高橋元秀
日本臨床 68(-) (980), 220-223, 2010-06
NAID 40017181748

Related Pictures

★リンクテーブル★

リンク元	「細菌」「破傷風」「クロストリジウム属」「破傷風抗毒素」
関連記事	「clostridium」「tetani」「Clostridium」

「細菌」

Clostridium tetani
	Clostridium tetani with characteristic 'tennis racket' appearance.
Scientific classification
Kingdom:	Bacteria
Phylum:	Firmicutes
Class:	Clostridia
Order:	Clostridiales
Family:	Clostridiaceae
Genus:	Clostridium
Species:	C. tetani
Binomial name
	Clostridium tetani; Flügge, 1881

　　[★]

英: bacterium,(pl.) bacteria
同: バクテリア
関: 特殊な細菌、細菌の鑑別、細菌の同定？、細菌の分類？

細菌の命名

ラテン語であり、イタリックで表す。
「属名 + 種名」で表現される。

グラム染色性と形状による分類と疾患

形状

球菌

Staphylococcus aureus

多様

ナイセリア属

淋菌

Neisseria gonorrhoeae

淋病

ストレプトコッカス属

化膿性連鎖球菌

Streptococcus pyogenes

多様

莢膜

髄膜炎菌

Neisseria meningitidis

多様

肺炎球菌

Streptococcus pneumoniae

ベイヨネラ属

Veillonella

エンテロコッカス属

(総称)腸球菌

Enterococcus faecalis

モラクセラ属/
ブランハメラ亜属

Moraxella catarrhalis

肺炎

Enterococcus faecium

桿菌

Bacillus anthracis

好気性菌、有芽胞菌、莢膜

肺炎、尿路感染

Bacillus cereus

好気性菌、有芽胞菌

Escherichia coli

通性嫌気性

Clostridium tetani

嫌気性菌、有芽胞菌

下痢、肺炎、尿路感染

Clostridium botulinum

ボツリヌス中毒

プロテウス属

尿路感染

ウェルシュ菌

Clostridium perfringens

多様

サルモネラ属

パラチフス菌

Sallmonella serovar Paratyphi

腸チフス

通性嫌気性

ディフィシル菌

Clostridium difficile

多様

チフス菌

Sallmonella serovar Typhi

通性嫌気性

ガス壊疸菌群

セラチア属

Serratia

日和見感染

通性嫌気性

マイコバクテリウム科

マイコバクテリウム属

結核菌

Mycobacterium tuberculosis

無芽胞菌

Shigella

通性嫌気性

Mycobacterium leprae

Yersinia pestis

通性嫌気性

コリネバクテリウム科

コリネバクテリウム属

ジフテリア菌

Corynebacterium diphtheriae

ジフテリア

Yersinia enterocolitica

多様

通性嫌気性

Vibrio cholerae

通性嫌気性

アクチノマイセス科

アクチノマイセス属(放線菌属)

(総称)放線菌

Actinomyces

腸炎ビブリオ

Vibrio parahaemolyticus

腸炎ビブリオ感染症

通性嫌気性

リステリア属

Listeria monocytogenes

リステリア症

嫌気性菌、無芽胞菌、人獣共通感染症、通性細胞内寄生菌

パスツレラ科

ヘモフィルス属

インフルエンザ菌

Haemophilis influenzae

多様

パスツレラ属

パスツレラ属菌

Pasteurella multocida

人獣共通感染症

ストレプトバシラス属

ストレプトバシラス属菌

Streptobacillus moniliformis

鼠咬症

シュードモナス属

緑膿菌

Psudomonas aeruginosa

緑膿菌感染症

好気性、院内感染症

ボルデテラ属

百日咳菌

Bordetela pertussis

好気性、短桿菌

Brucella

好気性、細胞内増殖菌、短桿菌

Francisella tularensis

野兎病

好気性、球桿菌

レジオネラ属

Legionella pneumophila

ポンティアック熱/レジオネラ肺炎

好気性

バクテロイデス属

Bacteroides fragilis

嫌気性感染症

偏性嫌気性菌

らせん菌

スピロヘータ科

トレポネーマ属

梅毒トレポネーマ

Treponema pallidum subspecies pallidum

梅毒

ボレリア属

回帰熱ボレリア

Borrelia recurrentis

回帰熱

ライム病ボレリア

Borrelia burgdorferi

Leptospira interrogans serovar icterohaemorrhagiae

黄疸出血性レプトスピラ症(レプトスピラ症、ワイル病、黄疸性ワイル病)

？

？

カンピロバクター属菌

？

Helicobacter pylori

「破傷風」

　　[★]

英: tetanus, lockjaw
同: テタヌス
関: 破傷風菌 Clostridium tetani

概念

嫌気性芽胞形成性グラム陽性桿菌である破傷風菌(Clostridium tetani)による感染症であり、破傷風菌が産生した外毒素テタノスパスミン(tetanospasmin)による中枢神経障害(随意筋痙攣)をきたすことが本疾患の病態である。
破傷風菌は土壌や塵など環境中に広く、またヒトや動物の消化管にも存在するが、破傷風菌に汚染された環境で外傷を契機に感染が成立する。
感染症ではあるが、神経毒による中毒性感染症であある。

病型

参考1

全身性破傷風：全身の筋の強直性攣縮　＋　自律神経症状(早期は易刺激性、不穏、発汗、頻脈。後期には著しい発汗、不整脈、不安定な高血圧・低血圧、発熱)
限局性破傷風
頭部破傷風
新生児破傷風

病態

SMB.260

破傷風毒素(テタノスパスミン)は亜鉛依存性プロテアーゼ活性を有しており、シナプス小胞付随蛋白であり開口分泌に関与するシナプトブレビンを特異的に切断し、シナプスへの神経伝達物質の放出を妨げる。
症状の発現は脊髄の抑制ニューロンが遮断される事による。
自律神経ニューロンも遮断されるので、自律神経症状も発現する。　→　著しい血圧、脈拍の変動

潜伏期

3日～3週間

経過

治療

SMB.260 YN. H-55 SPE.359

創部　：デブリドマン
抗毒素：ヒトTIGの投与　→　神経細胞に取り込まれた後では毒素を中和できなくなる。
抗菌　：ペニシリンGの大量投与。テトラサイクリン(SPE.359)
対症療法：呼吸管理、筋弛緩薬、抗痙攣薬(ジアゼパム)、刺激の軽減(日光の遮蔽)

予防

破傷風トキソイドによる能動免疫
小児期にジフテリア・破傷風・百日咳混合ワクチンを、それ以外の者は沈降破傷風トキソイド(破傷風トキソイド＊)を3回注射しておけば約5年間程度の免疫が得られる。

免疫

感染後免疫は成立しない。

予後

死亡率：40% (SPE.359)
救急救命センターレベルでならば死亡率は10%程度に下げることが可能である。

参考

1. [charged] Tetanus - uptodate [1]

国試

101G057

「クロストリジウム属」

　　[★]

英: Clostridium
関: 細菌

芽胞形成
グラム陽性桿菌
ほとんどが偏性嫌気性菌

例外的に酸素に耐性が有るのがC. tertium, C. histolyticum, C.innocuum, C.perfringens

クロストリジウム属

Clostridium tetani：破傷風菌：破傷風
Clostridium botulinum：ボリツヌス菌：ボリツヌス中毒
Clostridium perfringens：ウェルシュ菌：(a:創傷より侵入)ガス壊疽(クロストリジウム性ガス壊疽)、蜂巣炎、子宮感染、菌血症 (b:腸管内で外毒素分泌)食中毒、致死性腸炎
Clostridium difficile：ディフィシル菌：偽膜性大腸炎、抗生物質関連大腸炎・下痢症
Clostridium septicum：
Clostridium novyi：
Clostridium histolyticum：
Clostridium oedematiens：

「破傷風抗毒素」

　　[★]

英: tetanus antitoxin, TAT
商: テタガム、テタノセーラ、テタノブリンIH、テタノブリン、破傷風グロブリン
関: 破傷風、Clostridium tetani

「clostridium」

　　[★]

関: クロストリジウム、クロストリジウム属

「tetani」

　　[★]

np

強縮

関: tetanic、tetanus、tetany

「Clostridium」

　　[★] クロストリジウム属

[Sherris-1] Ryan, KJ; Ray, CG, eds. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 0-8385-8529-9.

[CDC_2006-2] Centers for Disease Control and Prevention (2006). "Tetanus". In Atkinson, W; Hamborsky, J; McIntyre, L et al. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book) (10th ed.). Public Health Foundation. |displayeditors= suggested (help)

[Brock-3] Madigan, M; Martinko, J, eds. (2005). Brock Biology of Microorganisms (11th ed.). Prentice Hall. ISBN 0-13-144329-1.

[UW-4] Todar, Ken (2005) Pathogenic Clostridia, Ken Todar's Microbial World, University of Wisconsin - Madison.

[isbn0-07-146633-9-5] Loscalzo, Joseph; Fauci, Anthony S.; Braunwald, Eugene; Dennis L. Kasper; Hauser, Stephen L; Longo, Dan L. (2008). Harrison's principles of internal medicine. McGraw-Hill Medical. ISBN 0-07-146633-9.

[urlTetanus_in_Emergency_Medicine-6] "Tetanus in Emergency Medicine". Emedicine. Retrieved 2011-09-01.

[7] Bruggemann, H.; Baumer, S.; Fricke, WF.; Wiezer, A.; Liesegang, H.; Decker, I.; Herzberg, C.; Martinez-Arias, R. et al. (Feb 2003). "The genome sequence of Clostridium tetani, the causative agent of tetanus disease". Proc Natl Acad Sci U S A 100 (3): 1316–21. doi:10.1073/pnas.0335853100. PMC 298770. PMID 12552129.

Clostridium tetani

Clostridium tetani with characteristic 'tennis racket' appearance.
Scientific classification
Kingdom:	Bacteria
Phylum:	Firmicutes
Class:	Clostridia
Order:	Clostridiales
Family:	Clostridiaceae
Genus:	Clostridium
Species:	C. tetani
Binomial name
*Clostridium tetani* Flügge, 1881

匿名

検索

案内

Clostridium tetani

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Contents

History

Characteristics

Vaccination

Toxicity

Toxin action

Genome structure

References

Further reading

External links

UpToDate Contents

English Journal

Japanese Journal

Related Pictures

★リンクテーブル★

「細菌」

細菌の命名

グラム染色性と形状による分類と疾患

「破傷風」

概念

病型

病態

潜伏期

経過

治療

予防

免疫

予後

参考

国試

「クロストリジウム属」

クロストリジウム属

「破傷風抗毒素」

「clostridium」

「tetani」

「Clostridium」