1
|
Fabris F, Megighian A, Rossetto O, Simonato M, Schiavo G, Pirazzini M, Montecucco C. Local Tetanus Begins with a Vesicle-Associated Membrane Protein Cleavage-Associated Neuromuscular Junction Paralysis around the Site of Tetanus Neurotoxin Release. THE AMERICAN JOURNAL OF PATHOLOGY 2024:S0002-9440(24)00208-6. [PMID: 38885925 DOI: 10.1016/j.ajpath.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024]
Abstract
Local tetanus develops when limited amounts of tetanus neurotoxin (TeNT) are released by Clostridium tetani generated from spores inside a necrotic wound. Within days, a spastic paralysis restricted to the muscles of the affected anatomical area develops. This paralysis follows the retrograde transport of TeNT inside the axons of spinal cord motoneurons and its uptake by inhibitory interneurons with cleavage of a vesicle-associated membrane protein required for neurotransmitter release. Consequently, incontrollable excitation of motoneurons causes contractures of innervated muscles and leads to local spastic paralysis. Here, the initial events occurring close to the site of TeNT release were investigated in a mouse model of local tetanus. A peripheral flaccid paralysis was found to occur, before or overlapping, the spastic paralysis. At variance from the confined TeNT proteolytic activity at the periphery, central vesicle-associated membrane protein cleavage can be detected within inhibitory interneurons controlling motor neuron efferents innervating muscle groups distant from the site of TeNT release. These results indicate that TeNT does have peripheral activity in tetanus and explains why the spastic paralysis observed in local tetanus, although confined to single limbs, generally affects multiple muscles. The initial TeNT neuroparalytic activity can be detected by measuring the compound muscle action potential, providing a very early diagnosis and therapy, and thus preventing the ensuing life-threatening generalized tetanus.
Collapse
Affiliation(s)
- Federico Fabris
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Aram Megighian
- Department of Biomedical Sciences, University of Padua, Padua, Italy; Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Ornella Rossetto
- Department of Biomedical Sciences, University of Padua, Padua, Italy; Center of Myology CIR-Myo, University of Padua, Padua, Italy; Institute of Neuroscience, National Research Council, Padua, Italy
| | - Morena Simonato
- Institute of Neuroscience, National Research Council, Padua, Italy
| | - Giampietro Schiavo
- Department of Neuromuscular Diseases and UCL Queen Square Motor Neuron Disease Centre, UCL Queen Square Institute of Neurology; (ǁ)UK Dementia Research Institute, University College London, London, United Kingdom
| | - Marco Pirazzini
- Department of Biomedical Sciences, University of Padua, Padua, Italy; Center of Myology CIR-Myo, University of Padua, Padua, Italy.
| | - Cesare Montecucco
- Department of Biomedical Sciences, University of Padua, Padua, Italy; Institute of Neuroscience, National Research Council, Padua, Italy.
| |
Collapse
|
2
|
Zilli J, Häußler TC, Ives EJ, Schmidt MJ. Case report: A severe case of generalized tetanus in a young cat. Front Vet Sci 2023; 10:1328331. [PMID: 38130435 PMCID: PMC10734167 DOI: 10.3389/fvets.2023.1328331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
A 10-month-old, 3 kg, female spayed Domestic Shorthair cat was presented with a chronic, infected wound at the level of the proximo-lateral left pelvic limb. General physical examination revealed a weight-bearing lameness of the left pelvic limb, which was moderately and circumferentially swollen and edematous proximal to the tarsal joint. On the lateral aspect of the proximal thigh, there was a chronic wound of 1 cm in diameter and an additional exudative skin lesion was present throughout the whole length of the caudo-lateral thigh. Complete blood count and serum biochemistry profile revealed mild anemia, increased serum amyloid A, hyponatraemia, hypochloraemia, hypocalcaemia, hyperkalaemia, hypermagnesaemia, hyperglycaemia, increased creatine kinase, and increased liver parameters. Surgical exploration of the wound was performed, and necrotizing fasciitis was suspected. The affected limb was amputated and swabs for bacterial culture were taken from both the skin lesions and surgical site before wound closure. One day after surgery, mild muscular contractions on the forehead and an increased muscle tone of the right pelvic limb were evident. One day later, the cat developed a generalized increase in extensor tone, with intermittent opisthotonos, resulting in lateral recumbency. Based on these clinical signs, a diagnosis of generalized tetanus was made and treatment with midazolam, methocarbamol, and metronidazole was started. Despite an improvement of all blood parameters, the cat progressively deteriorated and 4 days after surgery, it developed episodes of tetanic convulsions, associated with hyperthermia and ventricular arrhythmias. Despite intensive care and medical management, the cat died following a cardio-respiratory arrest 3 days later. This case report describes a rare case of severe generalized tetanus in a young cat.
Collapse
Affiliation(s)
- Jessica Zilli
- Department of Veterinary Clinical Sciences, Small Animal Clinic – Clinical Neurology, Neuroradiology and Neurosurgery, Justus-Liebig-University, Giessen, Germany
- Neurology and Neurosurgery Service, Anderson Moores Veterinary Specialists, Linnaeus Veterinary Limited, Winchester, United Kingdom
| | - Thomas C. Häußler
- Department of Veterinary Clinical Sciences, Small Animal Clinic – Surgery, Justus-Liebig-University, Giessen, Germany
| | - Edward J. Ives
- Neurology and Neurosurgery Service, Anderson Moores Veterinary Specialists, Linnaeus Veterinary Limited, Winchester, United Kingdom
| | - Martin J. Schmidt
- Department of Veterinary Clinical Sciences, Small Animal Clinic – Clinical Neurology, Neuroradiology and Neurosurgery, Justus-Liebig-University, Giessen, Germany
| |
Collapse
|
3
|
Mayousse V, Soete C, Jeandel A. Suspected Generalized Neonatal Tetanus in a Litter of Puppies. J Am Anim Hosp Assoc 2023; 59:51-55. [PMID: 36584314 DOI: 10.5326/jaaha-ms-7246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 01/01/2023]
Abstract
Tetanus, caused by Clostridium tetani neurotoxin, is extensively described in adult dogs and is frequently associated with a recent history of wounds. Although this condition is reported in 2-3 mo old puppies, tetanus has not been described in neonates. Herein, we report the clinical signs of 3-5 day old American Bully puppies from the same litter, presenting with an acute onset of marked generalized stiffness of the extensor muscles, trismus, and an inability to suckle. Three puppies died because of tetanus: one died during consultation, one was euthanized owing to respiratory distress, and the third died 1 mo after initial presentation following deterioration. All three of these puppies were clinically affected by omphalitis. Complete bloodwork, toxicological screening (including strychnine assay), serology, and polymerase chain reaction tests for selected infectious diseases were unremarkable. Necropsy of the euthanized puppy confirmed suppurative omphalitis, which may have contributed to C. tetani infection. These are the first cases of suspected neonatal tetanus in puppies, which is a frequent condition in newborn humans and is associated with omphalitis as the route of infection.
Collapse
Affiliation(s)
- Vincent Mayousse
- From Neurology Unit (V.M.), Centre Hospitalier Vétérinaire des Cordeliers, Meaux, Il de France, France
| | - Caroline Soete
- From Internal Medicine Unit (C.S.), Centre Hospitalier Vétérinaire des Cordeliers, Meaux, Il de France, France
| | - Aurélien Jeandel
- From Neurology Unit, Centre Hospitalier Vétérinaire Pommery, Reims, France (A.J.)
| |
Collapse
|
4
|
Danciu CG, Milgram J, Ober CA, Tăbăran FA, Demény H, Chai O. Coxofemoral luxation as a complication of localised tetanus in a cat. JFMS Open Rep 2022; 8:20551169221090889. [PMID: 35462862 PMCID: PMC9021486 DOI: 10.1177/20551169221090889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case summary A 9-month-old male neutered domestic shorthair cat presented 2 weeks after castration with a 48 h history of acute-onset lateral recumbency and severe hindlimb rigidity. Physical examination findings included hyperthermia, tachypnoea, hindlimb rigidity and a healed orchidectomy site. Neurological examination of the head and forelimbs was normal; however, there was a spastic, non-ambulatory paraparesis of the hindlimbs, which was more severe on the left. Abnormal findings included mildly elevated serum creatine kinase levels and on electromyography there was bilateral pathological spontaneous activity of the biceps femoris muscles. A tentative diagnosis of tetanus was made based on clinical presentation. Treatment was initiated with tetanus antitoxin, diazepam, metronidazole, buprenorphine and physiotherapy of the hindlimbs. There was an improvement over the following 20 days. Twenty-five days later the cat presented with acute, painful, non-weightbearing lameness of the left hindlimb. Physical examination was suggestive of craniodorsal coxofemoral joint luxation, which was confirmed radiographically. This was treated with analgesia and rest. A marked clinical improvement was observed at the 3-month follow-up. Relevance and novel information To our knowledge, there have been no previously published reports of spontaneous coxofemoral joint luxation as a complication of hindlimb localised tetanus infection in cats. This report suggests that coxofemoral luxation should be considered as a possible complication in young cats with hindlimb localised tetanus.
Collapse
Affiliation(s)
- Cecilia-Gabriella Danciu
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK.,Department of Veterinary Preclinical and Clinical Sciences, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania
| | - Joshua Milgram
- Department of Small Animal Surgery, The Koret School of Veterinary Medicine, Rehovot, Israel
| | - Ciprian Andrei Ober
- Department of Veterinary Preclinical and Clinical Sciences, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania
| | - Flaviu Alexandru Tăbăran
- Department of Veterinary Preclinical and Clinical Sciences, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania
| | - Helga Demény
- Department of Veterinary Preclinical and Clinical Sciences, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania
| | - Orit Chai
- Department of Veterinary Neurology and Neurosurgery, The Koret School of Veterinary Medicine, Rehovot, Israel
| |
Collapse
|
5
|
Abstract
Tetanus is a severe and potentially fatal infection caused by the bacterium Clostridium tetani. Presentations of tetanus include generalized tetanus, neonatal tetanus, cephalic tetanus, and localized tetanus, the latter two being much rarer. We present case of a 55-year-old male farmer, presented with an injury to the left toe. A surgical wound exploration and washout with administration of human tetanus immunoglobulin and tetanus toxoid were given as treatment with antibiotic support. This case report points out the importance of the early recognition of a rare form of this fatal infectious disease, which may present with prodromal symptoms before the generalized form shows its clinical effects. Successful management includes prompt diagnosis, neutralization of circulating toxin and elimination of C. tetani infection, control of spasms, maintenance of the airway, and management of respiratory failure and autonomic dysfunction.
Collapse
Affiliation(s)
- Deepak S Sharma
- Department of Intensive Care Medicine, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | - Mit B Shah
- Department of Intensive Care Medicine, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| |
Collapse
|
6
|
Bianchi E, Biserni R, Gallucci A, Pisoni L, Menchetti M, Gandini G. Changes in electromyography and F wave responses in two cats with presumed local tetanus: implications for diagnosis and prognosis. J Feline Med Surg 2013; 15:927-31. [PMID: 23439760 DOI: 10.1177/1098612x13479599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two cases of focal tetanus in the cat are described. Clinical findings included severe muscular spasms of the pelvic limbs in one cat, and involvement of the thoracic limbs and muscles of the neck and face in the other. Electromyography in both cats showed spontaneous activity characterised by the presence of motor unit potentials. F waves, never previously reported in focal tetanus in animals, showed significantly increased F/M amplitude ratio in both cats and increased F wave duration in one cat. The electrodiagnostic findings provided relevant diagnostic and, possibly, prognostic information.
Collapse
Affiliation(s)
- Ezio Bianchi
- 1Department of Veterinary Medical Science, University of Parma, Parma, Italy
| | | | | | | | | | | |
Collapse
|
7
|
Abstract
PRACTICAL RELEVANCE Neurological causes of lameness are infrequently seen in cats but they are an important consideration when an obvious orthopaedic cause cannot be identified. Monoparetic cats are also frequently presented for veterinary investigation with the main complaint being lameness. CLINICAL CHALLENGES Neurological causes of lameness may be difficult to determine without access to advanced imaging modalities, electrodiagnostics or cerebrospinal fluid analysis. AUDIENCE This review, aimed at all veterinarians who treat cats, sets out to describe the specific approach to cats with lameness that cannot be attributed to an orthopaedic cause. It describes the diagnosis and management of the most common neurological conditions responsible for lameness or monoparesis in cats.
Collapse
Affiliation(s)
- Laurent Garosi
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hertfordshire SG5 3HR, UK.
| |
Collapse
|
8
|
Mykkänen AK, Hyytiäinen HK, McGowan CM. Generalised tetanus in a 2-week-old foal: use of physiotherapy to aid recovery. Aust Vet J 2011; 89:447-51. [PMID: 22008124 DOI: 10.1111/j.1751-0813.2011.00845.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A 2-week-old Estonian Draft foal presented with signs of severe generalised tetanus, recumbency and inability to drink. The suspected source of infection was the umbilicus. Medical treatment was administered, including tetanus antitoxin, antimicrobial therapy and phenobarbital to control tetanic spasms. In addition, an intensive physiotherapy program was carried out during the recovery period. Techniques designed for syndromes involving upper motor neuron spasticity in humans were applied. Exercises aimed at weight-bearing and mobility were executed with the help of a walking-frame. The foal made a complete recovery. To our knowledge, this is the first report of the use of physiotherapy in the treatment of tetanus in horses.
Collapse
Affiliation(s)
- A K Mykkänen
- Department of Equine and Small Animal Medicine, University of Helsinki, Finland.
| | | | | |
Collapse
|
9
|
Langner KFA, Schenk HC, Leithaeuser C, Tholen H, Simon D. Localised tetanus in a cat. Vet Rec 2011; 169:126. [PMID: 21730036 DOI: 10.1136/vr.d3459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- K F A Langner
- Small Animal Clinic, University of Veterinary Medicine Hannover, Buenteweg 9, 30559 Hannover, Lower Saxony, Germany.
| | | | | | | | | |
Collapse
|
10
|
Abstract
PRESENTATION This report describes a kitten with paraplegia and extensor rigidity of the pelvic limbs associated with motor neuron loss and chronic denervation of skeletal muscle. Persistent skeletal muscle atrophy and degeneration had resulted in immobile stifle and hock joints and severe pelvic limb rigidity consistent with a neurogenic form of arthrogryposis. Both pelvic limbs were equally affected and the kitten showed no signs of pain. INVESTIGATIONS Electromyography identified spontaneous activity in the pelvic limbs. Muscle and peripheral nerve biopsies showed pathology consistent with denervation. On necropsy, 3 weeks after admittance, severe degenerative changes including axonal necrosis and myelin degeneration were confirmed in the lumbar spinal cord. CLINICAL RELEVANCE There are very few descriptions of feline motor neuron degeneration in the literature and obtaining an ante-mortem diagnosis is difficult. Although an inherited disorder cannot be ruled out, a condition acquired congenitally in utero or postnatally was suspected in this case.
Collapse
|
11
|
Gatineau M, El-Warrak AO, Marretta SM, Kamiya D, Moreau M. Locked Jaw Syndrome in Dogs and Cats: 37 Cases (1998–2005). J Vet Dent 2008; 25:16-22. [DOI: 10.1177/089875640802500106] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A consecutive series of cases of dogs and cats with locked jaw syndrome (inability to open or close the mouth) are reported in this study. Dogs were significantly overrepresented (84.0 %) and adult dogs were more frequently affected (81.0 %). Temporomandibular joint ankylosis due to fracture was the most common cause (54.0 %) of locked jaw syndrome. Additional potential causes of locked jaw syndrome are masticatory muscle myositis, neoplasia, trigeminal nerve paralysis and central neurological lesions, temporomandibular joint luxation and dysplasia, osteoarthritis, retrobulbar abscess, tetanus, and severe ear disease. Treatment of locked jaw is directed towards the primary cause. It is important to treat the tonic spasm in order to minimize periarticular fibrosis. Surgical intervention is recommended for temporomandibular joint ankylosis. Masticatory muscle myositis treatment is initiated by gradually opening the mouth, with medical treatment based on immunosuppressive therapy. Fracture and masticatory muscle myositis are associated with a relatively good prognosis in regard to short-term outcome as compared to animals with central neurologic lesions or osteosarcoma which have a poor prognosis.
Collapse
Affiliation(s)
- Matthieu Gatineau
- From the Faculty of Veterinary Medicine (Gatineau, El-Warrack, Moreau), University of Montreal at Saint Hyacinthe, Quebec, 3200 Rue Sicotte, St-Hyacinthe, Québec, Canada, J2S 2M2; and the University of Illinois, 1008 West Hazelwood Drive, Urbana, IL, 61802
| | - Alexander O. El-Warrak
- From the Faculty of Veterinary Medicine (Gatineau, El-Warrack, Moreau), University of Montreal at Saint Hyacinthe, Quebec, 3200 Rue Sicotte, St-Hyacinthe, Québec, Canada, J2S 2M2; and the University of Illinois, 1008 West Hazelwood Drive, Urbana, IL, 61802
| | - Sandra Manfra Marretta
- From the Faculty of Veterinary Medicine (Gatineau, El-Warrack, Moreau), University of Montreal at Saint Hyacinthe, Quebec, 3200 Rue Sicotte, St-Hyacinthe, Québec, Canada, J2S 2M2; and the University of Illinois, 1008 West Hazelwood Drive, Urbana, IL, 61802
| | - D Kamiya
- From the Faculty of Veterinary Medicine (Gatineau, El-Warrack, Moreau), University of Montreal at Saint Hyacinthe, Quebec, 3200 Rue Sicotte, St-Hyacinthe, Québec, Canada, J2S 2M2; and the University of Illinois, 1008 West Hazelwood Drive, Urbana, IL, 61802
| | - Maxime Moreau
- From the Faculty of Veterinary Medicine (Gatineau, El-Warrack, Moreau), University of Montreal at Saint Hyacinthe, Quebec, 3200 Rue Sicotte, St-Hyacinthe, Québec, Canada, J2S 2M2; and the University of Illinois, 1008 West Hazelwood Drive, Urbana, IL, 61802
| |
Collapse
|
12
|
Linnenbrink T, McMichael M. Tetanus: pathophysiology, clinical signs, diagnosis, and update on new treatment modalities. J Vet Emerg Crit Care (San Antonio) 2006. [DOI: 10.1111/j.1476-4431.2006.00192.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
De Risio L, Zavattiero S, Venzi C, Del Bue M, Poncelet L. Focal canine tetanus: diagnostic value of electromyography. J Small Anim Pract 2006; 47:278-80. [PMID: 16674723 DOI: 10.1111/j.1748-5827.2006.00046.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A four-year-old, male Italian hound was presented with severe spasticity of both thoracic limbs that worsened with external stimuli. The remainder of the neurological and general physical examination was normal. Complete blood cell count, chemistry profile, and serology for protozoal diseases were within normal limits. Survey radiography of the cervicothoracic spine and abdominal ultrasonography showed no abnormalities. Electromyography of the thoracic limbs demonstrated the presence of "doublets" and simultaneous activity in both agonist and antagonist muscles. These abnormalities may be explained by a defective glycinergic inhibition at the spinal cord level. Together with the history, progression of signs, and clinical findings, electromyography supported a presumptive diagnosis of focal tetanus. The dog received tetanus antitoxin and antibiotic treatment and gradually improved over four months.
Collapse
Affiliation(s)
- L De Risio
- Surgery and Emergency Medicine Unit, Animal Health Department, Veterinary School of Parma, University of Parma, Via del Taglio 8, 43100 Parma, Italy
| | | | | | | | | |
Collapse
|