Respiratory complications in dogs with tetanus: A retrospective study of 53 cases

Tetanus can lead to respiratory complications, and the outcome of dogs affected by this disease is still largely unknown. This retrospective study aimed to evaluate the frequency and outcome of 53 dogs with tetanus and respiratory complications between February 2006 and January 2019. Medical records from dogs diagnosed with tetanus admitted to a referral teaching hospital were reviewed. Fifty-three dogs were diagnosed with tetanus and respiratory complications were observed in 26.4% (14/53) of dogs; 8 developed aspiration pneumonia (AP), 5 developed upper airway obstruction (UAO) and 1 dog developed both. A total of 5 AP dogs were mechanically ventilated. Three dogs with UAO had tracheostomy tubes placed. Dogs with respiratory complications had a poorer outcome, with only 14.3% (2/14) surviving to discharge, compared to 94.8% (37/39) for dogs with no respiratory complications. Respiratory complications such as AP and UAO were common in dogs with tetanus, and this was associated with a poorer outcome.

Tetanus in animals

Tetanus is a neurologic disease of humans and animals characterized by spastic paralysis. Tetanus is caused by tetanus toxin (TeNT) produced by Clostridium tetani, an environmental soilborne, gram-positive, sporulating bacterium. The disease most often results from wound contamination by soil containing C. tetani spores. Horses, sheep, and humans are highly sensitive to TeNT, whereas cattle, dogs, and cats are more resistant. The diagnosis of tetanus is mainly based on the characteristic clinical signs. Identification of C. tetani at the wound site is often difficult.

Association between clinically probable REM sleep behavior disorder and tetanus in dogs

BACKGROUND

Abnormal sleep behavior has been reported in 5 dogs during recovery from tetanus.

HYPOTHESIS

REM sleep behavior disorder (RBD) is a more common consequence of tetanus than previously reported in veterinary literature and easily confused for epileptic seizures.

ANIMALS

Sixty-one client-owned dogs diagnosed with tetanus at 2 UK referral centers.

METHODS

A retrospective review of medical records was combined with a questionnaire sent to owners of surviving dogs, to identify cases that developed clinically probable RBD and determine its clinical progression and effect on quality of life of affected dogs and their owners. Descriptive statistical evaluation was performed.

RESULTS

Eleven dogs (18%) died or were euthanized before discharge. At least 46% surviving dogs developed abnormal "dream enactment" clinically consistent with RBD. Twitching, running, and vocalization were new sleep behaviors in 53, 80, and 60% of affected dogs. Clinically probable RBD was described as violent or "nightmare"-like in 36% affected dogs, and like an epileptic seizure in 40% affected dogs. When trialed, antiepileptic medications were ineffective. Onset occurred before discharge in 25% cases. For dogs that developed clinically probable RBD postdischarge, onset occurred within 2 weeks of discharge in 77% dogs. Clinically probable RBD did not worsen in severity or frequency in any dog, and spontaneously resolved within 6 months in 43% cases.

CONCLUSIONS AND CLINICAL IMPORTANCE

Clinically probable RBD is a common sequel to canine tetanus with many clinical similarities to epileptic seizure activity. Owners should be made aware of its potential development and care taken to avoid misdiagnosis with epileptic seizure activity.

[Evaluation of an immunochromatographic dipstick test for the assessment of tetanus immunity in horses]

Knowledge of tetanus immunity in equine patients is crucial in cases of injuries, elective surgeries, or when effective vaccination protocols are to be designed. The Fassisi® TetaCheck is a stall-side rapid test which was developed to address these issues. The purpose of the present study was to evaluate its performance parameters. To this end, the qualitative test results obtained by two blinded observers were compared to tetanus toxoid antibody levels from 99 serum samples, measured with a double antigen ELISA. Additionally the colour intensities of the test window were quantified using a camera and photo editing software. Assuming that the protective level of tetanus toxoid antibodies is ≥ 0.1 IE/ml, the tetanus quick stick (TQS) showed a sensitivity of 83.6% and a specificity of 100%. almost perfect (K = 0.88). Exchanging the observer did not affect the interpretation of theTQS (K = 0.80; K = 0.84). The definition of five distinct colour intensities of the "test window" enabled a clear differentiation of unprotected individuals from those with a protective immunity. There was a linear relationship between the objectively measured colour intensities and the tetanus toxoid antibody concentration (r2 = 0.74). The TQS thus proved to be a robust and reliable test in the stall-side assessment of tetanus immunity in horses. Its implementation in equine daily practice can help to avoid unnecessary immunizations in adult horses and therefore minimize vaccination side effects.

Long-term effects of tetanus toxoid inoculation on the demography and life expectancy of the Cayo Santiago rhesus macaques

Tetanus was a major cause of mortality in the free-ranging population of rhesus monkeys on Cayo Santiago prior to 1985 when the entire colony was given its first dose of tetanus toxoid. The immediate reduction in mortality that followed tetanus toxoid inoculation (TTI) has been documented, but the long-term demographic effects of eliminating tetanus infections have not. This study uses the Cayo Santiago demographic database to construct comparative life tables 12 years before, and 12 years after, TTI. Life tables and matrix projection models are used to test for differences in: (i) survival among all individuals as well as among social groups, (ii) long-term fitness of the population, (iii) age distribution, (iv) reproductive value, and (v) life expectancy. A retrospective life table response experiment (LTRE) was performed to determine which life cycle transition contributed most to observed changes in long-term fitness of the population post-TTI. Elimination of clinical tetanus infections through mass inoculation improved the health and well-being of the monkeys. It also profoundly affected the population by increasing survivorship and long-term fitness, decreasing the differences in survival rates among social groups, shifting the population's age distribution towards older individuals, and increasing reproductive value and life expectancy. These findings are significant because they demonstrate the long-term effects of eradicating a major cause of mortality at a single point in time on survival, reproduction, and overall demography of a naturalistic population of primates.

Retrospective analysis of wound characteristics and tetanus development in captive macaques

Traumatic wounds and access to outdoor enclosures containing soil contribute to development of tetanus in nonhuman primates. A retrospective, matched case-control study was conducted at a primate center to evaluate these factors by analysis of medical records of animals sustaining traumatic injuries during a 3-yr study period. Thirty-one macaques with traumatic injuries and a clinical diagnosis of tetanus were selected as cases, and 62 macaques with traumatic injuries and no diagnosis of tetanus were selected as controls. For an animal with injuries to the digits, the odds of developing tetanus were 9.6 times those of a similar animal without injuries to the digits (Odds Ratio [OR] = 9.55, 95% CI = 1.56-58.59); with injuries to the tail, the odds of developing tetanus were 8.0 times those of a similar animal without injuries to the tail (OR = 7.95, 95% CI = 0.82-77.04); and with injuries in more than one location, the odds of developing tetanus were 8.5 times those for a similar animal with injuries in just one location (OR = 8.45, 95% CI = 1.01-70.46). A nonhuman primate with injuries to the leg was less likely to develop tetanus than a similar nonhuman primate without injuries to the leg (OR = 0.19, 95% CI = 0.03-1.2). Results indicated that wound location is associated with development of tetanus infection in rhesus macaques. Identification of high-risk trauma cases will allow better allocation of wound management and tetanus prophylaxis in institutions, especially in those housing nonhuman primates outdoors.

Generalized tetanus in a Labrador retriever

A 10-week-old, intact female, Labrador retriever was presented for progressive extensor rigidity, facial swelling, and difficulty in walking. Generalized tetanus was diagnosed and treated successfully.

Tetanus in the equine species: a retrospective study of 31 cases

BACKGROUND

Few studies exist about factors affecting the outcome of horses with tetanus.

ANIMALS

31 equids (30 horses and 1 donkey) with a clinical diagnosis of tetanus admitted to the Equine Clinic of the University of Liege between 1991 and 2006. The cases were divided into two groups according to the outcome (survivors and non-survivors).

METHODS

The clinical data of survivors and non-survivors were compared using an ANOVA (continuous data) or a Fisher's test (discrete data).

RESULTS

The survival rate was 32%. Most animals were 5 years or younger, and none had been appropriately vaccinated. The non-survivors were significantly younger than the survivors. The development of dyspnoea, recumbency, and the combination of dysphagia, dyspnoea, and recumbency was observed significantly more in the non-survivors than in the survivors. The timing of tetanus antitoxin administration (either immediately after the onset of suggestive signs or after a delay) was not different between the two groups. The time between the occurrence of a wound and the first signs ranged from 2 days to 2 months and was not significantly different between groups. All non-survivors died within 8 days of the first signs.

CONCLUSIONS & CLINICAL IMPORTANCE

This study suggests that young animals are affected more often and more severely by tetanus than older animals. Dyspnoea, recumbency, and the combination of dysphagia, dyspnoea, and recumbency can be considered as indicators of a poor prognosis in equids suffering from tetanus.

Outbreaks of tetanus in beef cattle and sheep in Brazil associated with disophenol injection

Outbreaks of tetanus, in which 297 beef cattle and 50 sheep were affected and died, were associated with the injection of a Clostridium tetani-contaminated anthelmintic (disophenol). The disease was observed on five farms in Rio Grande Sul, Brazil.

Thirteen cases of tetanus in dogs

The records of 13 dogs with tetanus were reviewed, 12 of the dogs survived and were discharged, but the other died as a result of the acute onset of hyperthermia. Long-term follow up was available for 10 of the survivors of which nine were reported to be normal. One case was euthanased after a cervical spine fracture four months after it was discharged. Complications encountered during management included aspiration pneumonia in three cases, urinary tract infection in two cases, and upper respiratory tract obstruction, hiatal hernia, coxofemoral luxation, seizures and respiratory arrest in one case each. None of the dogs required ventilatory support, and the complications were managed successfully. The dogs were nursed intensively and monitored carefully.

Retrospective Study of Tetanus in 20 Dogs: 1988–2004

The case records of 20 dogs that were treated for tetanus between 1988 and 2004 were reviewed. Young, large-breed dogs were most commonly affected. Twelve dogs had a likely source of infection identified. All dogs were treated with intravenous antibiotics and supportive care, such as muscle relaxants and sedation for muscle tremors and rigidity. Sixteen dogs received tetanus antitoxin. The mortality rate was 50%. Complete recovery in survivors required approximately 1 month.

Risk factors associated with outcome in dogs with tetanus: 38 cases (1987–2005)

OBJECTIVE

To assess the clinical course of disease and risk factors associated with outcome in dogs with tetanus.

DESIGN

Retrospective case series.

ANIMALS

38 dogs with tetanus.

PROCEDURES

Data were collected from medical records of dogs with tetanus, including signalment; wound characteristics; initial clinical signs; severity of worst clinical signs; time to wound management, antimicrobial treatment, and antitoxin administration; and 28-day survival rate. Statistical analyses were performed to evaluate relationships between the potentially predictive variables and disease progression and outcome.

RESULTS

The 28-day survival rate was 77% (among 35 uncensored dogs). The most common initial clinical signs in affected dogs were ocular (n = 18) and facial (11) abnormalities. Nineteen dogs progressed to recumbency with severe muscle spasms, and 14 dogs had high or low heart rate or blood pressure values. Eight dogs died or were euthanized because of complications of tetanus. There was a significant association between younger age and development of more severe clinical signs. Furthermore, a significant inverse relationship between development of severe clinical signs and survival was identified. There was no association between earlier initiation of wound management, antimicrobial administration, or antitoxin administration and either progression of signs or 28-day survival rate. Wound type was not associated with 28-day survival rate.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that younger dogs with tetanus may be more likely to develop severe clinical signs. The prognosis for survival in dogs with tetanus is good if abnormalities in heart rate or blood pressure values do not develop.

Tetanus antibody titers and duration of immunity to clinical tetanus infections in free-ranging rhesus monkeys (Macaca mulatta)

Prior to 1985 tetanus was a major cause of mortality in the free-ranging colony of rhesus monkeys on Cayo Santiago, accounting for almost a quarter of annual deaths. In 1985 and 1986 all animals (except infants) received primary and booster doses, respectively, of tetanus toxoid. In subsequent years primary immunizations were given to all yearlings, and boosters were administered to all 2-year-old animals during the annual capture of the colony. The main objectives of the tetanus immunization program were to reduce the pain and suffering caused by tetanus infections and to decrease mortality in the colony. Other objectives were to evaluate the efficacy of the two-dose tetanus toxoid immunization protocol and to determine whether additional boosters might be required to provide adequate long-term protection against tetanus infections. The immediate effect of the mass immunization program was the elimination of clinical tetanus infections in the population and a 42.2% reduction in the overall mortality rate. Since the immunization program began, no cases of tetanus have been observed in the colony, except in two unimmunized infants, and it has not been necessary to give tertiary injections of tetanus toxoid to maintain protection against infection. A sample collected in 2004 of the original cohort of monkeys immunized in 1985 and 1986 showed that 93.3% (14/15) had protective tetanus antibody titers (>0.01 IU/ml) at the ages of 20-23 years, which is close to the life expectancy of the Cayo Santiago rhesus macaques. Two intramuscular doses of tetanus toxoid provided long-term, if not lifelong, protection against tetanus for rhesus monkeys living in a tropical clime where tetanus is enzootic and the risk of infection is great.

Focal canine tetanus: diagnostic value of electromyography

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.

Immune responses to commercial equine vaccines against equine herpesvirus-1, equine influenza virus, eastern equine encephalomyelitis, and tetanus

Horses are commonly vaccinated to protect against pathogens which are responsible for diseases which are endemic within the general horse population, such as equine influenza virus (EIV) and equine herpesvirus-1 (EHV-1), and against a variety of diseases which are less common but which lead to greater morbidity and mortality, such as eastern equine encephalomyelitis virus (EEE) and tetanus. This study consisted of two trials which investigated the antigenicity of commercially available vaccines licensed in the USA to protect against EIV, EHV-1 respiratory disease, EHV-1 abortion, EEE and tetanus in horses. Trial I was conducted to compare serological responses to vaccines produced by three manufacturers against EIV, EHV-1 (respiratory disease), EEE, and tetanus given as multivalent preparations or as multiple vaccine courses. Trial II compared vaccines from two manufacturers licensed to protect against EHV-1 abortion, and measured EHV-1-specific interferon-gamma (IFN-gamma) mRNA production in addition to serological evidence of antigenicity. In Trial I significant differences were found between the antigenicity of different commercial vaccines that should be considered in product selection. It was difficult to identify vaccines that generate significant immune responses to respiratory viruses. The most dramatic differences in vaccine performance occurred in the case of the tetanus antigen. In Trial II both vaccines generated significant antibody responses and showed evidence of EHV-1-specific IFN-gamma mRNA responses. Overall there were wide variations in vaccine response, and the vaccines with the best responses were not produced by a single manufacturer. Differences in vaccine performance may have resulted from differences in antigen load and adjuvant formulation.

[Tetanus in cats: 3 case descriptions]

Three cats with spasticity on one leg or on all four limbs were presented between 1996 and 1998 at the Department of clinical veterinary medicine, Section of neurology, Vetsuisse-Faculty of Bern. The presumptive diagnosis was tetanus. A focal form was present in two cases and generalised tetanus in one cat. All cats had a history of injury at the affected legs respectively at the neck. The first clinical signs were seen between two days and three weeks after injury. The bacteriologic examination of serous fluid from the site of injury revealed an infection with Clostridium. EMG in one cat during anaesthesia showed motor united potentials (MUPs) on the spastic leg. All patients received antibiotics (Penicillin, respectively Amoxicillin/Clavulanic acid and Metronidazol). Supportive aid were initially sedation, wound revision and in one cat nutrition through oesophageal sonde. In a second phase physiotherapy was performed. All three animals were significantly better after a couple of weeks, two cats were without symptoms after eight and five weeks respectively.

Clostridial disease associated with neurologic signs: tetanus, botulism, and enterotoxemia

Clostridial infections are found worldwide in almost all species of animals and may involve a variety of body systems and present with a diversity of clinical signs. Most damage done through clostridial infections is due to the action of toxins released from the bacteria.Thus, disease caused by Clostridium spp should more correctly be called intoxication. Two prominent clostridial infections are associated with neurologic signs: Clostridium botulinum and C tetani. In both infections, the mechanism that is responsible for causing the problem is similar, despite the remarkable difference in clinical presentation. In addition, neurologic signs are described with C perfringens types C and D but are not the dominant feature of these diseases.

Tetanus in a camel (Camelus dromedarius)--a case report

Twenty days after an open castration, a 5-year-old dromedary was presented to the Dubai Camel Hospital with severe central nervous symptoms. The dromedary showed the following signs: off feed, stiff gait with extended neck, external swelling of the preputial sheath and groin region, and foamy saliva drooling from the mouth. The dromedary was unable to swallow. Three days after admission, the camel developed lockjaw, and on the fifth day it was unable to stand owing to paralysis of the hindquarters. Because of the severity of the disease and because it did not respond to treatment, the camel was euthanized 26 days after the operation and submitted to the Central Veterinary Research Laboratory for further investigation. Both castration wounds were closed and spermiducts were filled with necrotic masses from which Clostridium tetani was isolated. Two mice, which were injected with the filtrate of the thioglycolate broth, developed typical signs of tetanic spasm of the hind leg. Faecal samples from camel and horse paddocks that were only 50 metres apart were negative for C. tetani. However, C. tetani was isolated from two soil samples of the horse paddock. It is recommended that camels should be vaccinated against tetanus prior to castration.

Tetanus in the cat--an unusual presentation

Tetanus is rare in cats owing to their innate resistance. Clinical diagnosis may not be obvious in the early stages of the disease when characteristic signs of generalised tetanus are absent. However, the history of a penetrating/neglected wound and the presence of persistent involuntary muscle rigidity in a mentally alert animal should always lead to the suspicion of tetanus. Prompt diagnosis and treatment are the keys to a successful outcome.

Collaborative study for the establishment of two European Pharmacopoeia Biological Reference Preparations for serological potency testing of tetanus vaccines for veterinary use

The European Directorate for the Quality of Medicines (EDQM) has organised an international collaborative study, divided into two phases, aimed at producing and establishing two suitable reference sera for serological potency testing of tetanus vaccines for veterinary use for batch consistency demonstration. In phase I pools of sera were produced by immunising guinea pigs and rabbits with tetanus toxoid using the immunisation schedule prescribed by the European Pharmacopoeia (Ph. Eur.) for potency testing of tenanus vaccines for veterinary use. Following aliquoting and freeze-drying, characterization of the materials by immunochemical and biological assays enabled us to conclude that the sera should be suitable reference materials in respect of in-vitro assay methods for Clostridium (C.) tetani. The candidate (c) Ph. Eur. Biological Reference Preparations (BRP) were calibrated by Toxin Binding Inhibition test (ToBI) in phase II of the study by a large group of laboratories, including both manufacturers and official medicines control laboratories (OMCL). The activity of the proposed reference sera was determined by comparison with the existing equine monovalent World Health Organization (WHO) International Standard (IS). This study enabled us to provide a definitive value for the antitoxin activity of the reference preparations in respect of their anti-tetanus antibody content.

Presumed localized tetanus in two cats

In this report two cases of localised tetanus in two young (<1 year) intact male and outdoor DSH cats, which had been missing, are described. Clinical examination revealed severe muscular spasms on the right (case 1) or both thoracic limbs (case 2). In the latter cat, wrinkling of the forehead and mild trismus were also seen. The routine diagnostic workup (CBC, survey radiographs of the spine, CSF analysis) did not reveal any abnormalities in both cats. EMG testing on the affected muscles in the second animal showed persistent spontaneous motor unit potentials, strongly indicating tetanus. The treatment, that was symptomatic (diazepam, metronidazole) and supportive (physical therapy, assist feeding and intravenous fluid therapy) resulted in the progressive improvement of limb rigidity and the restoration of motor dysfunction in a period of 5- (case 1) and 2- (case 2) month duration.

Effect of transcutaneous immunization with co-administered antigen and cholera toxin on systemic and mucosal antibody responses in sheep

Direct application of antigens to skin together with an adjuvant, a procedure called transcutaneous immunization (TCI), can induce systemic immune responses in mice, humans, cats and dogs. In previous studies we found that cholera toxin (CT) applied topically on unbroken skin induces systemic antibody and lymphocyte proliferative responses in sheep. The current study examined whether concurrent administration of CT and tetanus toxoid (TT) delivered transcutaneously could induce specific antibody responses to both antigens in sheep. Antibodies to both TT and CT were induced by TCI although antibody titres in serum to TT were higher in sheep receiving TT plus alum by intramuscular injection (n=5) than TT plus CT by TCI (n=5). The ratio of IgG1/IgG2 antibody to TT in serum was near unity, and the route of immunization, TCI versus injection, did not influence this ratio. In contrast, the ratio of IgG1/IgG2 antibody differed significantly between the two antigens, TT and CT, delivered by TCI, with a higher proportion of IgG1 antibody in serum to CT than TT. Antibody to TT was detected in lung washes from TCI and injection groups, with IgG1 predominating over IgG2 in both groups. IgA antibodies to CT and TT were detected in sera of CT and TT-immunized groups respectively but in lung washes IgA antibody to TT was detected only in the injection group. Results show that TCI induced systemic antibody responses to CT and the co-administered antigen TT, whereas no evidence was obtained for mucosal IgA responses following TCI.

Evaluation of IgG concentration and IgG subisotypes in foals with complete or partial failure of passive transfer after administration of intravenous serum or plasma

The purpose of this study was to evaluate the ability of an equine plasma product i.v. and a concentrated serum product i.v. to deliver antibodies to 46 foals with failure of passive transfer (FPT). Treatment of FPT was as per manufacturers recommendations, using plasma (950 ml/unit) or a concentrated serum product (250 ml/unit). Significant variables affecting the 3 day post-transfusion serum immunoglobulin G (IgG) concentration of foals included body weight, pretransfusion IgG concentration, number of product units transfused, foaling season and product administered. Plasma treatment had a greater increase in post-transfusion serum IgG concentrations compared to the serum product treatment mainly because plasma contained approximately twice the amount of IgG per unit as the serum product. The change in equine influenza virus and tetanus toxoid-specific IgGa, IgGb, and IgG(T) titres was measured in foals from pretransfusion to 3 days post-transfusion. For each gram of IgG transfused, the change in antigen-specific IgG subisotypes were similar for both treatment groups. The results of this study suggest that similar foal serum IgG concentrations can be achieved 3 days post-transfusion by administering 1 unit of plasma or 2-3 units of serum product.

Passive transfer of maternal immunoglobulin isotype antibodies against tetanus and influenza and their effect on the response of foals to vaccination

Influenza and tetanus-specific antibodies of the IgG sub-isotypes are posively transferred to foals via colostrum and inhibit their response to inactivated influenza vaccines and tetanus toxoid. High titres of influenza antibodies of IgGa and IgGb subisotypes and tetanus antibodies of the IgGa, IgGb and IgG(T) subisotypes were detected in postsucking serum samples collected from foals born to mares that had received booster doses of multicomponent vaccines during the last 2 months of gestation. Thereafter, titres declined in an exponential manner but were still detectable in all foals at age 26 weeks, regardless of whether they had been vaccinated prior to age 26 weeks. Mean +/- s.e. half-life of decline of influenza IgGa antibodies (27.0 +/- 2.3 days) was significantly shorter than that of influenza IgGb antibodies (39.1 +/- 2.7 days; P<0.005). Tetanus IgGa and IgGb antibodies declined with half-lives of 28.8 +/- 3.0 and 34.8 +/- 5.1 days, respectively. Titres of tetanus IgG(T) antibodies were substantially higher than those of influenza IgG(T) antibodies in postsucking samples and remained so through age 26 weeks, declining with a half-life of approximately 35 days. Postsucking titres of tetanus and influenza antibodies of the IgA isotype were low and declined rapidly to undetectable levels. Yearlings showed significant increases in titre of influenza IgGa, IgGb and IgG(T) subisotype antibodies but no increase in influenza IgA antibodies in response to 2 doses of multicomponent vaccines containing tetanus toxoid and inactivated influenza A-1 and A-2 antigens. Yearlings also showed strong tetanus IgGa, IgGb and IgG(T) subisotype responses to one dose of vaccine and a substantial further rise in titre in response to administration of a second dose 3 weeks later, but failed to show an increase in titre of tetanus IgA antibodies. The influenza and tetanus IgGa, IgGb and IgG(T) subisotype responses of 6-month-old foals to vaccination followed the same pattern as those shown by yearlings but titres were generally lower. In contrast, 3-month-old foals failed to show increases in titre of either influenza or tetanus IgG subisotypes in response to 2 doses of vaccine and generally needed 1-3 additional booster doses of vaccine to achieve titres similar to those achieved by yearlings after 2 doses. Based on the finding that maternal antibodies exert a significant inhibitory effect on the response of foals to tetanus toxoid and inactivated influenza antigens, it is recommended that primary immunisation of foals born to vaccinated mares should not commence before age 6 months.

Tetanus in the horse: a review of 20 cases (1970 to 1990)

The case records of 20 horses with tetanus referred to the Ontario Veterinary College-Veterinary Teaching Hospital between 1970 and 1990 were reviewed. The fatality rate was 75%. There was a strong association with previous vaccination and survival (P = .03). Most of the animals had been injured an average of 9 days (range 2 to 21 days) prior to development of clinical signs. Hyperesthesia and prolapse of the third eyelid were the most common clinical signs. Treatment regimens varied during hospitalization; however, all horses received parenteral penicillin, tranquilizers, tetanus toxoid, and antitoxin. Five of the nonsurviving animals were given intrathecal tetanus antitoxin. One animal had seizures as a complication of intrathecal treatment. The prognosis was best for horses that (1) had been vaccinated prior to the injury, (2) responded to the phenothiazine tranquilizers, and (3) did not rapidly (over 24 to 48 hours) become recumbent. Considering the species susceptibility, potential for contaminated wounds, and the increased survival of vaccinated horses, yearly revaccination is recommended.

Esophageal hiatal hernia and megaesophagus complicating tetanus in two dogs

Two dogs with tetanus developed transient megaesophagus and hiatal hernia associated with gastroesophageal reflux and regurgitation. The megaesophagus and hiatal hernia were diagnosed radiographically and resolved with resolution of the tetanus. These 2 cases, plus previously reported cases, indicate that tetanus can cause megaesophagus and esophageal dysfunction. Therefore, thoracic radiography should be included as part of the diagnostic evaluation of dogs suspected of having tetanus.

Electrocardiographic abnormalities associated with tetanus in two dogs

Bradycardia, sinus arrest, and second-degree atrioventricular block developed in 2 dogs with tetanus. Clinical signs attributable to bradycardia were not apparent. Administration of atropine resulted in resolution of the arrhythmias. Both dogs responded well to supportive treatment; the bradycardia resolved within 4 days of onset without specific treatment. Tetanus should be included in the differential diagnosis when increased neuromuscular excitability and bradycardia are evident, as is found in toxicity with acetylcholinesterase inhibitors, increased intracranial pressure, and other neurologic disorders.