Tetanus is caused by clostridium tetani - an anaerobic, flagellated, exotoxin-secreting, Gram-positive bacillus that forms a characteristic terminal spore ('drumstick').
It produces a powerful exotoxin - tetanospasmin - which acts on the motor cells in the CNS and which is probably conveyed along the peripheral nerves directed from the affected part.
Often, progress to clinical tetanus may seem unrelated to the degree of the initial insult; thus an extensive injury which has received early and adequate wound toilet is far less at risk than a contaminated puncture wound which has been neglected.
In primitive communities, where dung is used to dress the umbilical cord in the newborn, tetanus neonatorum may occur.
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