[CW: Firsthand account includes description of the death of an infant. Skip approximately first 3 minutes to avoid.]
What comes to mind when you hear the word tetanus? For many people, it’s probably the horrible thought of stepping on a rusty nail or the every-so-often Tdap booster you get at your doctor’s office. Thanks to the wide availability of this incredibly effective vaccine, not many of us have an image of what an infection with tetanus actually looks like or how deadly it can be. But that’s not the case everywhere, especially in places with limited access to these life-saving vaccines. In this episode, we take you through the biology of the spore-forming, soil-dwelling, obligately anaerobic, Gram positive Clostridium tetani and the powerful paralytic neurotoxins it produces. We then venture into the history of this pathogen, a history that includes a tour through early medical texts and a discussion of the origins of epidemiology as viewed through the context of neonatal tetanus in the American South. We round out the episode by reviewing where tetanus still poses a substantial threat today and highlighting some very exciting ways this deadly pathogen may be used to treat cancer! Tune in to gain a newfound respect for this incredible microbe!
| History | Biology |
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| Chapeton-Montes, Diana, et al. “The population structure of Clostridium tetani deduced from its pan-genome.” Scientific reports 9.1 (2019): 1-11. | Cook, T.M., Protheroe, R.T. and Handel, J.M., 2001. Tetanus: a review of the literature. British Journal of Anaesthesia, 87(3), pp.477-487. |
| Cohen, Jonathan E., et al. “Comparative pathogenomics of Clostridium tetani.” PloS one 12.8 (2017): e0182909. | Dong, M., Masuyer, G. and Stenmark, P., 2019. Botulinum and tetanus neurotoxins. Annual review of biochemistry, 88, pp.811-837. |
| Coleman, George E. “Investigating Tetanus (Lockjaw).” The Scientific Monthly 31.6 (1930): 560-564. | Blencowe, H., Lawn, J., Vandelaer, J., Roper, M. and Cousens, S., 2010. Tetanus toxoid immunization to reduce mortality from neonatal tetanus. International journal of epidemiology, 39(suppl_1), pp.i102-i109. |
| Dong, Min, Geoffrey Masuyer, and Pål Stenmark. “Botulinum and tetanus neurotoxins.” Annual review of biochemistry 88 (2019): 811-837. | Roper, M.H., Vandelaer, J.H. and Gasse, F.L., 2007. Maternal and neonatal tetanus. The Lancet, 370(9603), pp.1947-1959. |
| Douvoyiannis, Miltiadis, Peter F. Belamarich, and David L. Goldman. “Tetanus After Vaccine Refusal and an Opportunity for the Pediatric Infectious Diseases Specialist.” Clinical Pediatrics 54.6 (2015): 513-516. | World Health Organization, 2018. The immunological basis for immunization series: module 3: tetanus. |
| Harrinson, I. “Case of Tetanus Infantum.” British Medical Journal 1.159 (1860): 27. | Blain, A., Tiwari, T., 2020. Manual for the surveillance of vaccine-preventable diseases. Chapter 16: Tetanus. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.html |
| Huber, John B. “Tetanus and the Glorious Fourth.” Scientific American 101.1 (1909): 8-8. | WHO 2021. Fact Sheet Immunization Coverage. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage |
| Kantha, Sachi Sri. “A centennial review; the 1890 tetanus antitoxin paper of von Behring and Kitasato and the related developments.” The Keio journal of medicine 40.1 (1991): 35-39. | Selvanesan, B.C., Chandra, D., Quispe-Tintaya, W., Jahangir, A., Patel, A., Meena, K., Alves Da Silva, R.A., Friedman, M., Gabor, L., Khouri, O. and Libutti, S.K., 2022. Listeria delivers tetanus toxoid protein to pancreatic tumors and induces cancer cell death in mice. Science Translational Medicine, 14(637), p.eabc1600. |
| Mansfield, Michael J., and Andrew C. Doxey. “Genomic insights into the evolution and ecology of botulinum neurotoxins.” Pathogens and disease 76.4 (2018): fty040. | |
| McMillen, Sally G. ““No Uncommon Disease”: Neonatal Tetanus, Slave Infants, and the Southern Medical Profession.” Journal of the history of medicine and allied sciences 46.3 (1991): 291-314. | |
| Mellanby, Jane, and Jane Green. “How does tetanus toxin act?.” Neuroscience 6.3 (1981): 281-300. | |
| Pappas, Georgios, Ismene J. Kiriaze, and Matthew E. Falagas. “Insights into infectious disease in the era of Hippocrates.” International journal of infectious diseases 12.4 (2008): 347-350. | |
| Pearce, J. M. “Notes on tetanus (lockjaw).” Journal of Neurology, Neurosurgery, and Psychiatry 60.3 (1996): 332. | |
| Popoff, Michel. “From saprophytic to toxigenic clostridia, a complex evolution based on multiple diverse genetic transfers and/or rearrangements.” Research in Microbiology 166.4 (2015): 221-224. | |
| Singh, Bal Ram, Bilian Li, and Dorothy Read. “Botulinum versus tetanus neurotoxins: why is botulinum neurotoxin but not tetanus neurotoxin a food poison?.” Toxicon 33.12 (1995): 1541-1547. | |
| von Behring, Emil, and Sbibasaburo Kitasato. “The mechanism of immunity in animals to diphtheria and tetanus.” Deutsche Med. Wochenschr (1890). | |
| Wilkins, C. A., et al. “Occurrence of Clostridium tetani in soil and horses.” South African Medical Journal= Suid-afrikaanse Tydskrif vir Geneeskunde 73.12 (1988): 718-720. | |
| Wolfe, Nathan D., Claire Panosian Dunavan, and Jared Diamond. “Origins of major human infectious diseases.” Nature 447.7142 (2007): 279-283. |
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