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Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Tetanus is an acute, often-fatal disease of the nervous system that is caused by nerve toxins produced by the bacterium Clostridium tetani. This bacterium is found throughout the world in the soil and in animal and human intestines.
Contaminated wounds are the sites where tetanus bacteria multiply. Deep wounds or those with devitalized (dead) tissue are particularly prone to tetanus infection.
Puncture wounds, such as those caused by nails, splinters, or insect bites, are favorite locations of entry for the bacteria. The bacteria can also be introduced through burns, any break in the skin, and injection-drug sites. Tetanus can also be a hazard to both the mother and newborn child (by means of the uterus after delivery and through the umbilical cord stump).
The potent toxin that is produced when the tetanus bacteria multiply is the major cause of harm in this disease.
The tetanus toxin affects the site of interaction between the nerve and the muscle that it stimulates. This region is called the neuromuscular junction. The tetanus toxin amplifies the chemical signal from the nerve to the muscle, which causes the muscles to tighten up in a continuous ("tetanic" or "tonic") contraction or spasm. This results in either localized or generalized muscle spasms. Tetanus toxin can affect neonates to cause muscle spasms, inability to nurse, and seizures. This typically occurs within the first two weeks after birth and can be associated with poor sanitation methods in caring for the umbilical cord stump of the neonate. Of note, because of tetanus vaccination programs, there have only be a few cases of neonatal tetanus reported in the U.S. since 1990, and in each of these cases, the mothers were incompletely immunized. Worldwide, however, neonatal tetanus is still, unfortunately, common.
The incubation period between exposure to the bacteria in a contaminated wound and development of the initial symptoms of tetanus ranges from two days to two months, but it's commonly within 14 days of injury.
During a one- to seven-day period, progressive muscle spasms caused by the tetanus toxin in the immediate wound area may progress to involve the entire body in a set of continuous muscle contractions. Restlessness, headache, and irritability are common.
The tetanus neurotoxin causes the muscles to tighten up into a continuous ("tetanic" or "tonic") contraction or spasm. The jaw is "locked" by muscle spasms, giving the name "lockjaw" (also called "trismus"). Muscles throughout the body are affected, including the vital muscles necessary for normal breathing. When the breathing muscles lose their power, breathing becomes difficult or impossible and death can occur without life-support measures. Even with breathing support, infections of the airways within the lungs can lead to death.
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