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Am. J. Trop. Med. Hyg., 80(5), 2009, pp. 827-831
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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Microbiologic Characterization and Antimicrobial Susceptibility of Clostridium tetani Isolated from Wounds of Patients with Clinically Diagnosed Tetanus

James I. Campbell, Lam Thi Minh Yen, Huynh Thi Loan, To So Diep, Tran Thi Thu Nga, Nguyen Van Minh Hoang, Le Thanh Son, Nguyen van Vinh Chau, Christopher Parry, Jeremy J. Farrar, Tran Tinh Hien, AND Stephen Baker*
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine, Department of Clinical Medicine University of Oxford, Oxford, United Kingdom; Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam; University of Liverpool, Liverpool, United Kingdom

Clostridium tetani is the etiologic agent of the muscle-spasming disease tetanus. Despite an effective vaccine, tetanus is an ongoing problem in some developing countries. Diagnosis by bacterial culture is not done because it is generally unnecessary and the entry of route of the bacteria can be inapparent. We attempted to isolate and evaluate C. tetani from the wounds of 84 patients with tetanus. We effectively isolated C. tetani from 45 patients. All strains tested positive by polymerase chain reaction for the gene encoding tetanus neurotoxin. Antimicrobial susceptibilities were determined by disc diffusion and E-test. All C. tetani isolates were susceptible to penicillin and metronidazole but resistant to co-trimoxazole. Despite treatment with high doses of penicillin, C. tetani was isolated after 16 days of intravenous penicillin in two cases. These data show that the intravenous route for penicillin may be inadequate for clearing the infection and emphasizes wound debridement in the treatment of tetanus.

Received November 12, 2008. Accepted for publication January 18, 2009.

Acknowledgments: The authors wish to acknowledge the efforts of all the Medical and Nursing staff of the Tetanus Intensive Care Unit of the Hospital of Tropical Diseases. They also thank the laboratory staff of the Microbiology Department, in particular, Son Chau for production of media.

Financial support: This work was funded by the Wellcome Trust, London, UK.

* Address correspondence to Stephen Baker, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Viet Nam. E-mail: sbaker{at}oucru.org

Authors’ addresses: James I. Campbell, Jeremy J. Farrar, and Stephen Baker, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam and Centre for Tropical Medicine, Department of Clinical Medicine University of Oxford, Oxford, United Kingdom. Lam Thi Minh Yen, Huynh Thi Loan, To So Diep, Tran Thi Thu Nga, Nguyen Van Minh Hoang, Le Thanh Son, Nguyen van Vinh Chau, and Tran Tinh Hien, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam. Christopher Parry, University of Liverpool, Liverpool, United Kingdom.






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