Disease Summary

Alternative Names (Synonyms)

Disease Type

Infectious/Non-Infectious Agent associated with the Disease

• Clostridium tetani produces two toxins: (B88)
  • Tetanolysin has no known pathogenic significance. (B88)
  • Tetanus toxin is a protein neurotoxin that causes toxaemia and clinical signs. (B88)

Infective "Taxa"

• Clostridium tetani  - Clostridium

Non-infective agents

Physical agents

References

Disease Author

Major References / Reviews

Code and Title List

Elephants:

B10.49.w21, B16.18.w18, B64.27.w4, B214.3.7.w3, B336.53.w53
P5.39.w1

Elephas maximus - Asian Elephant

• B212.w41, B214.3.7.w3
• J2.6.w2, J351.32.w1, J352.27.w1
• P64.1.w3, P501.1.w2, P502.1.w5

Loxodonta africana - African Elephant

• B453.7.w7

Other References

Code and Title List

• B450.17.w17
• D301.3.w3

Detailed Clinical and Pathological Characteristics

• Germination of Clostridium tetani spores requires a suitable anaerobic environment, such as necrotic tissue in deep penetrating wounds, to proliferate and release the neurotoxin that diffuses through the vascular vessels and peripheral nerves to the CNS causing the characteristic tetanic tonic-clonic convulsions. (B88, B101, B283)

Clinical Characteristics

• Early signs are stiffness, muscular tremors and hyperexcitability. (B88)
• Stiff gait. (J2.6.w2)
• Tonic-clonic convulsions. (B88)
• Hyperesthesia. (B101)
• Difficulty in prehension and swallowing. (B101)
• Pyrexia. (B101)
• Death due to respiratory arrest. (B88)

• Stiff gait. (J2.6.w2)
• Hypersensitivity to sound. (J351.32.w1, J352.27.w1)
• Inability to open mouth (strong contraction of the muscles of mastication). (B214.3.7.w3, J2.6.w2, J351.32.w1, J352.27.w1, P502.1.w5)
  • "Locked jaw", either partial or complete, with  inability to drink or swallow salivation. (P64.1.w3, P502.1.w5)
  • "Jaws tightly closed". (J351.32.w1, J352.27.w1)
  • Strong contraction of mastication muscles. (B214.3.7.w3)
• Impaired appetite. (P64.1.w3)
• Inability to feed and swallow. (J2.6.w2, P502.1.w5)
• Inability to feed, but on the second day able to swallow water given slowly into the mouth. (J352.27.w1)
• Enophthalmus. (J2.6.w2)
• Third eyelid prolapse. (J351.32.w1, J352.27.w1)
• Weak movements of the trunk. (J2.6.w2)
• Stiff limbs and jerky movements. (P64.1.w3)
• Development of a stiff gait and difficulty in moving. (P502.1.w5)
• Tonic spasms. (J2.6.w2, J351.32.w1, J352.27.w1, P502.1.w5)
  • These affected the whole body. (P502.1.w5)
• Pyrexia. (J2.6.w2)
• Oedematous limbs. (J2.6.w2, J351.32.w1, J352.27.w1)
• Recumbency. (J2.6.w2)
  • Falling and prostration terminally. (P502.1.w5)
• Death. (J2.6.w2, P502.1.w5)

A description is available in Elephants and their Diseases- A Treatise on Elephants - Part V - Chapter VIII - Rabies. Tetanus. Tuberculosis. Full text included.

Incubation

• Incubation period varies from one to several weeks. (B101)
• Average incubation is 10-14 days. (B101) 

• An elephant was reported to be lame on the right fore limb for about one week before the clinical signs of tetanus developed. On post mortem examination it was confirmed that the right fore foot contained a penetrating metallic foreign body wound, surrounded by necrotic tissue and considered the probable source of infection. (J2.6.w2) 

Mortality / Morbidity

• Mortality is at least 50%. (B88)
• Highest mortality rates are recorded in juvenile animals. (B88)

• Tetanus is rare in elephants. (B212.w41)
• Tetanus is usually fatal in elephants. (B214.3.7.w3)
• Of two specific cases reported in the early literature, one animal died and the other survived. (J2.6.w2, J351.32.w1, J352.27.w1)
• In five cases in Kerala, India, all were fatal. (P502.1.w5)
• Seven of eight recorded cases fatal. (P64.1.w3)

Pathology

• Note: Tetanus does not itself produce specific gross or histopathological lesions. (J2.6.w2)

• In one elephant, the foot contained a penetrating wound caused by a metallic foreign body, with surrounding tissue necrosis. (J2.6.w2)

Human Health Considerations

Disease has been reported in either the wild or in captivity in:

• An approximately eight-year-old elephant was reported to suffer tetanus in a New York Zoological Park. (J351.32.w1, J352.27.w1)
• An eight-year-old elephant. (B214.3.7.w3)
• A privately owned five-year-old female elephant was reported to suffer tetanus in United States. (J2.6.w2)
• Five working elephants in Kerala, India. (P502.1.w5)
• Eight elephants. (P64.1.w3)

Loxodonta africana - African Elephant

• The disease occurs rarely in Loxodonta africana - African Elephant. (B453.7.w7)

Further information on Host species has only been incorporated for  species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Host species with further information available are listed below:

Host Species List

• Elephants (Elephantidae - Elephants (Family))
• Elephas maximus - Asian Elephant
• Loxodonta africana - African Elephant

(List does not contain all other species groups affected by this disease)

Disease has been specifically reported in Free-ranging populations of:

• The disease occurs rarely in Loxodonta africana - African Elephant. (B453.7.w7)

Further information on Host species has only been incorporated for  species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Host species with further information available are listed below:

Host Species List

• Loxodonta africana - African Elephant

(List does not contain all other species groups affected by this disease)

General Information on Environmental Factors/Events and Seasonality

• Clostridium tetani is found worldwide in soil and is a common transient in the intestines. (B88, B101)

Regions / Countries where the Infectious Agent or Disease has been recorded

• In elephants: United States. (J2.6.w2, J351.32.w1, J352.27.w1)

Regions / Countries where the Infectious Agent or Disease has been recorded in Free-ranging populations

• --

General Information on Investigation / Diagnosis

• Clinical signs, post mortem examination findings. (B101)
• Isolation of Clostridium tetani from wound exudates. (B88)
• Tetanus toxin PCR can be used to support the demonstration of Clostridium tetani isolation. (B88)

• Clinical signs, post mortem examination findings. (J2.6.w2, J351.32.w1, J352.27.w1)
  • Clinical signs in association with the presence of an appropriate wound allowed presumptive diagnosis. (J2.6.w2)
• Slender Gram-positive bacilli detected in direct smears of wound exudate. (J2.6.w2)
  • Aerobic and anaerobic culture from the infected wound was attempted but Gram-negative bacilli overgrew the cultures. (J2.6.w2)

• History & Documentation
• Physical Examination of Mammals
• Environmental Assessment
• Necropsy of Mammals
• Chapter 2 - B36 Field Manual of Wildlife Diseases - Specimen Collection and Preservation
• Chapter 3 - B36 Field Manual of Wildlife Diseases - Specimen shipment
• Appendix A - B36 Field Manual of Wildlife Diseases - Sample specimen history form

Similar Diseases (Differential Diagnosis)

• Cardiac Glycoside Toxicity in Elephants
• Rabies (with special reference to Waterfowl, Hedgehogs and Elephants)
• Tutu (Coriaria arborea) Toxicity in Elephants
• Varagu (Paspalum scrobiculatum) Toxicity in Elephants

Note: The risk of tetanus should be considered with Foot Wounds in Elephants

Specific Medical Treatment

• Treatment aims are:
  • to neutralise circulating tetanus toxin by an adequate dose of antitoxin. (B88, B101)
  • to suppress toxin production and release by use of parental penicillin or metronidazole and wound disinfection. (B88, B101)

• Tetanus antitoxin, 30,000 units intravenously, was given to a five-year-old elephant, repeated after six and twelve hours. (J2.6.w2)
• Procaine penicillin intramuscularly was given daily from the day that the first signs were noticed. Later, after the wound was discovered, chloramphenicol was given also. (J2.6.w2)
• Tetanus antitoxin subcutaneously, 100,000 units on the first day of clinical signs, 120,000 units on the second day, 60,000 units on the third day and 80,000 units on the fourth day were given to an eight-year-old elephant. (J351.32.w1, J352.27.w1)
• In a study population of 196 elephants, tetanus antitoxin was given in ten cases of abscesses. (B450.17.w17)
• Crystalline penicillin intramuscularly and antitetanus serum has been used unsuccessfully. (P502.1.w5)
  • Additional treatment with tetanus immunoglobulin 2,500 mg intravenously was also unsuccessful. (P502.1.w5)
• Chloramphenicol 8 g added to fluids was given intravenously over a period of six hours. (J2.6.w2)
• Antitetanus serum (2.5 lakhs units) and crystalline penicillin (450 lakhs units) were given in an elephant which survived. (P64.1.w3)

• Treatment and Care - General
• Medicating Elephants
• Intramuscular Injection of Elephants
• Intravenous Injection of Elephants
• Subcutaneous Injection in Elephants

General Nursing and Surgical Techniques

• Supportive treatment  includes fluid therapy and/or stomach tube feeding, sedatives and muscle relaxants and exclusion of external stimuli. (B88, B101)

• Fluid therapy: 2.5% dextrose in 0.45% saline, with sodium bicarbonate at 300 mEq per gallon. (J2.6.w2)
• Electrolytes and dextrose 15-25 liters intravenously. (P502.1.w5)
• Anaesthesia using chloral hydrate, 2 ounces/60 g of a 7% solution given rectally as a treatment for tetanic spasms, and a further 4 ounces given when spasms recurred. (B214.3.7.w3, J351.32.w1, J352.27.w1)
• Diazepam 400-800 mg intramuscularly to adult elephants. (P502.1.w5)
• Promazine hydrochloride 900 mg was given intravenously and resulted in slight relaxation of the jaws but the elephant was still dysphagic. (J2.6.w2)
• Antiinflammatory treatment for the wound: dipyrone 7.5 g added to fluids given intravenously over a period of six hours. (J2.6.w2)
• Dexamethasone 40 mg. (J2.6.w2)
• Wound cleaning with hydrogen peroxide. (J2.6.w2)
• Supportive treatment included hand feeding, tube feeding, and hoisting and slinging.
• Diazepam 250 mg, intravenous electrolytes and glucose, repeated the following day, in one elephant which survived. (P64.1.w3)

• Treatment and Care - General
• Medicating Elephants
• Intramuscular Injection of Elephants
• Intravenous Injection of Elephants

Preventative Measures

• Vaccination is available for elephants. (B10.49.w21)
• Use of annual boosters has been reported, however the level and duration of protection requires further research. (B336.53.w53) 

• Wounds should be properly cleaned. (B88, B101)

• If a penetrating foreign body in the sole has been diagnosed from radiography, an opening must be made with a hoof knife under sedation to remove the foreign body  and drain the wound. In such cases, 1,500 IU of tetanus antitoxin subcutaneously should be given for short-term protection. (J4.171.w5)

• Ensure hygienic conditions during surgical procedures. (B88, B101) 

• --

Environmental and Population Control Measures

ELEPHANTS

• General hygienic housing conditions. (B64.27.w4)
• Appropriate foot care. (B64.27.w4)

• Environmental and Population Management - General
• Environmental Assessment