The role of the gastrointestinal tract in toxigenic Clostridium tetani infection: A case-control study

Nguyen van Hao, Nguyen Ngoc My Huyen, Nguyen Thi Han Ny, Vo Thi Nhu Trang, Nguyen van Minh Hoang, Duong Bich Thuy, Nguyen Thanh Nguyen, Pham Thi Lieu, Ha Thi Hai Duong, Tran Thi Diem Thuy, Phung Tran Huy Nhat, Dong Thi Hoai Tam, Maciej F. Boni, Lam Minh Yen, Le van Tan, Tran Tan Thanh, James Campbell, C. Louise Thwaites

Research output: Contribution to journalArticlepeer-review


Tetanus arises from wound contamination with Clostridium tetani, but approximately one fifth of patients have no discernable entry wound. Clostridium tetani is culturable from animal feces, suggesting the gastrointestinal tract could be an endogenous reservoir or direct-entry portal, but human data are lacking. In this study of 101 Vietnamese adults with tetanus and 29 hospitalized control subjects, admission stool samples were cultured for C. tetani. Anti-tetanus toxin antibodies were measured by ELISA. Clostridium tetani toxigenicity was evaluated using polymerase chain reaction and sequencing. Toxigenic C. tetani was cultured from stool samples in 50 of 100 (50%) tetanus cases and 12 of 28 (42.9%) control subjects (P 5 0.50), and stool samples of 44 of 85 (52.4%) tetanus cases with clinically identified wounds compared with 6 of 15 (47.6%) patients without clinically identified wounds (P 5 0.28). Nine of 12 (75%) control subjects with toxigenic C. tetani in their stool samples lacked protective antibody concentrations. These findings fail to show evidence of an association between gastrointestinal C. tetani and tetanus infection, but emphasize the importance of increasing vaccination coverage.

Original languageEnglish (US)
Pages (from-to)494-497
Number of pages4
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number2
StatePublished - Aug 2021

All Science Journal Classification (ASJC) codes

  • Parasitology
  • Virology
  • Infectious Diseases


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