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I know that Cl tetani is not invasive and strictly localised. I think toxemia means spread in the blood. I am thinking this sentence

The volume of infected tissue is small, and the disease is almost entirely a toxemia.

Cl tetani has spores. This suggests me that these spores spread through blood. They then open and become pathogenic in some tissues where they remain strictly locally (so small area/volume of infected tissue; I think area is better word, since the disease is not invasive) and pathogenic.

How do you understand the quoted sentence about pathogenesis of Cl tetani?

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up vote 5 down vote accepted

Clostridium tetani produces a protein toxin, tetanospasmin which causes the major symptom of tetanus, namely involuntary muscle spasms. C. tetani is an aerobic species, does not infect the blood, and apparently only produces toxin in anaerobic conditions.

If a pathogenic bacterium propagates through the bloodstream this condition is referred to as bacteraemia. In the case of C. tetani it is the toxin which enters the bloodstream, not the bacteria, hence toxaemia. The bacteria, being anaerobic, are inhibited from spreading through aerobic tissues.

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