Tetanus

Tetanus: Overview

Alternative names: Tetanus is often also referred to as “lockjaw”.

Tetanus is a bacterial infection that spreads through the body and affects the central nervous system.  It causes painful muscle contractions, in most cases affecting the jaw and neck, which is why it is also called "Lockjaw".

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Tetanus used to be a common cause of death, but is now seldom seen because of antibiotic treatment and vaccinations.

Less commonly, the disease may take a milder form known as 'Local Tetanus', involving muscle contractions that occur only in the area around a wound.

The rarest form is 'Cephalic Tetanus', which affects only the head and usually occurs after head trauma (wounds, skull fracture, dental procedures, eye injury, ear infection, etc.)

Incidence; Causes and Development; Contributing Risk Factors

Since 1947, cases of tetanus in the United States have been reduced by more than 95% and tetanus-related deaths by up to 99%.  This reduction came as a result of the continued use of the tetanus antitoxin for wound treatments and the joint use of tetanus vaccines since the 1930s and 1940s.  The disease almost always occurs in those who have not been properly immunized.

However, infections still happen to this day and the disease has not been completely eradicated.  People of all ages can be infected by this bacterial disease but it can be particularly serious in newborn babies when an unvaccinated mother becomes infected.  According to the WHO it is estimated that about 49,000 newborn children were killed by neonatal Tetanus in 2013.

Tetanus is caused by Clostridium tetani bacteria which are able to survive as spores outside of a host for very long periods of time.  Although they are most commonly found in animal manure, contaminated soil, dust, and saliva, they can be present on just about any surface.

Tetanus bacteria and/or spores can gain entry into the body through any type of skin puncture or wound.  Examples include:

  • Burns
  • Contaminated wounds
  • Wounds that contain dead tissue
  • Crush injuries
  • Surgery
  • Superficial wounds
  • Insect bites
  • Intravenous drug use or other injections
  • A serious fracture in which the bone is exposed to infection

When Clostridium tetani enters the body, it multiplies at a rapid rate inside deep wounds or dead tissue and releases tetanospasmin – a very potent neurotoxin.  Once this neurotoxin reaches the bloodstream, the whole body is affected and tetanus symptoms start to be observed.

Muscle spasms and stiffness occur due to interference by tetanospasmin with the signals between the brain and the nerves in the spinal cord.

There are certain risk factors that can increase your likelihood of getting Tetanus, such as:

  • Failure to have vaccinations or booster shots
  • A wound coming into contact with manure or soil
  • Not cleaning wounds properly
  • Necessary surgical intervention being delayed for more than 6 hours
  • Large areas of tissue being removed
  • Punctures from rusty objects (e.g. nails) that provide a habitat for bacteria

Signs and Symptoms

Symptoms usually occur within 14 days of exposure to the bacteria through a wound, at which point symptoms become apparent.  However, this incubation period can range from 2 days to 2 months; the further the infected wound is from the central nervous system, the longer the incubation period will be.

The most serious symptom of Tetanus is painful muscle spasms that usually begin in the jaw (hence the name "lockjaw") and then progress to the rest of the body.  These spasms can cause difficulty swallowing and/or breathing.  Spasms usually last for a few minutes, occur frequently for 3 to 4 weeks, and can be so severe as to cause bone fractures and muscle tears.

Other possible symptoms include:

  • Fever
  • Sweating
  • Headaches
  • Irritability
  • Bloody stools
  • Diarrhea
  • Sensitivity to touch
  • Sore throat and swallowing difficulty
  • Difficulty breathing / suffocation
  • High blood pressure
  • Rapid and/or irregular heartbeat
  • Uncontrolled urination and/or bowel movements

Diagnosis and Tests

Diagnosis of Tetanus involves asking the patient about their recent history of injury (such as stepping on a nail that caused a deep skin puncture) and looking for the presence of symptoms such as lockjaw, muscle spasms, and fever.  Laboratory tests are generally not helpful for diagnosing Tetanus.

One test that has a high success rate in detecting Tetanus without false-positive results, is the 'spatula test': the doctor will touch the back of the throat with a soft-tipped

Due to the relative rarity of the variants Local Tetanus and Cephalic Tetanus, these are often misdiagnosed.

Treatment and Prevention

Tetanus prophylaxis is essential in wounds.  Persons with uncomplicated wounds who have not been vaccinated for tetanus in the prior 5 years should receive a tetanus booster.

Treatment focuses on halting the production of toxins produced by the bacteria and neutralizing them with antitoxin drugs.  The patient should be monitored for signs of breathing difficulty or muscle spasms.  Muscle relaxants may be used to control spasms, and mechanical breathing apparatus may be required.

Tetanus can be prevented by vaccination with tetanus toxoid, with booster shots every 10 years.  Immunization is critical in the prevention of Tetanus infection, and cuts, punctures or other wounds should always be sterilized and cleaned thoroughly.

Prognosis; Complications; Seek medical attention if...

The prognosis for Tetanus is generally good if the correct care is received in the early stages of infection, but recovery can take months.  The Tetanus toxins cause no permanent damage to the nervous system and the patient should recover fully.

The mortality rate is usually around 10%, even with treatment, but in unvaccinated persons over the age of 60 who develop Tetanus, this figure rises to over 60% once the disease process begins, regardless of what treatments are begun at that time.

In cases of Local Tetanus, localized contractions around the wound may last for weeks.  Although Local Tetanus is only fatal in about 1% of cases, it may precede the onset of Generalized Tetanus.

Cephalic Tetanus is the most dangerous form and carries a 15-30% mortality rate.

Complications that can arise from a tetanus infection include:

Consider having an anti-tetanus injection any time you suffer a deep puncture or wound.  Seek emergency medical attention immediately if you have suffered such a wound and start to experience severe muscle spasms, particularly those affecting the neck and/or jaw.

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