Tetanus is a condition that affects the nervous system and causes painful, uncontrolled muscle spasms. Because of widespread immunization, tetanus is now rare. Another name for tetanus is lockjaw.
What is the infectious agent that causes tetanus?
Tetanus is caused by a toxin (poison) produced by spores of the bacterium Clostridium tetani. Spores are hardy forms of the bacteria that can survive in the environment in an inactive state for a long time.
Where is tetanus found?
Tetanus occurs worldwide. Tetanus spores are found throughout the environment, usually in soil, dust, and animal waste
How do people get tetanus?
Tetanus spores can enter the body through a wound that is contaminated with soil, dust, or animal waste. Spores can get into the body through even a tiny pinprick or scratch, but they usually enter through deep puncture wounds or cuts, like those made by nails or knives. Tetanus spores can also get into the body when skin is damaged by burns or by injecting contaminated street drugs. Once the spores enter a wound, they produce a powerful nerve poison that spreads through the body and causes painful symptoms.
The first signs of tetanus infection are usually a headache and spasms or cramping of the jaw muscles (lockjaw). As the poison spreads, it progressively attacks more groups of muscles, causing spasms in the neck, arms, legs, and stomach, and sometimes violent convulsions (seizures).
How soon after exposure do symptoms appear?
The time between the contamination of a wound and the first symptoms is usually less than 2 weeks but can range from 2 days to months. In general, the shorter the time between exposure and symptoms, the more severe the disease.
he hallmark feature of tetanus is muscle rigidity and spasms
In generalized tetanus, the initial complaints may include any of the following:
Irritability, muscle cramps, sore muscles, weakness, or difficulty swallowing are commonly seen.
Facial muscles are often affected first. Trismus or lockjaw is most common. This condition results from spasms of the jaw muscles that are responsible for chewing. A sardonic smile -- medically termed risus sardonicus -- is a characteristic feature that results from facial muscle spasms.
Muscle spasms are progressive and may include a characteristic arching of the back known as opisthotonus (Figure 2). Muscle spasms may be intense enough to cause bones to break and joints to dislocate.
Severe cases can involve spasms of the vocal cords or muscles involved in breathing. If this happens, death is likely, unless medical help (mechanical ventilation with a respirator) is readily available.
Figure 2: Picture of opisthotonus or arched back due to muscle spasms in a person with generalized tetanus; SOURCE: CDC
In cephalic tetanus, in addition to lockjaw, weakness of at least one other facial muscle occurs. In two-thirds of these cases, generalized tetanus will develop.
In localized tetanus, muscle spasms occur at or near the site of the injury. This condition can progress to generalized tetanus.
Neonatal tetanus is identical to generalized tetanus except that it affects the newborn infant. Neonates may be irritable and have poor sucking ability or difficulty swallowing...
Medical treatment has two aims: limit growth and eventually kill the infecting C. tetani and thus eliminate toxin production; the second aim is to neutralize any toxin that is formed. If the toxin has already affected the patient, the two aims are still important, but supportive measures will be needed for the patient. These steps are outlined below:
Antibiotics (for example, metronidazole [Flagyl, Flagyl 375, Flagyl ER], penicillin G or doxycycline [Adoxa, Alodox, Avidoxy, Doryx, Monodox, Oracea, Oraxyl, Periostat, Vibramycin, Vibramycin Calcium, Vibramycin Monohydrate, Vibra-Tabs]) to kill the bacteria, tetanus booster shot, if necessary, and occasionally, antitoxin (termed tetanus immune globulin or TIG) to neutralize the toxin Wound cleansing to remove any obvious bacteria collections (abscesses) or foreign bodies; if the patient is exhibiting any toxin-related problems, TIG is usually administered first and wound care is delayed for a few hours while the TIG neutralizes toxin because infected wounds, when manipulated, may release more toxin Supportive measures Pain medicine as needed Sedatives such as diazepam (Valium) to control muscle spasms and muscle relaxants Ventilator support to help with breathing in the event of spasms of the vocal cords or the respiratory muscles IV rehydration because, as muscles spasm constantly, increased metabolic demands are placed on the body.
Common first signs of tetanus include muscular stiffness in the jaw (lockjaw) followed by stiffness of the neck, difficulty in swallowing, rigidity of abdominal muscles, generalized spasms, sweating and fever.
Symptoms usually begin 7 days after bacteria enter the body through a wound, but this incubation period may range from 3 days to 3 weeks.
Tetanus Shots for Adults
Most people think tetanus is caused by stepping on a rusty nail or receiv-ing a serious puncture wound. But in reality, tetanus bacteria is everywhere, especially in dirt, dust and manure, and it can enter the body through a tiny pinprick, scratch from an animal, splinters, bug bites and burns that break the skin. A tetanus infection can be deadly. As many as 40 percent of people who get a tetanus infection die from it. The disease affects the nervous system and can result in spasms strong enough to break bones. One condition that often happens with tetanus is a spasm and tight-ening of the mouth that causes the jaw to stiffen, also called lock jaw. Tetanus infection also can cause the muscles of the diaphragm to spasm and tighten, making it difficult to breathe. The disease can lead to dangerously high blood pressure, breath-ing failure and pneumonia that can result in coma or death. More adults are taking the threat of tetanus lightly — because vac-cination is almost 100 percent effective — however, it is impor-tant to have your tetanus
Tetanus Shots
Most people received a series of tetanus vaccinations when they were children. It is administered in children usually in combination with vaccines against other illnesses such as pertussis (whooping cough) and diphtheria. Tetanus shots generally are required for children before starting school. Five doses of vaccine are recommended before the age of 6. After the initial series of immu-nizations, a booster of tetanus and diphtheria vac-cine (referred to as Td) should be given at 11-12 years of age and every 10 years after that.
When Should I Get a Tetanus Booster?
• If it has been more than 10 years since you had a tetanus shot. For most adults, the protection from a tetanus shot falls off with time. • If you’re 50 years and older. According to the CDC, a number of people in this age group didn’t receive their first tetanus shots during childhood. If you are in this age group and haven’t had these shots, you should start with a series of three Td shots. • If you are unsure or have no records of receiving the first series of tetanus shots or boosters as a child. • If you’re traveling to a country with hot, damp climates and soil that con-tains a lot of organic matter. • If you’re an agricultural worker, or if you work with dirt and manure. • If your job or activities cause a lot of cuts and scrapes on your skin. • If you’re recovering from tetanus infection. Having a case of tetanus does not mean you cannot get it again. • Pregnant women who have not been immunized and haven’t received a recent booster or may deliver in an unhygienic place. When you are immunized, anti-bodies that fight the disease are passed from you to your fetus. (Please consult your healthcare provider, especially if you are in the first trimester of pregnancy.) • If you are hurt and require emer-gency tetanus treatment
Are There Side Effects?
You probably will be sore for a day or two near the spot of the vaccination. You also might expe-rience some redness and swelling where the shot was given for 1-2 days. You can treat these symptoms by taking a non-aspirin pain reliever, such as acetaminophen or ibuprofen. It’s very rare you would have a serious allergic reaction from the Td vaccine, but if you experience a deep, aching pain and loss of muscle in your upper arm(s) that starts 2 days to 4 weeks after you get the shot, contact your healthcare provider right away
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