Definition

     Tetanus is a potentially deadly nervous system disease due to the bacteria Clostridium tetani (C. tetani). The toxin affects the nerves and muscles, causing them to spasm and become tense.

Causes

• The cause of the disease is a bacterium known as Clostridium tetani.  This bacterium usually gets into a wound and then secretes a toxin that causes the symptoms of the disease, i.e., Muscle Spasms, tense nerves, exaggerated reflexes, and hypersensitivity to sensation.

• Those who most often develop the infection are migrant farm workers, people who have not been immunized, intravenous drug users, newborns, and the elderly.  Also, people who take medicine by injection have a higher risk of infection.

• Any type of wound (including Frostbite, Burns, and infections) increases one's chance of developing tetanus.

Symptoms

• Symptoms on average begin 8-12 days after the infection, but can occur as late as 15 weeks later.

• At first, there may be just pain and tingling at the site of the infection.

• Followed commonly by jaw stiffness, neck stiffness, trouble swallowing, and irritability.

• Eventually, one experiences spasms and stiffness of other muscles, including those of the face, back, and jaw. There may be difficulty opening the mouth.

• Increased and exaggerated reflexes

• Occasionally, the patient's throat may close-up, or he may stop breathing.

• Usually, there is no fever.  Patients are usually awake and sentient.

• Extreme sensitivity to any stimulus or sensation -- it is not uncommon for patients with this condition to express Convulsions when exposed to even minor sensations.

• There is a high risk of developing other complications, i.e., Heart Failure, inability to urinate, or inability to have a bowel movement.  Some with tetanus may not be able to breathe on their own, requiring support and careful monitoring in the hospital.

Screening and Diagnostics

• Diagnosis is made by symptoms and the doctor's examination.  There is no dependable blood test available at this time to make the diagnosis.

Treatments

• Once the patient develops the infection, they need to be treated with antibiotics (most often penicillin) and also with tetanus immune globulin (5000 units).

• Once recovered, he will still need to receive the immunizations so as not to develop the disease in the future.

• Those recovering from tetanus will need rest and quiet-preferably, a dark, quiet, isolated room.

• Sometimes, sedatives will be required.

• Monitoring for arrested breathing and Heart Failure is advised.

• This disease still carries a high risk of death and the patient has to be watched very closely. In the past, up to 40% affected died.  Now, however, with better technology, the risk of death is lower.

Complications 

• Airway obstruction

• Respiratory arrest

• Heart failure

• Pneumonia

• Fractures

• Brain damage due to lack of oxygen during spasms

Prevention

• Prevention of the infection is the main key to controlling this disease.  Very effective vaccines are available, so the disease can be completely prevented.

• In childhood, the vaccine is given as a series of DTaP (stands for diptheria, tetanus, and Pertussis) vaccines (usually given at 2 months, 4 months, 6 months, 15 to 18 months, and then at 4 to 6 years.  After that a repeat vaccine called Td is given at 11 to 16 years).

• In adults who have never been vaccinated, the person is given 2 Td (stands for diptheria or tetanus toxoid) doses 4 to 6 weeks apart, and then a third dose after 6-12 months.

• For people who have been fully vaccinated, they get booster doses of Td every 10 years.  However, if they have a major wound that is dirty, they will need a repeat dose of Td if it has been over five years since their last immunization.

• If the patient has not been vaccinated and they have a dirty wound, they are given the vaccination, but they also need to be given a medicine called tetanus immune globulin (250 units) which will protect them until the vaccination takes effect.