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TETANUS

Tetanus is an infectious disease caused by spores of the bacteria clostridium tetani. These bacteria are widespread and can enter the body through a punctured wound. Tetanus infection is extremely severe and affects the entire body.

Tetanus is commonly called as lockjaw. The people affected with tetanus may have breathing difficulty which may be fatal. There is no specific cure for tetanus. Its treatment focuses on managing the symptoms and preventing complications until the infection resolves.

SIGNS AND SYMPTOMS

The following are the signs and symptoms of tetanus:

  • Pain triggered by minor occurrences, such as loud noise, physical touch or light
  • Spasms and stiffness in your jaw muscles (trismus)
  • Painful body spasms lasting for several minutes
  • Stiffness of abdominal muscles
  • Tachycardia (rapid heartbeat)
  • Stiffness of neck muscles
  • Difficulty in swallowing
  • Bloody stools (feces)
  • Sensitivity to touch
  • Sore throat
  • Headache
  • Sweating
  • Diarrhea
  • Fever

It takes around 7-10 days for the symptoms to appear after the initial infection.

CAUSES

Tetanus is caused by spores of clostridium tetani which is present in soil, manure and other environmental agents. Spores probably enter the deep flesh wounds and develop into bacteria which release a toxin called tetanospasmin. Tetanospasmin affects the nerves controlling the muscles and the patient may experience muscle spasm and stiffness. It is commonly seen in people who have never taken a tetanus vaccine. It is not a contagious disease.

RISK FACTORS

The following are the risk factors for tetanus:

  • Wounds that have been contaminated with saliva or feces
  • Injections into the muscle (intramuscular)
  • Compound fractures
  • Intravenous drug use
  • Surgical procedures
  • Superficial wounds
  • Puncture wounds
  • Dental infections
  • Crush injuries
  • Insect bites
  • Burns

COMPLICATIONS

Complications of tetanus include:

  • Fractures: In some patients, severe muscle spasms and convulsions may lead to bone fractures.
  • Aspiration pneumonia: Inhalation of stomach contents can cause lower respiratory infection eventually leading to pneumonia.
  • Laryngospasm:The patient affected with tetanus may have spasm of larynx which causes breathing difficulty and suffocation.
  • Tetanic seizures: The infection may spread to brain and cause seizures.
  • Pulmonary embolism: A blood vessel in lung may get blocked causing difficulty in breathing and circulation.
  • Severe kidney failure (acute renal failure): Severe muscle spasms can cause muscle destruction and excess release of muscle protein (myoglobin). Excess myoglobin is harmful to kidneys and may cause kidney failure.

DIAGNOSIS

The doctor may confirm tetanus infection in the patient by

  • Checking for signs and symptoms such as muscle spasm, stiffness and pain
  • Discussing the medical and immunization history
  • Examining the patient physically

There are no lab tests that can confirm tetanus

TREATMENT

Tetanus treatment includes:

  • Medications to relieve symptoms
  • Supportive care
  • Wound care

Medications to ease symptoms

Antitoxin: The doctor may give tetanus antitoxin such as tetanus immune globulin, which can neutralize the toxin that is bound to nerve tissue.

Antibiotics: They are given orally or by injection to fight tetanus infection.

Vaccine: It is advisable to get vaccinated with tetanus vaccine as soon as tetanus diagnosis is made.

Sedatives: The doctor may recommend sedatives to control muscle spasms.

Other drugs: Other drugs such as magnesium sulfate, beta blockers and morphine maybe given by the doctor to treat the patient symptomatically.

Supportive care

Severe cases of tetanus need to be hospitalized and may require ventilator support to relieve breathing difficulty.

Wound care

The tetanus infection enters the body through wounds, thus, preventing the development of tetanus spores is vital in the treatment of tetanus. Wound debridement is a procedure in which the doctor may surgically remove dead tissue, foreign material, dirt or manure from the wound.

PREVENTION

Tetanus can be prevented with proper immunization. As a part of regular immunization, the children are given the tetanus vaccine as a combination vaccine-diphtheria, tetanus toxoids and acellular pertussis (DTaP) vaccine.

The DTaP vaccine is given in a series of five shots, in the arm or thigh to children at the ages:

  • 2 months
  • 4 months
  • 6 months
  • 15 to 18 months
  • 4 to 6 years

The booster vaccine is also given as a combination with a booster of diphtheria vaccine and pertussis [Tetanus, diphtheria and pertussis (Tdap) vaccine].It is advisable for adolescents to get a dose of Tdap, generally between the ages of 11 and 12, and a Td booster once every ten years thereafter.

 

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