Information about Tetanus
Tetanus is a life-threatening disease. It is caused by a toxin produced by bacteria that typically enter the body as a dormant form (spore) through a deep cut or puncture wound. The spores require an environment with a low oxygen content for about seven to 10 days to be activated to the growing form of the bacteria that produces the toxin. The toxin travels along nerves to the spinal cord, where it produces muscle rigidity and spasms. Tetanus is sometimes called lockjaw, because difficulty opening the mouth is often the first symptom; rigidity may become so severe the jaw is frozen shut.
The bacterial spores of Clostridium tetani are found worldwide in soil, dust, animal feces, and, occasionally, human feces. Incidence is highest in rural areas with warm climates or in any population that is not immunized or is only partially immunized. People over the age of 50 are most commonly affected, usually because they have not gotten booster vaccinations.
Severity ranges from mild muscle stiffness to convulsive spasms that can choke or suffocate the victim by blocking the respiratory airway. The illness usually lasts from four to six weeks. Infection rarely occurs when a person is properly immunized. Aggressive treatment has reduced the overall mortality rate to less than 25 percent in the United States, and incidence is now rare in this country.
What Causes Tetanus?
- Tetanus is caused by bacterial infection from C. tetani, which usually enters the body through a wound. Less often, tetanus follows a burn, surgery, or injection of illicit drugs into the skin.
Symptoms of Tetanus
- Muscle rigidity and pain, typically in the jaw, neck, back, and abdomen
- Muscle spasms or cramping, often first felt in the jaw and neck, which may progress to painful spasms throughout the body
- Stiffness of the neck, shoulder, back and possibly other muscles of the torso
- Violent convulsions (seizures)
- Pain and tingling at the wound site
- Swallowing or breathing difficulty
- Grimacing due to involuntary constriction of facial muscles
- In severe cases: high fever, profuse sweating, rapid heartbeat or heart rhythm disturbances
- Immunization should be initiated in early infancy. The DTP vaccine (diphtheria, tetanus, and pertussis) is most often used.
- Get a booster shot every five to 10 years or after sustaining a deep wound.
- Clean wounds with soap and water and apply an antiseptic, such as hydrogen peroxide.
Diagnosis of Tetanus
- Patient history should include any prior tetanus immunization, allergic reactions to immunizations or penicillin and recent wounds.
- Diagnosis is generally based on characteristic clinical findings.
- Wound cultures may be taken, although not all patients with tetanus produce a positive test result.
How to Treat Tetanus
- Deep, often surgical cleansing of the wound is commonly performed to eliminate invading bacteria.
- Antitoxin should be administered immediately to neutralize the bacterial toxin.
- Antibiotics (usually penicillin, doxycycline or metronidazole) are administered intravenously.
- Muscle relaxants, such as diazepam (Valium), may be used to relieve muscle stiffness.
- Neuromuscular blockers (drugs that block nerve-to-muscle signals) may be administered to control violent spasms, especially if they threaten breathing.
- For patients with severe breathing difficulty, tracheostomy (the implantation of a breathing tube through a surgical opening in the throat) may be needed, along with mechanical ventilation.
- Tetanus vaccine may be administered.
When to Call a Doctor
- EMERGENCY Get immediate medical attention whether or not a wound is present if you begin to suffer from unusual muscle spasms and stiffness.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media