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Tetanus
.
In many countries, the average doctor may never see a
patient with tetanus - this is because the tetanus vaccine is part of childhood
immunization and the infection has become rare
Written by Adam Felman
Tetanus, also called
lockjaw, is a serious infection caused by Clostridium tetani. This bacterium
produces a toxin that affects the brain and nervous system, leading to
stiffness in the muscles.
If Clostridium tetani
spores are deposited in a wound, the neurotoxin interferes with nerves that
control muscle movement.
The infection can
cause severe muscle spasms, serious breathing difficulties, and can ultimately
be fatal.
Although tetanus
treatment exists, it is not uniformly effective. The best way to protect
against tetanus is to take the vaccine.
Fast facts on tetanus
Here are some key
points about tetanus. More detail and supporting information is in the main
article.
· Tetanus is caused by
the Clostridium tetani bacterium
· The early symptoms of
tetanus include diarrhea, fever, and headache
· Earlier diagnosis
predicts better outcomes
What is tetanus?
Tetanus can be fatal
but vaccinations are standard in the U.S.
Tetanus is a serious
bacterial infection.
The bacteria exist in
soil, manure, and other environmental agents.
A person who
experiences a puncture wound with a contaminated object can develop the
infection, which can affect the whole body. It can be fatal.
In the United States,
there are about 30 cases a year. These are mostly people who have not been
vaccinated against tetanus or who have not kept up their booster shots every 10
years.
Tetanus is a medical
emergency. It will need aggressive wound treatment and antibiotics.
Symptoms
Tetanus symptoms
usually emerge about 7 to 10 days after initial infection. However, this can
vary from 4 days to about 3 weeks, and may, in some cases, may take months.
In general, the
further the injury site is from the central nervous system, the longer the
incubation period. Patients with shorter incubation times tend to have more
severe symptoms.
Muscle symptoms
include spasms and stiffness. Stiffness usually starts with the chewing
muscles, hence the name lockjaw.
Muscle spasms then
spread to the neck and throat, causing difficulties with swallowing. Patients
often have spasms in their facial muscles.
Breathing
difficulties may result from neck and chest muscle stiffness. In some people,
abdominal and limb muscles are also affected.
In severe cases, the
spine will arch backward as the back muscles become affected. This is more
common when children experience a tetanus infection.
Most individuals with
tetanus will also have the following symptoms:
· bloody stools
· diarrhea
· fever
· headache
· sensitivity to touch
· sore throat
· sweating
· rapid heartbeat
Treatment
Any cut or wound must
be thoroughly cleaned to prevent infection. A tetanus-prone wound should be
treated by a medical professional immediately.
A wound likely to
develop tetanus is defined as:
· a wound or burn that
requires surgical intervention that is delayed for over 6 hours
· a wound or burn that
has a considerable amount of removed tissue
· any puncture-type
injury that has been in contact with manure or soil
· serious fractures
where the bone is exposed to infection, such as compound fractures
· wounds or burns in
patients with systemic sepsis
Any patient with a
wound listed above should receive tetanus immunoglobulin (TIG) as soon as
possible, even if they have been vaccinated.
Tetanus
immunoglobulin contains antibodies that kill Clostridium tetani. It is injected
into a vein and provides immediate short-term protection against tetanus.
TIG is just
short-term and does not replace the long-term effects of vaccination. Experts
say that TIG injections can be safely administered to pregnant and
breastfeeding mothers.
Doctors may prescribe
penicillin or metronidazole for tetanus treatment. These antibiotics prevent
the bacterium from multiplying and producing the neurotoxin that causes muscle
spasms and stiffness.
Patients who are
allergic to penicillin or metronidazole may be given tetracycline instead.
In treating muscle
spasms and stiffness, patients may be prescribed:
· Anticonvulsants, such
as diazepam (Valium), relax the muscles to prevent spasms, reduce anxiety, and
work as a sedative.
· Muscle relaxants,
such as baclofen, suppress nerve signals from the brain to the spinal cord,
resulting in less muscle tension.
· Neuromuscular
blocking agents block the signals from nerves to muscle fibers and are useful
in controlling muscle spasms. They include pancuronium and vecuronium.
Surgery
If the doctor thinks
the tetanus prone wound is very large, they may surgically remove as much of
the damaged and infected muscle as possible (debridement).
Debridement is the
act of removing dead or contaminated tissue, or foreign material. In the case
of a tetanus-prone wound, the foreign material may be dirt or manure.
Nutrition
A patient with
tetanus requires a high daily calorie intake because of increased muscle
activity.
Ventilator
Some patients may
need ventilator support to help with breathing if their vocal cords or
respiratory muscles are affected.
Causes
Tetanus is caused by
the Clostridium tetani bacterium.
Clostridium tetani
spores are able to survive for a long time outside of the body. They are most
commonly found in animal manure and contaminated soil, but may exist virtually
anywhere.
When Clostridium
tetani enter the body, they multiply rapidly and release tetanospasmin, a
neurotoxin. When tetanospasmin enters the bloodstream, it rapidly spreads
around the body, causing tetanus symptoms.
Tetanospasmin
interferes with the signals traveling from the brain to the nerves in the
spinal cord, and then on to the muscles, causing muscle spasms and stiffness.
Clostridium tetani
enters the body mainly through skin cut or puncture wounds. Thoroughly cleaning
any cut helps prevent an infection from developing.
Common ways of
contracting tetanus include:
· wounds that have been
contaminated with saliva or feces
· burns
· crush injuries
· wounds that include
dead tissue
· puncture wounds
Rare ways of
contracting tetanus include:
· surgical procedures
· superficial wounds
· insect bites
· compound fractures
· intravenous drug use
· injections into the
muscle
· dental infections
Prevention
Most cases of tetanus
occur in people who have never had the vaccine or who did not have a booster
shot within the previous decade.
Vaccination
The tetanus vaccine
is routinely given to children as part of the diphtheria and tetanus toxoids
and acellular pertussis (DTaP) shot.
The DTaP vaccine
consists of five shots, usually given in the arm or thigh of children when they
are aged:
· 2 months
· 4 months
· 6 months
· 15 to 18 months
· 4 to 6 years
A booster is normally
given between the ages of 11 and 18 years, and then another booster every 10
years.
If an individual is
traveling to an area where tetanus is common, they should check with a doctor
regarding vaccinations.
Do I need a tetanus
shot?
Anyone who receives a
deep or dirty wound and has not had a booster shot over the last 5 years should
have another booster.
A patient in this
situation may also be given tetanus immune globulin, which works to prevent
infection.
It is important that
medical attention is sought swiftly as tetanus immune globulin only works for a
short time after the injury.
Diagnosis
In many countries,
the average doctor may never see a patient with tetanus. This is because the
tetanus vaccine is part of childhood immunization and the infection has become
rare.
In the U.S. in 2009,
for example, there were only 19 reported cases of tetanus.
The earlier a patient
is diagnosed with tetanus, the more effective the treatment will be. A patient
with muscle spasms and stiffness who has recently had a wound or cut is usually
diagnosed quickly.
Diagnosis may take
longer with patients who inject drugs because they often have other medical
conditions. They made need a blood test for confirmation.
Anybody who
experiences muscle spasms and stiffness should seek medical attention
immediately.
Complications
If the patient does
not receive treatment, the risk of life-threatening complications is higher and
mortality rates vary from 40 to 76 percent.
Complications may
include:
· Fractures: Sometimes,
in severe cases, the muscle spasms and convulsions may lead to bone fractures.
· Aspiration pneumonia:
If secretions or contents of the stomach are inhaled, a lower respiratory tract
infection can develop, leading to pneumonia.
· Laryngospasm: The
voice box goes into a spasm which can last up to a minute and cause breathing
difficulties. In severe cases, the patient can suffocate.
· Tetanic seizures: If
infection spreads to the brain, the person with tetanus can experience fits.
· Pulmonary embolism: A
blood vessel in the lung can become blocked and affect breathing and
circulation. The patient will urgently need oxygen therapy and anti-clotting
medication.
· Severe kidney failure
(acute renal failure): Severe muscle spasms can result in the destruction of
skeletal muscle which can cause a muscle protein to leak into the urine. This
can cause severe kidney failure.
Adam
Felman
Adam is
an Assistant Editor for Medical News Today’s Updates team, which focuses on
maintaining the quality and accuracy of our clinical content. Before joining
the team in 2017, Adam gained medical knowledge through hands-on experience in
global health insurance, and he developed his love of writing by giving advice
on building self-esteem and confidence. Outside of work, he is an
internationally decorated rapper, producer, and musician, and he even proposed
to his wife in a rap battle.
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