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Tetanus

Also referred to as lockjaw, tetanus is an acute exotoxin-mediated infection caused by the anaerobic, spore-forming, gram-positive bacillus Clostridiumtetani. The infection usually is systemic, but it may be localized.

Tetanus is entirely preventable by immunization but continues to be common in areas where soil is cultivated, in rural areas, in warm climates, during summer months, and among males. Neonates and me elderly are prominently involved. Because reporting is incomplete, the burden of illness is greater than statistics indicate. In the United States most cases follow injury, such as a puncture wound, laceration, or abrasion, and are often acquired outdoors.

Tetanus occurs worldwide, but it's more prevalent in agricultural regions and developing countries that lack mass immunization programs. It's one of the most common causes of neonatal deaths in developing countries.

When C. tetani enters the body, it causes local infection and tissue necrosis. It also produces toxins that enter the bloodstream and lymphatics and eventually spread to central nervous system tissue.

Causes

The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores of the bacteria may produce a powerful toxin, tetanospasmin, which acts on various areas of your nervous system. The effect of the toxin on your nerves can cause muscle stiffness and spasms — the major signs of tetanus.

Symptoms and Signs

Common symptoms include:

  • Problems with swallowing or breathing
  • Arching of the back and neck
  • Inability to pass urine
  • Sweating
  • Abnormal heart rate
  • Blood pressure

Diagnostic tests

Blood cultures and tetanus antibody tests commonly are negative; only one-third of patients have a positive wound culture. Cerebrospinal fluid pressure may increase above normal.

Treatment

Within 72 hours after a puncture wound, a patient with no previous history of tetanus immunization first requires tetanus immune globulin or tetanus antitoxin to confer temporary protection. Next, he needs active immunization with tetanus toxoid. A patient who hasn't received tetanus immunization within 5 years needs a booster injection of tetanus toxoid.

If tetanus develops despite immediate postinjury treatment, the patient requires airway maintenance and a muscle relaxant, such as diazepam, to decrease muscle rigidity and spasm. If muscle contractions aren't relieved by muscle relaxants, a neuromuscular blocker may be needed.

The patient with tetanus also requires high-dose antibiotics - preferably penicillin administered I. V. if he isn't allergic to it. If he is allergic to penicillin, tetracycline can be substituted.

Prevention

Tetanus can be prevented with a vaccine. Children who are less than 7 years of age can receive DTaP vaccine a combined vaccine against diphtheria, tetanus and whooping cough. Teenagers and adults should receive booster doses of Td vaccine, a combined vaccine against tetanus and diphtheria every Ten years.

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