Tetanus

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Overview

Tetanus is an infection characterized by a state of generalized hypertonia that manifests in the form of painful muscle spasms of the jaw and neck. The disease most commonly occurs in those who are not vaccinated or in the elderly with waning immunity. Currently, vaccination campaigns have decreased the incidence and prevalence of tetanus worldwide. The spasms from tetanus may last from minutes to weeks, with spasms starting in the face and then descending to the rest of the body. Symptoms are caused by toxins produced by the bacterium, Clostridium tetani. Based on the clinical features, there are four main types of tetanus.

Generalized tetanus

Neonatal tetanus

Localized tetanus

Cerebral tetanus

Tetanus, a clinical diagnosis, has no particular laboratory test to confirm the diagnosis. Treatment includes tetanus immunoglobulin, antibiotic therapy, neuromuscular blockade, and supportive care for respiratory complications, autonomic instability, and muscle spasms. Full tetanus immunization is required after recovery from the disease. Long-term sequelae have been reported from survivors.

Symptoms

The average time from infection to appearance of signs and symptoms (incubation period) is 10 days. The incubation period can range from 3 to 21 days.

The most common type of tetanus is called generalized tetanus. Signs and symptoms begin gradually and then progressively worsen over two weeks. They usually start at the jaw and progress downward on the body.

Signs and symptoms of generalized tetanus include:

Painful muscle spasms and stiff, immovable muscles (muscle rigidity) in your jaw

Tension of muscles around your lips, sometimes producing a persistent grin

Painful spasms and rigidity in your neck muscles

Difficulty swallowing

Rigid abdominal muscles

Progression of tetanus results in repeated painful, seizure-like spasms that last for several minutes (generalized spasms). Usually, the neck and back arch, the legs become rigid, the arms are drawn up to the body, and the fists are clenched. Muscle rigidity in the neck and abdomen may cause breathing difficulties.

These severe spasms may be triggered by minor events that stimulate the senses — a loud sound, a physical touch, a draft or light.

As the disease progresses, other signs and symptoms may include:

High blood pressure

Low blood pressure

Rapid heart rate

Fever

Extreme sweating

Localized tetanus

This uncommon form of tetanus results in muscles spasms near the site of a wound. While it's usually a less severe form of disease, it can progress to generalized tetanus.

Cephalic tetanus

This rare form of tetanus results from a head wound. It results in weakened muscles in the face and spasms of the jaw muscles. It also can progress to generalized tetanus.

Causes

Tetanus is different from other vaccine-preventable diseases because it does not spread from person to person.

The bacteria that causes the disease are usually found in soil, dust, and manure and enter the body through breaks in the skin. These cuts or puncture wounds can be caused by contaminated objects (for example, cutting your foot on a rusty nail).

Tetanus cases have developed from the following:right up arrow

Puncture wounds — including from splinters, body piercings, tattoos, and injection drugs

Gunshot wounds

Compound fractures

Burns

Surgical wounds

Injection drug use

Animal or insect bites

Infected foot ulcers

Dental infections

Infected umbilical stumps in newborns born of inadequately vaccinated mothers

Risk factors

The greatest risk factor for tetanus infection is not being vaccinated or not keeping up with the 10-year booster shots.


Other factors that increase the risk of tetanus infection are:


Cuts or wounds exposed to soil or manure

A foreign body in a wound, such as a nail or splinter

A history of immune-suppressing medical conditions

Infected skin lesions in people living with diabetes

An infected umbilical cord when a mother isn't fully vaccinated

Shared and unsanitary needles for illegal drug use

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Complications

Complications include contractions of respiratory muscles, vocal cords, and other critical areas of the body.[24] Sympathetic overactivity is the most significant cause of tetanus-associated mortality in critical patients. Further complications include:

Vocal cord paralysis leading to respiratory distress

Autonomic dysfunction- leading to hypertension

Asphyxia

Long bone fractures

Paralytic ileus

Joint dislocation

Aspiration pneumonia

Pressure sores

Stress ulcers

Coma

Nerve palsy

Urine retention

Seizures

Prevention

Vaccination can prevent tetanus infections, but only if you receive your booster shots on schedule. In the United States, the tetanus vaccine is given to children as part of the diphtheria-tetanus-pertussis shot, also called the DTap shot. This is a three-in-one vaccine that protects against diphtheria, pertussis, and tetanus. However, it doesn’t provide lifelong protection. Children need to get a booster shot at 11 or 12 years of age. Adults then need a booster vaccine called the Td vaccine (for tetanus and diphtheria) every 10 years after that. Check with your doctor if you aren’t sure if you’re up to date on your shots.

Proper treatment and cleaning of wounds can also help prevent the infection. If you’re injured outside and think your injury has made contact with soil, call your healthcare provider and ask about your risk of tetanus.