Tetanus

Tetanus

Definition:
Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and, ultimately, threaten your life. Tetanus is commonly known as "lockjaw."

Thanks to the tetanus vaccine, cases of tetanus are rare in the United States and the developed world. The incidence of tetanus is much higher in less-developed countries. Around a million cases occur worldwide each year.

Tetanus can be treated, but not always effectively. Fatality is highest in individuals who haven't been immunized and in older adults with inadequate immunization — wherever they may live. In countries with low vaccine rates, infants also are at high risk of severe illness and death.

Symptoms:
Signs and symptoms of tetanus may appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The average incubation period is seven to eight days.
Common signs and symptoms of tetanus, in order of appearance, are:

• Spasms and stiffness in your jaw muscles
• Stiffness of your neck muscles
• Difficulty swallowing
• Stiffness of your abdominal muscles
• Painful body spasms, lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light

Other signs and symptoms may include:

• Fever
• Sweating
• Elevated blood pressure
• Rapid heart rate

When to see a doctor
See your doctor to obtain a tetanus booster shot if you have a deep or dirty wound and you haven't had a booster shot within the past five years or aren't sure of your vaccination status. Or see your doctor about a tetanus booster for any wound — especially if it may have been contaminated with dirt, animal feces or manure — if you haven't had a booster shot within the past 10 years or aren't sure of your vaccination status.

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 actively impairs your motor neurons, nerves that control your muscles. The effect of the toxin on your nerves can cause muscle stiffness and spasms — the major signs of tetanus.

Complications:
Once tetanus toxin has bonded to your nerve endings it is impossible to remove. Complete recovery from a tetanus infection requires the growth of new nerve endings and can take up to several months.
Complications of tetanus infection may include:

• Disability. Treatment for tetanus typically involves the use of powerful sedatives to control muscle spasms. Prolonged immobility due to the use of these drugs can lead to permanent disability. In infants, tetanus infections may cause lasting brain damage, ranging from minor mental deficits to cerebral palsy.
• Death. Severe tetanus-induced (tetanic) muscle spasms can interfere with your breathing, causing periods in which you can't breathe at all. Respiratory failure is the most common cause of death. Lack of oxygen may also induce cardiac arrest and death. Pneumonia is another cause of death. 

Treatments and drugs:
Since there's no cure for tetanus, treatment consists of wound care, medications to ease symptoms and supportive care.

Wound care
Cleaning the wound is essential to preventing growth of tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound.

Medications

• Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus immune globulin. However, the antitoxin can neutralize only toxin that hasn't yet bonded to nerve tissue.
• Antibiotics. Your doctor may also give you antibiotics, either orally or by injection, to fight tetanus bacteria.
• Vaccine. Having tetanus once doesn't make you immune to the bacteria afterward. So you'll need to receive a tetanus vaccine in order to prevent future tetanus infection.
• Sedatives. Doctors generally use powerful sedatives to control muscle spasms.
• Other drugs. Other medications, such as magnesium sulfate and certain beta blockers, may be used to help regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine may be used for this purpose as well as sedation.

Supportive therapies
Tetanus infection often requires a long period of treatment in an intensive care setting. Since sedatives may result in shallow breathing, you may need to be supported temporarily by a ventilator.