Tetanus
Definition
Tetanus (commonly called lockjaw) is a disease manifested by uncontrolled muscle spasms. Tetanus is caused by the toxin (poison) produced by the bacteria, Clostridium tetani.
Description
This disease is frequently fatal, especially to the very old or very young. Tetanus is preventable by immunization or through administration of tetanus immune globulin. It occurs predominantly in developing countries among newborn infants, children, and young adults. It is still encountered in the U.S., especially in unimmunized or inadequately immunized adults over 50 years of age. The most frequent form of tetanus is a generalized type in which large quantities of poison from a wound are released into the blood stream, producing a quick and severe onset of the disease. Tetanus disease has a stimulating effect on certain muscle groups. Most of the time the muscles of the jaw, face, and neck are affected first, followed by an effect on progressively more distant muscles such as the arms and legs.
Causes
The tetanus bacteria depends upon the introduction of its spores into damaged tissue along with foreign bodies and/or other bacteria to provide the necessary conditions favorable to its growth. Tetanus is not directly transmitted from person to person. Instead, tetanus spores may be introduced into the body through a puncture wound contaminated with soil, street dust, animal feces; injected contaminated street drugs; lacerations; burns; or even trivial or unnoticed wounds.
Symptoms
The time between an injury and the occurrence of the first symptoms is typically less than two weeks but may range from 5 days to 15 weeks. The presenting symptoms are often jaw or neck stiffness, difficulty swallowing, and irritability. There may be pain or tingling at the site of inoculation (where the tetanus bacteria entered), followed by spasticity of nearby muscles. Later, there may be spasm of the neck, back, and abdominal muscles. Spasms of the respiratory muscles may cause acute asphyxia. Airway obstruction is common. The patient remains awake and alert throughout the illness.
Diagnosis
The diagnosis is made clinically by the medical history and physical findings.
Treatment
Immune globulin, given intramuscularly, is the immediate treatment of unimmunized individuals exposed to material likely to contain the tetanus bacteria. Treatment includes bed rest and quiet conditions. Sedation, paralysis with certain medications, and mechanical ventilation (i.e., respirator) may be necessary to control the spasms. Antimicrobial drugs, such as penicillin, are used to eradicate the bacteria. Recovery For patients who survive tetanus, recovery can be long (1 to 2 months) and burdensome. Muscle spasms may begin to decrease after 10 to 14 days and disappear after another week or so. Residual weakness, stiffness, and other complaints may persist for a prolonged period, but complete recovery can occur from uncomplicated tetanus. Patients with tetanus are hospitalized in an intensive care unit until it is clear that the progression of the disease has stabilized at a level that does not interfere with vital functions, and that therapy can be managed outside the unit.
Prevention
Tetanus is completely preventable by active immunization. Tetanus toxoid has proven to be safe since its introduction during the 1920s. Tetanus toxoid consists of inactivated tetanus toxin treated with chemicals or heat to decrease the toxic effect, but to retain its antigenic power. For practical purposes, tetanus should be considered a disease against which there is no naturally acquired immunity. Tetanus toxoid is available by itself, or frequently as one of three components in a vaccine. It can be combined with diphtheria toxoid and pertussis vaccine (DTP) for primary immunization of children, and with reduced diphtheria toxoid (Td) for immunization of older adults and children. For primary immunization in adults, tetanus toxoid is given in two doses 4 to 6 weeks apart, with a third dose 6 to 12 months later. Booster doses are recommended every 10 years to ensure the maintenance of protective antitoxin levels. Immunization is especially recommended for adults 50 years and older since most tetanus cases in recent years have occurred in this age group. Tetanus should be considered for:
- persons who are not sure whether they have received the initial series of boosters
- travelers to foreign countries with hot, damp climates
- agricultural workers who work with dirt or manure
- persons whose jobs expose them to cuts and scrapes
- pregnant women who have not been immunized, or who may have been inadequately immunized, or who may deliver their babies in unhygienic circumstances
Questions
Are my immunizations up-to-date? Is there a test after an injury that can determine if the tetanus disease is present? Are there any reactions or side effects to tetanus vaccine? If tetanus is present, what is the success rate of eliminating the disease and its toxins? Are there any after effects or any residual conditions left by the disease?
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