Tetanus

What is Tetanus? Tetanus is a severe, life-threatening bacterial infection caused by the spores of a bacterium, ‘Clostridium tetani’, which infiltrates the body through wounds, deep cuts, burns, etc., depositing toxins that affect the nervous system. It leads to muscle stiffness and chronic painful contractions in the neck and jaw muscles. Also called ‘lockjaw’, it can be categorized into four clinical types:

• Localized tetanus
• Generalized tetanus
• Neonatal tetanusz
• Cephalic tetanus.[1]

How Do You Get Infected? Tetanus is not a contagious disease, so it cannot be transmitted from one infected person to another. However, the spores of the bacterium that causes the infection can be contacted by a victim through any wound, cut, or burn of any sort.  Some include the following:

• Wounds from surgical operations, if not taken care of properly.
• Gunshot wounds
• Wounds from punctures like piercings, tattoos, splinters, etc.
• Deep cut injuries from knives, razors, glasses, ceramics, etc.
• Injuries from injections.
• Crush injuries
• Burns
• Animal bites.
• Severe fractures, where the bone is left exposed
• Foot ulcers.
• Ear infections
• Septic abortions
• Dental procedures
• Circumcision 
• The infected umbilical stump of a newborn baby(neonatal tetanus) if the mother was not immunized against tetanus during pregnancy.

Risk Factors The risk factors for tetanus include the following:

• Lack of taking vaccination doses against tetanus.
• Lack of booster shots every ten years.
• Wounds and burns that are not treated well enough.
• Presence of a foreign object such as a nail, a splinter of glass, etc. in an injury
• Diabetic patients who have ulcers and left untreated.

Complications Tetanus toxins, tetanospasmin, are hard to remove when bonded with the nerves; instead, they kill the nerves and die with them. Complications that may arise include:

• Fractured bones, especially the spine.
• Laryngospasm (involuntary tightening of vocal cord)
• Muscular tears
• Respiratory difficulties or failure
• Pneumonia
• Decreased heart function.
• Low blood pressure
• Lung artery blockage with blood clots (pulmonary embolism)
• Brain damage
• Death

Prevention of Tetanus

Prevention of Tetanus is through the following ways:

• Immunization/ Vaccination

Tetanus can be stopped if a person has immunity against the bacteria. Immunity is built first by starting a vaccine against the disease, and continued protection requires booster shots.  Diphtheria, tetanus, and pertussis (DTaP) vaccine is the immunization meant to be given to a child in the early stages of the child’s life, which is the primary series. And Tdap vaccines are the booster shots given after the primary series and ten years later. The World Health Organization (WHO) recommends that immunization be done in 6 phases after a child’s birth—3 primary shots and three booster shots—and after that, the sequence of 10 years with the booster shots should be taken. The three primary doses are recommended to be given at:

• Two months
• Four months
• Six months

The three booster shots at:

• 12 to 23 months
• 4 to 6 years
• 9 to 15 years

Tdap vaccines are given to adults who have never been immunized before and to pregnant women in their trimester to pass immunity over to their children until they get their primary shots.

• Proper wound care.

To prevent your body from getting under attack from Clostridium tetani spores, one should take care of every type of wound, cut, burn, carefully. If you have an injury, stop the bleeding, clean the wound with clean water and antiseptics, apply antibiotic ointments, and cover them up with clean bandages. Always cover the wound and avoid them from getting in touch with areas prone to tetanus bacterium. If you think your wounds have been exposed to the bacterium, then you should visit a doctor immediately. Treatment The following are treatment procedures for tetanus:

• Tetanus Immunoglobulin (TIG)

TIG contains antibodies that kill and neutralize the spores and the toxins that have been incubating and spreading in your bloodstream. TIG helps in shortening the duration of tetanus and reduces its severity.

• Antibiotics

Administration of antibiotics such as penicillin, metronidazole, tetracycline, etc., are given to stop the spores from producing toxins that cause muscle pain and spasm.

• Medications to stop muscle stiffness and pains.

Anticonvulsants such as benzodiazepam, diazepam, lorazepam serve as sedatives and mainstay in the treatment of tetanus., Muscle relaxants such as baclofen reduce muscle tension, and Neuromuscular blocking agents such as pancuronium and vecuronium control muscle spasms.

• Surgery

In a case where the doctor feels that tetanus infected wound tissue needs to be removed, the surgical procedure; debridement is used to remove the damaged tissues.

• Ventilators

To aid in breathing difficulties.

• High-Calorie Intake

For increased muscular activities, you need a high-calorie intake daily.  

Symptoms

After being infected by the spores of the bacterium, they take 7-10 days to incubate before symptoms begin to show. On incubation, the bacteria begin to interfere with the nerve signals and you’ll begin to experience severe spasm and stiffness in various muscles especially the facial and the upper body muscles. The contractions start from the jaw, neck, throat, and continue to extend to the chest, spine, back, and abdomen.

Some of the symptoms that are associated with this disease include:

• Difficulty in breathing
• Swallowing difficulty/sore throat
• Severe pains in the affected muscles
• Faster heart rate
• Headaches
• Fever
• Sweating
• High blood pressure
• Diaspora, etc.

Causes

Tetanus is caused by a bacterium called ‘Clostridium tetani’ which lays domicile in areas unknown but common to us; the soil, dust, saliva, manure, animals’ intestines, and feces, etc. The bacterium is anaerobic, that is, it thrives better in the absence of oxygen, producing more spores that can remain infectious for more than 40 years.

The spores produced by the bacterium infiltrates your body through deep cuts, wounds, burns, and begin to release the tetanus toxin called ‘tetanospasmin’. Once these neurotoxins are released into the bloodstream, they interfere with and block out the nerve signals between the brain and the spinal cord, and from your spine to your muscles. The nerve signal blocks cause severe stiffness and contractions to your muscles, oftentimes leading to muscle tissue injury.

FAQ

• How long does it take to recover from tetanus?

Muscle spasms may last for about 3 to 5 weeks with adequate treatment and slowly get better. Total recovery can take months.

• How is tetanus diagnosed?

There is no lab test for tetanus. Diagnosis is based on your symptoms, your history of any wound, physical examination, and vaccination history

• Can you get tetanus from a shallow cut?

Yes, there is a possibility that we can get infected through any cut or wound, as far as they come in contact with the tetanus bacteria.

• If I cut myself, should I get a tetanus shot?

If you have a fear of getting infected from any cut especially when your immunization is not up to date, getting a tetanus immunoglobulin and a tetanus vaccine should be your option to prevent further infection.

• Why does rust cause tetanus?

Rust is formed and found on metals and is rich in organic materials like manure and soil, chances of growth of Clostridium tetani are high in this region. They can be inhibitors of tetanus bacteria. It is not mandatory that tetanus is caused only by rust materials, it is one of the causes for tetanus.