Tetanus

Introduction

Tetanus (lockjaw) is a serious bacterial disease caused by Clostridium tetani. It manifests as a stiffening of the muscles and can be extremely life threatening. It is a preventable disease. Clostridium tetani is mostly commonly found the soil, dust and animal feces but can be literally anywhere and it is global. Transmission of the disease is through open cuts, punctures, lacerations or other types of deep skin wounds. The bacteria enters the wound and the spores can begin producing a toxin (tetanospasmin) which then triggers the onset of symptoms. Tetanus can not be transmitted by human to human contact.^[1][2][3]

Prevention

• Tetanus vaccination*
• Clean all wounds and surrounding skin with warm soapy water. Use of a wahscloth for removing any debris is advised.
• Apply antibiotic cream/ointment to all cleaned wounds and surrounding skin.
• Apply bandages to wounds to prevent post-cleansing exposure.
• Change bandages at least once daily

Open blisters on the feet and ankles, such as those which develop while hiking, are also possible sites for infection. Keep open blisters clean, dry and bandaged to help prevent bacteria from entering the wound. While healing, wear clean, dry socks and change them daily.

Pre-Exposure Vaccination

Currently, for adults age 18 years old and over, immunization is a single-dose vaccine and is effective for up to 10 years duration.*
Those patients who have suffered a deep skin wound during the 10 year period may be given a booster injection at the time of wound treatment regardless of the date of last immunization.

*It should be noted that the "effectiveness duration" period is under review by several different health organizations around the world. The 10 year period is still used by most medical practitioners though the regulations may be changed to a 5 or 7 year duration period in the near future.

In industrialized nations, most children receive the tetanus vaccine as part of the DTaP (Diptheria, Tetanus & Pertussis) pre-school immunizations program. If you have been given this series during childhood, a booster is recommended between ages 11 & 18, then routinely every 10 years thereafter.^[1][4]

Symptoms and Treatment

Symptoms

Tetanus can manifest itself in three different forms.

Generalized Tetanus
This form is the most common and encompasses approximately 80% of all cases. The incubation time for this form is 7-8 post-injury. Symptoms can take as long as 21 days to appear and include initial jaw muscle spasms (lockjaw), progressive painful spasms of the neck, chest and extremities, tetanic seizures (rigidity/locking of muscles) and/or convulsions. Breathing capabilities can be severely comprimised by tetanic seizures as they do not allow the muslces to expand/contract during respiration. The mortality rate for patients with generalized tetanus is 10-20%.

Localized Tetanus
This form of Tetanus is uncommon. Symptoms are localized or confined to muscles surrounding the area of the wound. It manifests itself most frequently in patients with partial immunity and can progress, becoming generalized Tetanus.

Cephalic Tetanus
This form is rare and has an incubation period of 1-2 days post-injury. Symptoms include cranial nerve palsies (twitches). It is seen in patients with wounds/lesions of the face and/or head regions. Cephalic Tetaus can progress to the generalized form.^[1]

Treatment

Patients with Tetanus require immediate hospitalization. Most patients will receive tetanus immune globulin and Tetanus toxoid booster injections. Antibiotics may be given for wound infection. Other medications may be administered to reduce muscle spasms and patients with severe spasms/rigidity may be placed on a ventilator to assist with respiration.^[1][5]