Tetanus is a disease of the nervous system marked by muscle spasms caused by a toxin produced by a bacteria called Clostridiumtetani.
What is going on in the body?
The bacteria that cause tetanus live in the soil. They are also found in animal intestines and human feces. Tetanus occurs when wounds or an infant's umbilical cord are contaminated with the bacteria.
The bacteria then multiply and produce a toxin, which affects the nervous system. The toxin travels through the nerves to the brain and spinal cord. The toxin blocks signaling that normal allows for relaxation of muscles at the appropriate time; therefore, it causes abnormal continuous muscle contraction that in its most severe form can cause death.
What are the causes and risks of the infection?
Tetanus is caused by a toxin made by the bacteria. The bacteria are generally introduced into the body through wounds in the skin. The risk of tetanus increases with deep puncture wounds infected by dirt or feces. The bacteria can also be introduced through the umbilical cord of a newborn.
Those at risk of tetanus include:
- newborns where the umbilical stump is infected
- women who develop infection after an abortion
- people with diabetes with infected foot or leg wound
- people after surgery involving the bowel
- a person with any puncture wound especially from a soiled or rusty object or an animal bite
- a drug addict who uses dirty needles
What can be done to prevent the infection?
Tetanus toxoid can prevent this disease. This toxoid is usually combined with the diphtheria toxoid and acellular pertussis vaccine in the
DTaP (for children) or Tdap (for adolescents and adults) immunization. It is initially given in early childhood. Booster shots are needed every 5 to 10 years to maintain immunity. For high-risk wounds in a person who has never been immunized or has not had the complete series of injections, tetanus immune globulin can be used to prevent tetanus.
How is the infection diagnosed?
Diagnosis of tetanus is based primarily on a medical history and physical examination.
Long Term Effects
What are the long-term effects of the infection?
The toxin blocks the transmission of signals irreversibly. No treatment is available to remove the toxin. A person with tetanus is supported medically, sometimes on a ventilator, for weeks until the toxin breaks down.
During that time, the individual is at risk for other infections simply because of exposure to them during their prolonged hospital course. When tetanus has generalized throughout the body, death is frequent either from the effects of the toxin or from complications incurred during the hospital stay.
What are the risks to others?
Tetanus is not contagious from person to person.
What are the treatments for the infection?
The goals of tetanus treatment are to eliminate the source of toxin and prevent muscle spasms. Treatment of tetanus includes the following:
- antibiotics to rid the body of any remaining toxin producing bacteria
- drainage and cleaning of infected wounds
- muscle relaxants
- pain control
- tetanus immune globulin is injected into the blood stream and will bind any tetanus toxin not already bound to nerve receptors
- cardiac medications to treat heart irregularities and blood pressure fluctuations
- supportive care such as the use of a
ventilator(artificial breathing machine) if breathing is impaired
What are the side effects of the treatments?
Allergic reactions may occur with any drug. A prolonged hospital course increases the risks of other infections.
What happens after treatment for the infection?
The mortality rate from tetanus is about 25% in the United States and 50% worldwide. Most people recover from tetanus completely. Recovery can take months.
How is the infection monitored?
Individuals with tetanus are generally treated in the
intensive care unit. After discharge, the person needs to make periodic visits to the healthcare professional, to whom any new or worsening symptoms should be reported.