1 an acute and serious infection of the central nervous system caused by bacterial infection of open wounds; spasms of the jaw and laryngeal muscles may occur during the late stages [syn: lockjaw]
2 a sustained muscular contraction resulting from a rapid series of nerve impulses
- A serious and often fatal disease arising through infection of an open wound by the anaerobic bacterium Clostridium tetani that is found in soil and the intestines and faeces of animals. The bacteria produce an exotoxin which causes spasmodic contraction of voluntary muscles, especially those of the neck and jaw.
- A state of muscle tension caused by sustained contraction arising from a rapid series of nerve impulses which do not allow the muscle to relax.
Tetanus is a medical condition that is characterized by a prolonged contraction of skeletal muscle fibres. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, obligate anaerobic bacterium Clostridium tetani. Infection generally occurs through wound contamination, and often involves a cut or deep puncture wound. As the infection progresses, muscle spasms in the jaw develop, hence the common name, lockjaw. This is followed by difficulty in swallowing and general muscle stiffness and spasms in other parts of the body. Infection can be prevented by proper immunization and by post-exposure prophylaxis.
Signs and symptoms
Tetanus affects skeletal muscle, a type of striated muscle. The other type of striated muscle, cardiac or heart muscle cannot be tetanized, because of its intrinsic electrical properties. In recent years, approximately 11% of reported tetanus cases have been fatal. The highest mortality rates are in unvaccinated persons and persons over 60 years of age. C. tetani, the bacterium that causes tetanus, is recovered from the initial wound in only about 30% of cases, and can be found in patients who do not have tetanus.
Spatula testThe "spatula test" for tetanus involves touching the posterior pharyngeal wall with a sterile, soft-tipped instrument, and observing the effect. A positive test result is the involuntary contraction of the jaw (biting down on the "spatula"), and a negative test result would normally be a gag reflex attempting to expel the foreign object.
A short report in The American Journal of Tropical Medicine and Hygiene states that in a patient research study, the spatula test had a high specificity (zero false-positive test results) and a high sensitivity (94% of infected patients produced a positive test result).
The wound must be cleaned. Dead and infected tissue should be removed by surgical debridement. Metronidazole treatment decreases the number of bacteria but has no effect on the bacterial toxin. Penicillin was once used to treat tetanus, but is no longer the treatment of choice, owing to a theoretical risk of increased spasms. However, its use is recommended if metronidazole is not available. Passive immunization with human anti-tetanospasmin immunoglobulin or tetanus immune globulin is crucial. If specific anti-tetanospasmin immunoglobulin is not available, then normal human immunoglobulin may be given instead. All tetanus victims should be vaccinated against the disease or offered a booster shot. It takes 2-14 days for symptoms to develop after infection. Symptoms peak 17 days after infection.
Mild tetanusMild cases of tetanus can be treated with:
Severe tetanusSevere cases will require admission to intensive care. In addition to the measures listed above for mild tetanus:
- human tetanus immunoglobulin injected intrathecally (increases clinical improvement from 4% to 35%)
- tracheostomy and mechanical ventilation for 3 to 4 weeks,
- magnesium, as an intravenous (IV) infusion, to prevent muscle spasm,
- diazepam (known under the common name Valium) as a continuous IV infusion,
- the autonomic effects of tetanus can be difficult to manage (alternating hyper- and hypotension, hyperpyrexia/hypothermia) and may require IV labetalol, magnesium, clonidine, or nifedipine.
Drugs such as chlorpromazine or diazepam, or other muscle relaxants can be given to control the muscle spasms. In extreme cases it may be necessary to paralyze the patient with curare-like drugs and use a mechanical ventilator.
In order to survive a tetanus infection, the maintenance of an airway and proper nutrition are required. An intake of 3500-4000 Calories, and at least 150g of protein per day, is often given in liquid form through a tube directly into the stomach, or through a drip into a vein. This high-caloric diet maintenance is required because of the increased metabolic strain brought on by the increased muscle activity.
PreventionTetanus can be prevented by vaccination. The CDC recommends that adults receive a booster vaccine every ten years, and standard care practice in many places is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated, or if he or she has had fewer than 3 lifetime doses of the vaccine. The booster cannot prevent a potentially fatal case of tetanus from the current wound, however, as it can take up to two weeks for tetanus antibodies to form. In children under the age of seven, the tetanus vaccine is often administered as a combined vaccine, DPT/DTaP vaccine, which also includes vaccines against diphtheria and pertussis. For adults and children over seven, the Td vaccine (tetanus and diphtheria) or Tdap (tetanus, diphtheria, and acellular pertussis) is commonly used. Nearly all of the cases in the United States occur in unimmunized individuals or individuals who have allowed their inoculations to lapse, whereas most cases in developing countries are due to the neonatal form of tetanus.
Tetanus is the only vaccine-preventable disease that is infectious but is not contagious.
Association with rustTetanus is often associated with rust, especially rusty nails, but this concept is somewhat misleading. Objects that accumulate rust are often found outdoors, or in places that harbour anaerobic bacteria, but the rust itself does not cause tetanus nor does it contain more C. tetani bacteria. The rough surface of rusty metal merely provides a prime habitat for a C. tetani endospore to reside. An endospore is a non-metabolising survival structure that begins to metabolise and cause infection once in an adequate environment. Because C. tetani is an anaerobic bacterium, it and its endospores will thrive in an environment that lacks oxygen. Hence, stepping on a nail (rusty or not) may result in a tetanus infection, as the low-oxygen (anaerobic) environment of a puncture wound provides the bacteria with an ideal breeding ground.
Famous tetanus victims
- George Montagu – English ornithologist; contracted tetanus when he stepped on a nail.
- Joe Powell – English footballer; contracted following amputation of a badly broken arm.
- John A. Roebling – Civil Engineer and Architect famous for his bridge designs, particularly the Brooklyn Bridge; contracted tetanus following amputation of his foot due to an injury caused by a ferry when it crashed into a wharf.
- George Crockett Strong – Union brigadier general in the American Civil War; from wounds sustained in the assault against Fort Wagner on Morris Island, South Carolina.
- Fred Thomson – silent film actor; stepped on a nail.
- Johann Tserclaes, Count of Tilly; wounded by a cannon ball in the Battle of Rain.
- Traveller – General Robert E. Lee's favourite horse; stepped on a nail.
- John Thoreau Jr. – brother of Henry David Thoreau.
- George Hogg – English adventurer who rescued war orphans in China; died in 1945 from an infection resulting from a foot injury.
- Tetanus Information from Medline Plus
- Tetanus Surveillance -- United States, 1998-2000 (Data and Analysis)
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