Tetanus
Tetanus is a disease caused by the
bacterium Clostridium tetani, which enters the body through an open
wound.
People at risk are those who do not
have current immunisation against tetanus.
Stiffness
of the jaw is often the first sign of tetanus.
Without treatment, one out of
three people affected will die.
Immunisation is
the best way to prevent infection: booster vaccinations should be given at least
every 10 years.
What
is tetanus?
Tetanus is a disease caused by a toxin produced by the bacterium
Clostridium tetani. The toxin affects the central nervous system, sometimes
resulting in death.
What causes
tetanus?
Spores of the bacterium Clostridium tetani are found in soil
and dust. Tetanus occurs when these spores enter the body through a break in the
skin, particularly in the case of puncture wounds caused by nails, splinters,
insect bites or gunshots. Bites and scratches from animals such as dogs and cats
can also result in tetanus. Once in the body, the spores germinate, releasing
active bacteria that multiply and produce neurotoxin. The bacteria stay at the
site of inoculation, but the toxin can spread through the body. This toxin
causes uncontrollable contraction of muscles, resulting in severe muscle spasms.
Who gets
tetanus and who is at risk?
People who have not been immunised against tetanus, or those whose
last immunisation is no longer current, are at risk of getting tetanus if
they’ve suffered an open wound.
In
recent years, two thirds of all tetanus cases have been in persons 50 years of
age and older.
Having
had a tetanus infection in the past does not make you immune to tetanus in the
future. Without treatment, one out of three affected people will die. The
mortality rate for newborns with untreated tetanus is even higher - two out of
three.
Symptoms and signs of tetanus
Common symptoms of tetanus include:
Stiffness of the jaw - usually the
first sign of tetanus
Stiffness of the neck and other
muscles
Spasms of the neck and other muscles
Rigidity of the chest muscles
Rigidity of the abdominal muscles
Spasms and rigidity of the back
muscles, often causing arching of the back
Seizures – painful, powerful bursts of
muscle contraction
Irritability
Fever
Other symptoms
may include:
Excessive sweating
Difficulty
swallowing
Hand or foot spasms
Drooling
Uncontrolled
urination
Uncontrolled
defecation
Tetanus
can develop even after a wound which appears trivial and uninfected.
The
incubation period is five days to 15 weeks.
How
is tetanus diagnosed?
Diagnosis of tetanus is based on the relevant medical history (Has
there been a break in the skin? When was the last tetanus shot received?) and
physical findings (common symptoms of tetanus).
Diagnostic tests, such as testing cultures of the wound site, are generally of
little value. Two thirds of the time, wounds test negative for the
Clostridium bacterium. Other tests that may be performed are tests to rule
out meningitis, rabies, strychnine poisoning or other diseases with similar
symptoms.
Can
tetanus be prevented?
The most important weapon against tetanus is adequate immunisation.
Most people receive their first vaccine as children in the form of a combined
tetanus-diptheria-pertussis (whooping cough) vaccine known as DTP. Booster shots
are given to teenagers and adults as a Td booster or singly as tetanus only.
Immunisation is considered to provide protection for 10 years.
Older
teenagers and adults who have been injured, especially with puncture-type
injuries, should receive booster immunisations for tetanus if their last
immunisation was more than 10 years previously. However, some medical experts
suggest that a vaccine is necessary if you haven’t had a booster in the last
5-10 years.
Thorough
cleaning of all injuries and wounds and the removal of dead or severely injured
tissue when appropriate, may reduce the risk of developing tetanus.
Make an
appointment with your doctor if you have never been immunised against tetanus,
or if you are unsure of your tetanus immunisation status.
How
is tetanus treated?
The first step in treatment is to control and reverse the tetanus
with antitoxin. Because of the possible danger of hypersensitivity to horse
serum antitoxin, tetanus immune globulin, which is derived from human serum
instead, is preferred when available. This prevents hypersensitivity reactions
to the toxin.
The
second step is to remove and destroy the source of the toxin. The wound area
must be carefully cleaned, and all dead tissue and foreign substances removed.
Surgical removal of infected tissue may also be necessary. Penicillin is given
intravenously to kill the toxin-producing Clostridium tetani.
Symptoms
of tetanus can be treated with supportive therapy. Muscle spasms can be treated
with muscle relaxants such as diazepam. Bed rest in a non-stimulating
environment (dim light, reduced noise, and stable temperature) is also
recommended.
During a
tetanus attack, sedatives are given to reduce the frequency of convulsions.
Padded side rails are also applied to the bed to prevent injury during a
seizure.
Antibiotics may be used to help combat secondary infection with other bacteria.
Fluids and nourishment are usually given intravenously during the acute stage of
the disease. Respiratory support with oxygen, endotracheal tube (a tube inserted
into the wind-pipe) and mechanical ventilation may also be necessary.
What
is the outcome of tetanus?
The death rate is high in children and the elderly. Wounds on the
head or face seem to be more dangerous than those on the body. If the person
survives the acute illness, recovery is generally complete. Uncorrected episodes
of hypoxia (lack of oxygen) caused by muscle spasms in the larynx (throat) may
lead to irreversible brain damage.
When to call
the doctor
Call your doctor if you sustain an open wound and you have not
received a tetanus booster within five years.
