Tetanus

Tetanus (from Ancient Greek τέτανος 'tension', 'stretched', 'rigid'), also known as lockjaw, is a bacterial infection caused by Clostridium tetani and characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually lasts for a few minutes. Spasms occur frequently for three to four weeks. Some spasms may be severe enough to fracture bones. Other symptoms of tetanus may include fever, sweating, headache, trouble swallowing, high blood pressure, and a fast heart rate. The onset of symptoms is typically 3 to 21 days following infection. Recovery may take months; about 10% of cases prove to be fatal. C. tetani is commonly found in soil, saliva, dust, and manure. The bacteria generally enter through a break in the skin, such as a cut or puncture wound caused by a contaminated object. They produce toxins that interfere with normal muscle contractions. Diagnosis is based on the presenting signs and symptoms. The disease does not spread between people. Tetanus can be prevented by immunization with the tetanus vaccine. In those with a significant wound and who have had fewer than three doses of the vaccine, both vaccination and tetanus immune globulin are recommended. The wound should be cleaned, and any dead tissue removed. In those who are infected, tetanus immune globulin, or, if unavailable, intravenous immunoglobulin (IVIG) is used. Muscle relaxants may be used to control spasms. Mechanical ventilation may be required if a person's breathing is affected. Tetanus occurs in all parts of the world but is most frequent in hot and wet climates where the soil has a high organic content. In 2015, there were about 209,000 infections and about 59,000 deaths globally. This is down from 356,000 deaths in 1990. In the US, since 2010, there have been less than 40 reported cases each year, almost all of which were in people who had not been vaccinated. An early description of the disease was made by Hippocrates in the 5th century BC. The cause of the disease was determined in 1884 by Antonio Carle and Giorgio Rattone at the University of Turin, and a vaccine was developed in 1924.

Signs and symptoms Tetanus often begins with mild spasms in the jaw muscles—also known as lockjaw. Similar spasms can also be a feature of trismus. The spasms can also affect the facial muscles, resulting in an appearance called risus sardonicus. Chest, neck, back, abdominal muscles, and buttocks may be affected. Back muscle spasms often cause arching, called opisthotonus. Sometimes, the spasms affect muscles utilized during inhalation and exhalation, which can lead to breathing problems. Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups, called tetany. These episodes can cause fractures and muscle tears. Other symptoms include fever, headache, restlessness, irritability, feeding difficulties, breathing problems, burning sensation during urination, urinary retention, and loss of stool control. Even with treatment, about 10% of people who contract tetanus die. The mortality rate is higher in unvaccinated individuals, and in people over 60 years of age.

Incubation period The incubation period of tetanus may be up to several months, but is usually about ten days. In general, the farther the injury site is from the central nervous system, the longer the incubation period. Shorter incubation periods will have more severe symptoms. In trismus nascentium (i.e., neonatal tetanus), symptoms usually appear from 4 to 14 days after birth, averaging about 7 days. Based on clinical findings, four different forms of tetanus have been described.

Generalized tetanus Generalized tetanus is the most common type, representing about 80% of cases. The generalized form usually presents with a descending pattern. The first sign is trismus or lockjaw, then facial spasms (called risus sardonicus), followed by stiffness of the neck, difficulty in swallowing, and rigidity of pectoral and calf muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes, with the body shaped into a characteristic form called opisthotonos. Spasms continue for up to four weeks, and complete recovery may take months.

Neonatal tetanus

Neonatal tetanus (trismus nascentium) is a form of generalized tetanus that occurs in newborns, usually those born to mothers who themselves have not been vaccinated. If the mother has been vaccinated against tetanus, the infants acquire protection through passive immunity. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. As of 1998, neonatal tetanus was common in many developing countries, and was responsible for about 14% (215,000) of all neonatal deaths. In 2010, the worldwide death toll was approximately 58,000 newborns. As a result of a public health campaign, the death toll from neonatal tetanus was reduced by 90% between 1990 and 2010. By 2013, the disease had been largely eliminated from all but 25 countries. Neonatal tetanus is rare in developed countries.

Local tetanus Local tetanus is an uncommon form of the disease, in which people have persistent muscle contractions in the same anatomic area as the injury. The contractions may persist for many weeks before gradually subsiding. Local tetanus is generally milder; only about 1% of cases are fatal, but it may precede the onset of generalized tetanus.

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