Tetanus is a vaccine preventable disease of the nervous system caused by a bacteria Clostridium tetani. This organism is widely distributed in soil contaminated with animal and human feces. The spores formed by the bacteria can survive for years and is resistant to various disinfectants and even boiling for about twenty minutes. Tetanus organism enters into the body after a skin injury that could range from a minor needle prick to a deep flesh wound. Once in human body, it produces a powerful protein toxin called tetanospasmin which causes increase in muscle tone and spasms. This disease is rare in developed world but is common in developing countries. A common practice of home delivery where non sterile knives are used to cut the umbilical cord leads to the development of tetanus in the newborn.

What are the Symptoms of Tetanus?

Tetanus symptoms appear between 7 to 14 days after the organism has entered into the body through injury

• Most common symptoms of tetanus is increase in muscle tone and spasms. The patient can notice increased tone of the jaw muscles while opening and closing the mouth. It is referred to as trismus or locked jaw.
• There can be difficulty in swallowing food/water.
• Increased tone of the abdominal muscle produces rigid abdomen and contraction of the back muscles leads to arching of the back (opisthotonus).
• Some patients suffer from painful and violent generalized body spasm which is triggered by slightest of stimulation such as a draft of air, loud noise, physical touch or light.
• There can be other associated signs and symptoms such as fever, excessive sweating, high blood pressure and increased heart rate.
• Complications of tetanus are broken bones due to violent body spasms, disability and death due to respiratory muscle spasm.

How is Tetanus Diagnosed?

Tetanus is diagnosed mainly by thorough history and physical examination. History of lack of immunization against tetanus and typical signs and symptoms like spasms, stiffness and pain are suggestive of tetanus. Laboratory tests are generally of less use in diagnosis of tetanus.

How do you treat Tetanus?

The goal of treatment in tetanus is to remove the source of infection, neutralize the unbound toxin, prevent muscle spasm and provide supportive care.

• The wound should be cleaned thoroughly and cleansed. Dirt, foreign objects and dead tissue should be removed from the wound.
• Antibiotics such as penicillin and metronidazole are prescribed to eradicate the organism and tetanus antitoxin is given to neutralize the toxin which has not yet bound with the nerve cells.
• Sedative drugs are given in order to control muscle spasms.
• Patients with compromised breathing may need to be kept in a ventilator.

Prevention

Tetanus occurs almost exclusively in people who are not immunized or hasn’t received a booster in last 10 years. Therefore all children should receive a primary series of vaccine. A booster dose is recommended every 10 years in adults. Pregnant women need to be immunized against tetanus during pregnancy in order to prevent tetanus in the newborn baby.