Tetanus

Dr. Parang Mehta, MD.

The disease is caused by bacteria named Clostridium tetani which enter the body usually by way of contaminated wounds.  Babies can also get it if the umbilical cord is cut with unsterile instruments at the time of birth, especially if their mothers have not received the tetanus toxoid vaccine during pregnancy.  

The bacteria are not invasive, and multiply only locally at their site of egress.  The bacteria do not cause much local problem, and the injury is often forgotten.  However, they produce a powerful toxin, tetanospasmin, which migrates to the nervous system and attaches to the nerves. The symptoms of tetanus usually occur 2-14 days later, but may be delayed for several months.

Signs of Tetanus

The toxin causes intense stimulation of the nervous system, causing the unfortunate patient to have painful spasms of the muscles.  The first sign is often "lockjaw", caused by a spasm of the masseter muscle.  Other early signs are headache, difficulty swallowing, neck stiffness, irritability, and restlessness.

Spasms gradually increase to involve the entire body.   In severe spasm, the patient's body may be bent like a bow, with only the heels and back of the head touching the bed.  Spasms can be triggered by light, sound, or touch, and are intensely painful.  The patient is unfortunately fully conscious, in agony, and in terrified apprehension of the next spasm.  Once the toxin has reached the nerves, the binding is irreversible, and tetanus before the advent of modern intensive care was usually fatal.

The Manifestations of Tetanus

Generalised tetanus is the most common type seen.  It is caused by bloodstream spread of the tetanus toxin to all parts of the body.  The child has spasm of the head and neck muscles first, followed by spread to the rest of the body.

Localised tetanus is a rare type.  The muscle spasms are limited to the area of the injury, and this type of disease is rarely fatal.  The spasms may last for many weeks, and sometimes the disease may progress to generalised tetanus.

Cephalic tetanus is another rare form of tetanus, which is limited to the head and the parts of the body controlled by the cranial nerves (the spinal nerves are not affected).  It usually is associated with injuries to the head, or with ear infections.

Neonatal tetanus is a deadly disease, and causes thousands of deaths in areas where tetanus vaccination is not common, especially in developing countries.  With vaccination, the mother develops antibodies to tetanus, and passes them on to the baby through the placenta.  Without vaccination, the mother has no antibodies, and the baby is born without any protection against tetanus.  If the umblical cord is cut by an unclean instrument, the cord stump is likely to get infected with tetunus bacteria, and the baby will develop tetanus.  Neonatal tetanus is generalied, and has a high death rate.

Treatment of Tetanus

The treatment of tetanus is difficult.  Removal of infected tissue, antibiotics to kill the Clostridium tetani, and tetanus immune globulin, are initial measures.  Muscle relaxants and paralytic agents, with artificial (mechanical) respiration are components of successful therapy.

Prevention of Tetanus

Tetanus can be prevented by the tetanus toxoid.  Vaccination of children is started at the age of 6 weeks (see link below for details of vaccines available).  Before the practice of vaccinating pregnant women with tetanus toxoid was adopted, tetanus of the newborn (tetanus neonatorum) was a major cause of neonatal deaths.

See also: Tetanus Vaccination

 

Last Revision: May 22, 2020