Karen Kline
To Graham, Alan ; Corrine Romero
info@wholelifeclinic.org
Sent: Thursday, October 28, 2004
Subject: Please read, "How is tetanus diagnosed?" toward the bottom of this article
Tetanus
Health24
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.
Alternative names
lockjaw
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. 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People who have not been immunised against tetanus, or those whose last immunisation is no longer
current, are at risk of getting tetanus if they've suffered an open wound.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.
Reviewed by Dr Andrew Whitelaw, MBBCh (Witwatersrand), MSc (UCT), FCPath (Micro) (SA).
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Karen Kline