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    Tetanus

    Lockjaw; Trismus

    Tetanus is infection of the nervous system with the potentially deadly bacteria Clostridium tetani (C. tetani).

    Causes

    Spores of the bacteria C. tetaniare foundin the soil, in animal feces andanimal teeth. In the spore form, C. tetanican remain inactive in the soil. But it can remain infectious for more than 40 years.

    You can get tetanus infection when the spores enteryour body through an injury or wound. The spores release bacteria that spread in the body and make a poison called tetanospasmin. This poison blocks nerve signals fromyour spinal cord toyour muscles, causing severe muscle spasms. The spasms can be so powerful that they tear the muscles or cause fractures of the spine.

    The time between infection and the first sign of symptoms isabout 7 to 21 days. Most cases of tetanus in the United States occur in those who have not been properly vaccinated against the disease.

    Symptoms

    Tetanus often begins with mild spasms in the jaw muscles (lockjaw). The spasms can also affectyour chest, neck, back, and abdominal muscles. Back muscle spasms often cause arching, called opisthotonos.

    Sometimes the spasms affect muscles that help with breathing, which can lead to breathing problems.

    Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups. This is called tetany. These episodes can cause fractures and muscle tears.

    Other symptoms include:

    • Drooling
    • Excessive sweating
    • Fever
    • Hand or foot spasms
    • Irritability
    • Swallowing difficulty
    • Uncontrolled urination or defecation

    Exams and Tests

    Your doctor will perform a physical exam and ask about your medical history. No specific lab test is available to determine the diagnosis of tetanus.

    Tests may be used to rule out meningitis, rabies, strychnine poisoning, and other diseases with similar symptoms.

    Treatment

    Treatment may include:

    • Antibiotics
    • Bedrest with a nonstimulating environment (dim light, reduced noise, and stable temperature)
    • Medicine to reverse the poison (tetanus immune globulin)
    • Muscle relaxers such as diazepam
    • Sedatives
    • Surgery to clean the wound and remove the source of the poison (debridement)

    Breathing support with oxygen, a breathing tube, and a breathing machine may be necessary.

    Outlook (Prognosis)

    Without treatment, one out of four infected people die. The death rate for newborns with untreated tetanus is even higher. With proper treatment, less than 10% of infected patients die.

    Wounds on the head or face seem to be more dangerous than those on other parts of 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 throat may lead to irreversible brain damage.

    Possible Complications

    • Airway obstruction
    • Respiratory arrest
    • Heart failure
    • Pneumonia
    • Fractures
    • Brain damage due to lack of oxygen during spasms

    When to Contact a Medical Professional

    Call your health care provider right awayif you have an open wound, particularly if:

    • You are injured outdoors.
    • The wound has been in contact with soil.
    • You have not received a tetanus booster (vaccine) within 5 years or you are not sure of your vaccination status.

    Call for an appointment with your health care provider if you have never been immunized against tetanus as an adult or child. Also callif your children have not been immunized, or if you are unsure of your tetanus immunization (vaccine) status.

    Prevention

    IMMUNIZATION

    Tetanus is completely preventable by being immunized (vaccinated). Immunization usually protects against tetanus infectionfor 10 years.

    In the United States, immunizations begin in infancy with the DTaP series of shots. The DTaP vaccine is a 3-in-1 vaccine that protects against diphtheria, pertussis, and tetanus.

    Td vaccine or Tdap vaccine is used to maintain immunity in those age7 and older. Tdap vaccine should be given once,before age 65, as a substitute for Td for those who have not had Tdap. Td boosters are recommended every 10 years starting at age 19.

    Older teenagers and adults who get injuries, especially puncture-type wounds, shouldget a tetanusbooster if it has beenmore than 10 years since the last booster.

    If you have been injured outside or in any way that makes contact with soil likely, contact your health care providerabout your riskof gettingtetanus infection. Injuries and wounds should be thoroughly cleaned right away. If the tissue of the wound is dying, a doctor will need to remove the tissue.

    You may have heard that you can get tetanus if you are injured by a rusty nail. This is true only if the nail is dirty and has the tetanus bacteria on it. It is the dirt on the nail, not the rust, that carries the riskof tetanus.

    References

    Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedules for Persons Aged 0 Through18 Years and Adults Aged 19 Years and Older — United States, 2013. MMWR. 2013;62(Suppl 1):1-19.

    Gerding DN, Johnson S. Clostridial infections. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA:Elsevier Saunders; 2011:chap 304.

    Reddy P, Bleck TP. Clostridium tetani (Tetanus). In: Mandell GL, Bennett JE, Dolan R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Saunders; 2009:chap 244.

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              Review Date: 1/29/2013

              Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

              The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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