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| |    Tetanus by Lynn Cates, M.D., F.A.A.P. reviewed by Laura Jana, M.D., F.A.A.P. Tetanus is a potentially fatal disease of the nervous system that can easily be prevented by an exceptionally safe and effective vaccine. Thanks to this vaccine, most people in developed countries like the United States have not had to witness the devastating effects of tetanus, but it is still all too common a sight in many parts of the world. Currently, there are only about 50 cases of tetanus in the United States each year, but there are about one million cases of tetanus worldwide, with an estimated half a million deaths per year among children in developing countries. What are the symptoms? Tetanus is characterized by strong and very painful contractions of muscles, particularly of the jaw and neck, earning it the common nickname of "lockjaw." It also leads to severe muscle spasms throughout the body. What causes tetanus? Tetanus is caused by a powerful nerve toxin (or poison) produced by the bacterium Clostridium tetani, which can be found anywhere there is soil and manure--in other words, just about everywhere. Who gets the disease? Anyone who has not been immunized or is not up-to-date on his tetanus immunizations is susceptible to tetanus. Babies born to mothers who have not been immunized against this disease are at particularly high risk of developing tetanus. Babies born to mothers who are up-to-date on their tetanus vaccine are protected because maternal antibodies readily cross the placenta and enter the baby's circulation. The disease is more common in males than females. In older children and adults, this may be because males are more likely to injure themselves than females. However, for reasons that aren't understood, baby boys are also more commonly affected than girls. How is it spread? Tetanus is contracted from the introduction of soil or manure directly into breaks in the skin (even tiny ones). It is not transmitted from person to person, or from animals to people. Your parents probably always warned you to be careful not to step on a rusty nail, and they were right--puncture wounds are one of the most common ways to get tetanus. The bacteria enter the body when the nail pushes soil (not rust!) into the body. They thrive particularly well in deep puncture wounds or cuts because they grow best when not exposed to oxygen. Although we usually associate tetanus with punctures or cuts, it can occur when there is any break in the skin, including those caused by animal bites, dental problems, or burns. Newborns who are not protected by their mothers' antibodies most often acquire tetanus through contamination of the umbilical stump. It is a particularly common problem when babies are routinely delivered in the home under unhygienic conditions. Tetanus occurs throughout the world, but is more common in warm climates. In newborns, the symptoms generally appear about 5 to 14 days after exposure. In older children and adults, the incubation period (that is, the time from exposure to the onset of symptoms) is from 2 days to several months. Most cases occur within two to three weeks of when the person was exposed. When should you suspect tetanus? Full-blown tetanus causes a typical pattern of severe muscle spasms, especially of the jaw and neck. It usually comes on gradually over a period of a day to a week. The muscle contractions are so strong they can break children's bones. In people who are partially immunized against tetanus, the muscle spasms may be milder, or may be localized to the area around the wound. How is it diagnosed? Occasionally the organism can be cultured from the wound, but usually the diagnosis is made based on the symptoms, a history of no (or only partial) tetanus immunization, and tests that rule out other conditions that can lead to muscle spasms (such as low blood calcium levels, seizures, and some kinds of poisonings). What is the treatment? Treatment for tetanus always requires the attention of a healthcare professional. It includes careful cleansing of the wound (including cutting away dead tissue around the area when needed), injection of tetanus immune globulin to help neutralize the toxin, and supportive care. Patients may need drugs to help relax their muscles, oxygen and ventilator support to help them breathe, and supplemental nutrition and fluids. An important part of their treatment is to disturb them as little as possible to prevent triggering the spasms. What is the outcome of tetanus? Spasms can last a week to many weeks. Those who survive generally have to spend prolonged periods of time in intensive care units. If a patient pulls through, there usually are no long-term effects unless the oxygen supply to the brain was cut off for a while by the spasms, resulting in brain damage. Unfortunately, death is common, occurring in about 1 in 10 cases.
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