Tetanus : Lock Jaw

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What is Tetanus? .

Tetanus is a serious life-threatening condition that affects the brain and the entire nervous system caused by a toxin of a common bacterium, Clostridium tetani. The spores of this bacterium are practically not found in virgin soil but frequently present in cultivated soil. It is also found in the human colon, house dust, animal feces, warehouses, contaminated heroin, and even in operating rooms. Indeed, they may be found anywhere. Once the spores penetrate the wounded skin, they germinate and produce a toxin (tetanospasmin) that invades the blood stream causing the illness.

Why is it called Lockjaw?

Tetanospasmin, next to botulism toxin, is one of the most potent microbial poisons. Once the spores are in the blood stream, they move inward toward the spinal cord at a speed of about 0.416 inch an hour, or about ten inches a day. After a week to 3 weeks, they start to cause short-circuiting of the nerve signals and block the ability of the muscles to relax. As a result, sustained muscle contractions develop, including lockjaw. The spasms of the facial muscles spread to the neck (causing nuchal rigidity, meaning stiffness of the neck), the hands, arms and legs, and also to the back, leading to severe (often fatal) breathing distress. Somehow, the spasms are initiated and aggravated by noise or touch.

How deadly is tetanus?

The mortality rate of tetanus is about 40% after it has spread, even in state-of-the-art medical centers. Each year, about one million infants die of tetanus because of poor hygiene. After the U.S. immunization laws were legislated in the 1970s, the reported cases of tetanus dramatically dropped to about 50 cases annually (75% of these are adults who have never had immunization).

How does tetanus spores enter our body?

The tetanus spores enter our system thru animal bites, burns, ulcers, infected umbilical cords, contaminated surgical wounds, needle injection sites, and thru the commonly blamed "rusty nail." Wounds resulting from any dirty item which has been in contact with soil or animal dung are suspect. The incubation period (time span from exposure to appearance of symptoms) averages two weeks, although in some cases lasting to several months.

What are the signs and symptoms?

The initial presentation may include headache and depression, malaise and fever, followed by swallowing discomfort and difficulty opening the jaws. Then, the neck becomes stiff and the cheek muscles go into spasm, giving the face a sardonic grin (risus sardonicus). Irritability soon develops and the spasms involve the entire body, leading to painful involuntary contraction of all muscles. There will be restlessness, anorexia and uncontrolled drooling of saliva. In a few cases, tetanus develops even without a previous history of a cut or a wound.

Can one get tetanus from a minor skin prick?

If the person is not immunized, yes, even from pricking a finger on a rose thorn, or a tiny needle stick. A study from Great Britain reported that about 33% of tetanus cases in that country resulted from a very trivial injury the patients had not even noticed or remembered. This is why immunization is very important in preventing this fatal disease.

How deadly is tetanus toxin?

The tetanus toxin is deadly poisonous (second only to botulism toxin). One tenth of a milligram of tetanospasmin is the fatal dose for an adult. Once this toxin reaches the nervous system, it can no longer be neutralized by antibodies produced by immunization or even by antitoxin. Prognosis in these cases is almost always fatal. Again, prevention is the key.

Is this bacterium an anaerobe?

Yes, Clostridium tetani is an anaerobe, meaning it is killed off by oxygen and grows only in oxygen-free environment. This is the reason wounds are washed thoroughly with water (H20) and hydrogen peroxide (H202) used by many to aerate the wounds, dilute the contamination, and kill the spores. This is also why deep penetrating wounds, where oxygen is least or absent, have a higher risk of developing tetanus among unimmunized individuals.

What vaccine is available to prevent tetanus?

DTaP immunization (used to be known as DPT) incorporates vaccines for the prevention of Diptheria (severe throat infection), Pertusis (whooping cough) and Tetanus. This is given when the infant is 2 months old, 4 months and six months, a set of 3 shots. A fourth injection is given when the child is 12-18 months old, a fifth shot at age 4 to 6, and a booster Tetanus-Diptheria (Td) at age 11 to 12 years old. Among adults, vaccination with Td is recommended every ten years. Adults who never had any immunization for tetanus will require a series of 3 injections of Td vaccine.

Can there be allergy to the vaccine?

Yes, it is possible for a person to be allergic to DTap or any other vaccines, or to any drug, for that matter. Your physician will guide you accordingly after a good history-taking and a thorough physical examination. The valuable benefits from immunization of any type is certainly worth the little risk getting it might entail. In general, available vaccines today are very safe.

How is the tetanus patient managed?

The main objective of the treatment is to tide the patient over the stage of the ailment preventing any deadly complications from occurring. The problems include asphyxia (suffocation) during spasm, exhaustion from generalized involuntary body spasms, pneumonia resulting from stomach contents backing up and into the lungs, and demise as a consequence of disorders of the control of vital brain functions like blood pressure, heart rhythm, and breathing. Penicillin and anti-toxin are given, plus a lot of supportive care.

Does the patient have to be on a ventilator?

Not all, but some cases may require a tracheostomy (a finger-size metal tube inserted thru the neck to the breathing pipe to allow patients to breathe better) and this tube is connected to a respirator, which will take over the breathing for the patient until he is able to breathe well on his/her own. The milder cases may respond to simple sedation and a quiet room to prevent spasms and not need a tracheostomy and/or a respirator.

Is it not too late to be immunized?

Unless one already has been infected with a full blown tetanus, it is never too late to have prophylactic (preventive) immunization. The procedure is simple and most effective, and it behooves everyone to acquire this protection from a horrible and deadly disease, a fatal illness that is preventable. For a more specific and personal advice, tailored to your individual situation and need, consult your physician. Your appropriate and prompt attention may save your life.

©2003Raoul R. Diez, M.A.O.D.