Symptoms and causes
Signs and symptoms of tetanus appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The average incubation period is seven to 10 days.
Common signs and symptoms of tetanus include:
- Spasms and stiffness in your jaw muscles (trismus)
- Stiffness of your neck muscles
- Difficulty swallowing
- Stiffness of your abdominal muscles
- Painful body spasms lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light
Possible other signs and symptoms include:
- Elevated blood pressure
- Rapid heart rate
When to see a doctor
See your doctor for a tetanus booster shot if you have a deep or dirty wound and you haven’t had a booster shot in five years. If you aren’t sure of when your last booster was, get a booster.
Or see your doctor about a tetanus booster for any wound — especially if it might have been contaminated with dirt, animal feces or manure — if you haven’t had a booster shot within the past 10 years or aren’t sure of when you were last vaccinated.
Spores of the bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores grow into bacteria that can produce a powerful toxin, tetanospasmin, which impairs the nerves that control your muscles (motor neurons). The toxin can cause muscle stiffness and spasms — the major signs of tetanus.
Nearly all cases of tetanus occur in people who have never been vaccinated or adults who haven’t kept up with their 10-year booster shots. You can’t catch tetanus from a person who has it.
The following increase your likelihood of getting tetanus:
- Failure to get vaccinated or to keep up to date with booster shots against tetanus
- An injury that lets tetanus spores into the wound
- A foreign body, such as a nail or splinter
Tetanus cases have developed from the following:
- Puncture wounds — including from splinters, body piercings, tattoos, injection drugs
- Gunshot wounds
- Compound fractures
- Surgical wounds
- Injection drug use
- Animal or insect bites
- Infected foot ulcers
- Dental infections
- Infected umbilical stumps in newborns born of inadequately immunized mothers
Once tetanus toxin has bonded to your nerve endings it is impossible to remove. Complete recovery from a tetanus infection requires new nerve endings to grow, which can take up to several months.
Complications of tetanus infection may include:
- Broken bones. The severity of spasms may cause the spine and other bones to break.
- Blockage of a lung artery (pulmonary embolism). A blood clot that has traveled from elsewhere in your body can block the main artery of the lung or one of its branches.
- Death. Severe tetanus-induced (tetanic) muscle spasms can interfere with or stop your breathing. Respiratory failure is the most common cause of death. Lack of oxygen may also induce cardiac arrest and death. Pneumonia is another cause of death.Doctors diagnose tetanus based on a physical exam, medical and immunization history, and the signs and symptoms of muscle spasms, stiffness and pain. Laboratory tests generally aren’t helpful for diagnosing tetanus .Tetanus, also known as lockjaw, is an infection characterized by muscle spasms. In the most common type the spasms begin in the jaw and then progress to the rest of the body. These spasms usually last a few minutes each time and occur frequently for three to four weeks. Spasms may be so severe that bone fractures may occur. Other symptoms may include fever, sweating, headache, trouble swallowing, high blood pressure, and a fast heart rate. Onset of symptoms is typically three to twenty-one days following infection. It may take months to recover. About 10% of those infected die.
Tetanus is caused by an infection with the bacterium Clostridium tetani, which is commonly found in soil, dust and manure.The bacteria generally enter through a break in the skin such as a cut or puncture wound by a contaminated object.They produce toxins that interfere with muscle contractions, resulting in the typical symptoms. Diagnosis is based on the presenting signs and symptoms. The disease does not spread between people.
Infection can be prevented by proper immunization with the tetanus vaccine. In those who have a significant wound and less than three doses of the vaccine both immunization and tetanus immune globulin are recommended. In those who are infected tetanus immune globulin or, if it is not available, intravenous immunoglobulin (IVIG) is used. The wound should be cleaned and any dead tissue should be removed. Muscle relaxants may be used to control spasms.Mechanical ventilation may be required if a person’s breathing is affected.
Signs and symptoms
Tetanus often begins with mild spasms in the jaw muscles—also known as lockjaw or trismus. The spasms can also affect the facial muscles resulting in an appearance called risus sardonicus. Chest, neck, back, abdominal muscles, and buttocks may be affected. 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, which is called “tetany”. These episodes can cause fractures and muscle tears. Other symptoms includedrooling, excessive sweating, fever, hand or foot spasms, irritability, difficulty swallowing, suffocation, heart attack, breathing problems, irregular heartbeat, and uncontrolled urination or defecation.
Even with treatment, about 10% of people who contract tetanus die.The mortality rate is higher in unvaccinated people and people over 60 years of age.
The incubation period of tetanus may be up to several months, but is usually about eight days.In general, the farther the injury site is from the central nervous system, the longer the incubation period. The shorter the incubation period, the more severe the symptoms. In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days. On the basis of clinical findings, four different forms of tetanus have been described.
Generalized tetanus is the most common type of tetanus, representing about 80% of cases. The generalized form usually presents with a descending pattern. The first sign is trismus, or lockjaw, and the facial spasms called risus sardonicus, followed by stiffness of the neck, difficulty in swallowing, and rigidity of pectoral and calf muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes with the body shaped into a characteristic form called opisthotonos. Spasms continue for up to four weeks, and complete recovery may take months. Sympathetic overactivity (SOA) is common in severe tetanus and manifests as labile hypertension, tachycardia, dysrhythmia, peripheral vasculature constriction, profuse sweating, fever, increased carbon dioxide output, increased catecholamine excretion and late development of hypotension. Death can occur within four days.
Neonatal tetanus is a form of generalized tetanus that occurs in newborns, usually those born to mothers who themselves have not been vaccinated. If the mother has been vaccinated against tetanus, the infants acquire passive immunity and are thus protected. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. As of 1998 neonatal tetanus was common in many developing countries and was responsible for about 14% (215,000) of all neonatal deaths. In 2010 the worldwide death toll was 58,000 newborns. As the result of a public health campaign, the death toll from neonatal tetanus was reduced by 90% between 1990 and 2010, and by 2013 the disease had been largely eliminated from all but 25 countries.Neonatal tetanus is rare in developed countries.
Local tetanus is an uncommon form of the disease, in which patients have persistent contraction of muscles in the same anatomic area as the injury. The contractions may persist for many weeks before gradually subsiding. Local tetanus is generally milder; only about 1% of cases are fatal, but it may precede the onset of generalized tetanus.
Cephalic tetanus is the rarest form of the disease and is limited to muscles and nerves in the head.It usually occurs after trauma to the head area, including skull fracture,laceration,eye injury dental extraction, and otitis media,but it has been observed from injuries to other parts of the body. Paralysis of the facial nerve is most frequently implicated, which may cause lockjaw, facial palsy, or ptosis, but other cranial nerves can also be affected. Cephalic tetanus may progress to a more generalized form of the disease. Due to its rarity, clinicians may be unfamiliar with the clinical presentation and may not suspect tetanus as the illness. Treatment can be complicated as symptoms may be concurrent with the initial injury that caused the infection. Cephalic tetanus is more likely than other forms of tetanus to be fatal, with the progression to generalized tetanus carrying a 15–30% case fatality rate.
Tetanus is caused by the tetanus bacterium Clostridium tetani. Tetanus is often associated with rust, especially rusty nails. Objects that accumulate rust are often found outdoors, or in places that harbour anaerobic bacteria, but the rust itself does not cause tetanus nor does it contain more C. tetani bacteria. The rough surface of rusty metal merely provides a prime habitat for C. tetani endospores to reside in (due to its high surface area), and the nail affords a means to puncture skin and deliver endospores deep within the body at the site of the wound.
An endospore is a non-metabolizing survival structure that begins to metabolize and cause infection once in an adequate environment. Because C. tetani is an anaerobic bacterium, it and its endospores thrive in environments that lack oxygen. Hence, stepping on a nail (rusty or not) may result in a tetanus infection, as the low-oxygen (anaerobic) environment is caused by the oxidization of the same object that causes a puncture wound, delivering endospores to a suitable environment for growth.
Tetanus is an international health problem, as C. tetani spores are ubiquitous. The disease occurs almost exclusively in persons unvaccinated or inadequately immunized. It is more common in hot, damp climates with soil rich in organic matter. This is particularly true with manure-treated soils, as the spores are widely distributed in the intestines and feces of many animals such as horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens Spores can be introduced into the body through puncture wounds. In agricultural areas, a significant number of human adults may harbor the organism. The spores can also be found on skin surfaces and in contaminated heroin.Heroin users, particularly those that inject the drug subcutaneously, appear to be at high risk of contracting tetanus.
Clostridium tetani is strongly durable due to its endospores. Pictured is the bacterium alone, with a spore being produced, and the spore alone.
Tetanus affects skeletal muscle, a type of striated muscle used in voluntary movement. The other type of striated muscle, cardiac, or heart muscle, cannot betetanized because of its intrinsic electrical properties.
The tetanus toxin initially binds to peripheral nerve terminals. It is transported within the axon and across synaptic junctions until it reaches the central nervous system. There it becomes rapidly fixed to gangliosides at the presynaptic inhibitory motor nerve endings, and is taken up into the axon by endocytosis. The effect of the toxin is to block the release of inhibitory neurotransmitters glycine and gamma-aminobutyric acid (GABA) across the synaptic cleft, which is required to check the nervous impulse. If nervous impulses cannot be checked by normal inhibitory mechanisms, the generalized muscular spasms characteristic of tetanus are produced. The toxin appears to act by selective cleavage of a protein component of synaptic vesicles, synaptobrevin II, and this prevents the release of neurotransmitters by the cells.
DiagnosisThere are currently no blood tests for diagnosing tetanus. The diagnosis is based on the presentation of tetanus symptoms and does not depend upon isolation of the bacterium, which is recovered from the wound in only 30% of cases and can be isolated from patients without tetanus. Laboratory identification of C. tetani can be demonstrated only by production of tetanospasmin in mice.Having recently experienced head trauma may indicate cephalic tetanus if no other diagnosis has been made.
- The “spatula test” is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a soft-tipped instrument and observing the effect. A positive test result is the involuntary contraction of the jaw (biting down on the “spatula”) and a negative test result would normally be a gag reflex attempting to expel the foreign object. A short report in The American Journal of Tropical Medicine and Hygiene states that, in a patient research study, the spatula test had a high specificity (zero false-positive test results) and a high sensitivity (94% of infected patients produced a positive test).
- Playing outdoors can mean getting cuts that may become infected with bacteria commonly found in soil, including the ones that cause tetanus. Tetanus vaccine can help prevent tetanus disease, commonly known as “lockjaw.” Tetanus is a serious disease that causes painful tightening of the muscles, usually all over the body. It can lead to “locking” of the jaw so the person cannot open his mouth or swallow. Tetanus leads to death in about one in ten cases.
- There are four combination vaccines used to prevent diphtheria, tetanus and pertussis (whooping cough): DTaP, Tdap, DT, and Td. Two of these (DTaP and DT) are given to children younger than seven years of age, and two (Tdap and Td) are given to older children and adults. Talk to your provider if you are unsure which vaccines you or your children have received in the past.
DTaP or DT
FOR INFANTS AND CHILDREN
- Children should get five doses of DTaP vaccine, one dose at each of the following ages:
- 2 months
- 4 months
- 6 months
- 15 through 18 months
- 4 through 6 years of age
- DT does not contain pertussis, and is used as a substitute for DTaP for children who cannot tolerate pertussis vaccine.
- DTaP vaccine may be given at the same visit as other vaccines.
- DTaP is not licensed for anyone over the age of six. Children older than six, adolescents, and adults may get a similar vaccine, Tdap or Td.
Td or Tdap
FOR PRETEENS, TEENS, AND ADULTS
- Td is a tetanus and diphtheria vaccine given to preteens, teens, and adults as a booster shot every ten years, or after an exposure to tetanus under some circumstances.
- Tdap is similar to Td but also contains protection against pertussis. Tdap should be given as a one-time booster in place of Td. Tdap is especially important for those in close contact with infants.
- Preteens and teens 11 through 18 years of age (preferably at age 11-12 years) should receive a single dose of Tdap.
- Adults 19 years of age and older who did not receive Tdap as a preteen or teen should also receive a single dose of Tdap.
- Pregnant women should receive a dose of Tdap during each pregnancy, preferably at 27 through 36 weeks to maximize that amount of protective antibodies passed to the baby, but the vaccine can be safely given at any time during pregnancy.
- New mothers who have never gotten Tdap should get a dose as soon as possible after delivery.
- Tdap should also be given to 7- through 10-year-olds who are not fully immunized against pertussis.
- Tdap can be given no matter when Td (tetanus and diphtheria vaccine) was last received.
Tetanus is an infection of the nervous system with a type of bacteria that is potentially deadly, calledClostridium tetani (C. tetani).
Spores of the bacteria C. tetani are found in the soil, and in animal feces and teeth. In the spore form,C. tetani can remain inactive in the soil. But it can remain infectious for more than 40 years.
You can get tetanus infection when the spores enter your body through an injury or wound. The spores release bacteria that spread in the body and make a poison called tetanospasmin (also known as tetanus toxin). This poison blocks nerve signals from your spinal cord to your muscles, causing severe muscle spasms. The spasms can be so powerful that they tear the muscles or cause fracturesof the spine.
The time between infection and the first sign of symptoms is about 7 to 21 days. Most cases of tetanus in the United States occur in those who have not been properly vaccinated against the disease.
Tetanus often begins with mild spasms in the jaw muscles (lockjaw). The spasms can also affect your chest, neck, back, and abdominal muscles. Back muscle spasms often cause arching, calledopisthotonos.
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:
- Excessive sweating
- Hand or foot spasms
- 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 diagnose tetanus.