Tetanus

Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and can threaten your life. Tetanus is commonly known as “lockjaw.”

Thanks to the tetanus vaccine, cases of tetanus are rare in the United States and other parts of the developed world. However, the disease remains a threat to those who aren’t up to date on their vaccinations, and is more common in developing countries.

There’s no cure for tetanus. Treatment focuses on managing complications until the effects of the tetanus toxin resolve.

Common side effects of the tetanus booster include painredness, warmth, swelling, itching, hives, and rash near the injection site; fever, headache, tirednessstomach upsetnauseavomitingdiarrhea, muscle aches and pains, or swollen glands.
 

Symptoms and causes

Symptoms

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:

  • Fever
  • Sweating
  • 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.

Causes

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.

Risk factors

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
  • Burns
  • Surgical wounds
  • Injection drug use
  • Animal or insect bites
  • Infected foot ulcers
  • Dental infections
  • Infected umbilical stumps in newborns born of inadequately immunized mothers

Complications

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 feversweatingheadachetrouble swallowinghigh 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, suffocationheart attackbreathing problemsirregular 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.

    Incubation period

    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

    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

     

    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

    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

    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.

Cause

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.

Pathophysiology

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.

  • Diagnosis

    There 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).

Causes

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.

Symptoms

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:

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.

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

Since there’s no cure for tetanus, treatment consists of wound care, medications to ease symptoms and supportive care.

Wound care

Cleaning the wound is essential to preventing growth of tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound.

Image result for tetanusImage result for tetanusMedications

  • Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus immune globulin. However, the antitoxin can neutralize only toxin that hasn’t yet bonded to nerve tissue.
  • Antibiotics. Your doctor may also give you antibiotics, either orally or by injection, to fight tetanus bacteria.
  • Vaccine. All people with tetanus should receive the tetanus vaccine as soon as they’re diagnosed with the condition.
  • Sedatives. Doctors generally use powerful sedatives to control muscle spasms.
  • Other drugs. Other medications, such as magnesium sulfate and certain beta blockers, might be used to regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine might be used for this purpose as well as sedation.

Supportive therapies

Severe tetanus infection often requires a long stay in an intensive care setting. Since sedatives can inhibit breathing, you might temporarily need a ventilator.

Prevention

Unlike many infectious diseases, recovery from naturally acquired tetanus does not usually result in immunity to tetanus. This is due to the extreme potency of the tetanospasmin toxin. Even a lethal dose of tetanospasmin is insufficient to provoke an immune response.

Tetanus can be prevented by vaccination with tetanus toxoid. The CDC recommends that adults receive a booster vaccine every ten years,and standard care practice in many places is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated, or if he or she has had fewer than three lifetime doses of the vaccine. The booster may not prevent a potentially fatal case of tetanus from the current wound, however, as it can take up to two weeks for tetanus antibodies to form.

In children under the age of seven, the tetanus vaccine is often administered as a combined vaccine, DPT/DTaP vaccine, which also includes vaccines against diphtheria and pertussis. For adults and children over seven, the Td vaccine (tetanus and diphtheria) or Tdap (tetanus, diphtheria, and acellular pertussis) is commonly used.

Post-exposure prophylaxis

Tetanus toxoid can be given in case of a suspected exposure to tetanus. In such cases, it can be given with or without tetanus immunoglobulin (also called tetanus antibodies or tetanus antitoxin It can be given as intravenous therapy or by intramuscular injection.

The guidelines for such events in the United States for non-pregnant people 11 years and older are as follows:

Vaccination statusClean, minor woundsAll other wounds
Unknown or less than 3 doses of tetanus toxoid containing vaccineTdap and recommend catch-up vaccinationTdap and recommend catch-up vaccination
Tetanus immunoglobulin
3 or more doses of tetanus toxoid containing vaccine AND less than 5 years since last doseNo indicationNo indication
3 or more doses of tetanus toxoid containing vaccine AND 5–10 years since last doseNo indicationTdap preferred (if not yet received) or Td
3 or more doses of tetanus toxoid containing vaccine AND more than 10 years since last doseTdap preferred (if not yet received) or TdTdap preferred (if not yet received) or Td

Treatment

Mild tetanus

Mild cases of tetanus can be treated with:

Severe tetanus

Severe cases will require admission to intensive care. In addition to the measures listed above for mild tetanus:

Drugs such as diazepam or other muscle relaxants can be given to control the muscle spasms. In extreme cases it may be necessary to paralyze the patient with curare-like drugs and use a mechanical ventilator.

In order to survive a tetanus infection, the maintenance of an airway and proper nutrition are required. An intake of 3,500 to 4,000 calories and at least 150 g of protein per day is often given in liquid form through a tube directly into the stomach (percutaneous endoscopic gastrostomy), or through a drip into a vein (parenteral nutrition). This high-caloric diet maintenance is required because of the increased metabolic strain brought on by the increased muscle activity. Full recovery takes 4 to 6 weeks because the body must regenerate destroyed nerve axon terminals

Treatment

Treatment may include:

  • Antibiotics
  • Bedrest with a calm 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, 1 out of 4 infected people die. The death rate for newborns with untreated tetanus is even higher. With proper treatment, less than 15% 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


When to Contact a Medical Professional

Call your health care provider right away if 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 call if 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 infection for 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 diphtheriapertussis, and tetanus.

Td vaccine or Tdap vaccine is used to maintain immunity in those age 7 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, should get a tetanus booster if it has been more 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 provider about your risk of getting tetanus 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 risk of tetanus.

Since there’s no cure for tetanus, treatment consists of wound care, medications to ease symptoms and supportive care.

Wound care

Cleaning the wound is essential to preventing growth of tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound.

Image result for tetanusImage result for tetanusMedications

  • Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus immune globulin. However, the antitoxin can neutralize only toxin that hasn’t yet bonded to nerve tissue.
  • Antibiotics. Your doctor may also give you antibiotics, either orally or by injection, to fight tetanus bacteria.
  • Vaccine. All people with tetanus should receive the tetanus vaccine as soon as they’re diagnosed with the condition.
  • Sedatives. Doctors generally use powerful sedatives to control muscle spasms.
  • Other drugs. Other medications, such as magnesium sulfate and certain beta blockers, might be used to regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine might be used for this purpose as well as sedation.

Supportive therapies

Severe tetanus infection often requires a long stay in an intensive care setting. Since sedatives can inhibit breathing, you might temporarily need a ventilator.

Prevention

Unlike many infectious diseases, recovery from naturally acquired tetanus does not usually result in immunity to tetanus. This is due to the extreme potency of the tetanospasmin toxin. Even a lethal dose of tetanospasmin is insufficient to provoke an immune response.

Tetanus can be prevented by vaccination with tetanus toxoid. The CDC recommends that adults receive a booster vaccine every ten years,and standard care practice in many places is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated, or if he or she has had fewer than three lifetime doses of the vaccine. The booster may not prevent a potentially fatal case of tetanus from the current wound, however, as it can take up to two weeks for tetanus antibodies to form.

In children under the age of seven, the tetanus vaccine is often administered as a combined vaccine, DPT/DTaP vaccine, which also includes vaccines against diphtheria and pertussis. For adults and children over seven, the Td vaccine (tetanus and diphtheria) or Tdap (tetanus, diphtheria, and acellular pertussis) is commonly used.

Post-exposure prophylaxis

Tetanus toxoid can be given in case of a suspected exposure to tetanus. In such cases, it can be given with or without tetanus immunoglobulin (also called tetanus antibodies or tetanus antitoxin It can be given as intravenous therapy or by intramuscular injection.

The guidelines for such events in the United States for non-pregnant people 11 years and older are as follows:

Vaccination statusClean, minor woundsAll other wounds
Unknown or less than 3 doses of tetanus toxoid containing vaccineTdap and recommend catch-up vaccinationTdap and recommend catch-up vaccination
Tetanus immunoglobulin
3 or more doses of tetanus toxoid containing vaccine AND less than 5 years since last doseNo indicationNo indication
3 or more doses of tetanus toxoid containing vaccine AND 5–10 years since last doseNo indicationTdap preferred (if not yet received) or Td
3 or more doses of tetanus toxoid containing vaccine AND more than 10 years since last doseTdap preferred (if not yet received) or TdTdap preferred (if not yet received) or Td

Treatment

Mild tetanus

Mild cases of tetanus can be treated with:

Severe tetanus

Severe cases will require admission to intensive care. In addition to the measures listed above for mild tetanus:

Drugs such as diazepam or other muscle relaxants can be given to control the muscle spasms. In extreme cases it may be necessary to paralyze the patient with curare-like drugs and use a mechanical ventilator.

In order to survive a tetanus infection, the maintenance of an airway and proper nutrition are required. An intake of 3,500 to 4,000 calories and at least 150 g of protein per day is often given in liquid form through a tube directly into the stomach (percutaneous endoscopic gastrostomy), or through a drip into a vein (parenteral nutrition). This high-caloric diet maintenance is required because of the increased metabolic strain brought on by the increased muscle activity. Full recovery takes 4 to 6 weeks because the body must regenerate destroyed nerve axon terminals

Treatment

Treatment may include:

  • Antibiotics
  • Bedrest with a calm 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, 1 out of 4 infected people die. The death rate for newborns with untreated tetanus is even higher. With proper treatment, less than 15% 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


When to Contact a Medical Professional

Call your health care provider right away if 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 call if 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 infection for 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 diphtheriapertussis, and tetanus.

Td vaccine or Tdap vaccine is used to maintain immunity in those age 7 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, should get a tetanus booster if it has been more 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 provider about your risk of getting tetanus 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 risk of tetanus.

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