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Tetanus

Clostridium tetani is a type of bacteria responsible for Tetany. The bacteria are found in two forms: as a spore (dormant) or as a vegetative cell (active) that can multiply.

Transmission

The spores are in soil, dust, and animal waste and can survive there for many years. These spores are resistant to extremes of temperature. The contamination of a wound with tetanus spores is common. Tetanus can only occur when the spores germinate and become active bacterial cells.

The active bacterial cells release two exotoxins; tetanolysin and tetanospasmin. The function of tetanolysin is unclear, but tetanospasmin is responsible for the disease.

The disease typically follows an acute injury that results in a break in the skin. Most cases result from a puncture wound, laceration or an abrasion.

Other tetanus-prone injuries include the following:

  • frostbite;
  • surgery;
  • crush wound;
  • abscesses;
  • childbirth; and
  • IV drug users (site of needle injection).

Tetanus may develop in people who are not immunized against it or in people who have failed to maintain adequate immunity with active booster doses of vaccine.

Symptoms

The hallmark feature of tetanus is muscle rigidity and spasms. In generalized tetanus, the initial complaints may include any of the following: Irritability, muscle cramps, sore muscles, weakness, or difficulty swallowing.

Facial muscles are often affected first. Trismus or lockjaw is most common. Muscle spasms are progressive and may include a characteristic arching of the back known as opisthotonus. Muscle spasms may be intense enough to cause bones to break and joints to dislocate.

Severe cases can involve spasms of the vocal cords or muscles involved in breathing. If this happens, death is likely, unless medical help is readily available.

Prevention

The majority of all adult types of tetanus cases can be prevented by active immunisation; neonatal cases are prevented by good hygiene and careful, sterile technique used to sever the umbilical cord and later (at 2 months old), beginning active immunizations. There are two main vaccines: for paediatric populations, DTPa (diphtheria, tetanus and acellular pertussis combination vaccine) is used; for non-immunised adults and booster shots, DTPa (tetanus and reduced amounts of diphtheria and acellular pertussis combination vaccine).

People who are not completely immunised and have a tetanus-prone wound should receive a tetanus booster in addition to tetanus antibodies.

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