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Tetanus

Definition

Tetanus is a bacterial infection that affects the nervous system. Tetanus bacteria from soil, dust, or manure enter the body through a break in the skin. The infection may result in severe muscle spasms. Such spasms lead to lockjaw, which prevents opening or closing of the mouth. Tetanus can be fatal.

Nervous System

CNS and PNS

© 2008 Nucleus Medical Art, Inc.

Causes

Tetanus is caused by a toxin produced by the spores of the bacterium Clostridium tetani .

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Your risk of tetanus is increased if you are:

  • Not immunized to tetanus
  • Not updating tetanus shot regularly
  • An IV drug user
  • Age: 50 or older
  • Have skin sores or wounds
  • Have had burns
  • Have had exposure of open wounds to soil or animal feces

Symptoms

Symptoms of tetanus may include:

  • Headache
  • Stiff jaw muscles (lockjaw) or neck muscles
  • Drooling or trouble swallowing
  • Muscle spasticity or rigidity
  • Sweating
  • Fever
  • Irritability
  • Pain or tingling at the wound site
  • High or low blood pressure
  • Seizures
  • Difficulty breathing
  • Heart beat that is irregular, too fast or too slow
  • Cardiac arrest
  • Dehydration
  • Pneumonia (a complication of the infection)

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The diagnosis is mainly based on the medical history. Your doctor may culture the wound, but culture results are not always accurate.

Treatment

Treatment may include:

  • Hospitalization to manage complications of the infection
  • Opening and cleaning of the wound, or sometimes surgical removal of the entire wounded area
  • Antibiotics
  • Tetanus immune globulin (antibodies against tetanus that help neutralize the tetanus toxin)
  • A tetanus shot, if your tetanus vaccine is not up to date

In some cases of trouble breathing or swallowing, a breathing tube may be inserted in the throat to help keep the airway open. In certain situations, a surgical procedure called a tracheotomy may be done to provide an open airway.

Prevention

The best means of prevention is immunization. All children (with few exceptions) should receive the DTaP vaccine, which protects against diphtheria , tetanus, and pertussis . This is a series of five shots and a booster shot.

All children (with few exceptions) should receive the diphtheria vaccine, usually in the form of the DTaP shot. The regular immunization schedule (for children and adults) is as follows:

  • DTaP vaccines at 2, 4, 6 months, 15-18 months, and 4-6 years of age
  • Booster dose of Tdap given at 11 or 12 years old—This is for children who have not already had the Td booster.
    • Those aged 13-18 years who missed the above booster dose or received Td only can receive one dose of Tdap 5 years after the last dose.
  • Booster of Tdap (one time dose for ages 19-64 years) or Td (every 10 years) to provide continued protection

For children aged 4 months to 6 years who have not yet received the vaccination, the Centers for Disease Control and Prevention (CDC) recommend the following catch-up schedule:

DosesMinimum Interval Between Doses
First and second dose4 weeks
Second and third dose4 weeks
Third and fourth dose6 months
Fourth and fifth dose 6 months
  • The fifth dose is not necessary if the fourth dose was administered at age 4 years or older.
  • DTaP is not indicated for persons aged 7 years or older.

Children seven years and older and adults who have not been vaccinated should also be vaccinated. The choice and timing will vary based on age and prior vaccine exposure. *

In addition to the vaccine, you can prevent tetanus by taking proper care of wounds:

  • Promptly clean all wounds.
  • See your doctor for medical care of wounds, especially if you have not had a tetanus vaccination in the last 10 years.

RESOURCES:

National Foundation for Infectious Diseases
http://www.nfid.org

National Institute of Allergy and Infectious Diseases
http://www.niaid.nih.gov

CANADIAN RESOURCES:

Canadian Family Physician
http://www.cfpc.ca/cfp/

Caring for Kids
http://www.caringforkids.cps.ca/

References:

Centers for Disease Control and Prevention (CDC) website. Available at: http://www.cdc.gov/ .

Harrison's Principles of Internal Medicine . 15th ed. McGraw-Hill Professional Publishing; 2001.

National Coalition for Adult Immunization website. Available at: http://www.nfid.org/ .

National Foundation for Infectious Diseases website. Available at: http://www.nfid.org .

Vaccines and preventable diseases: tetanus (lockjaw) vaccination. Vaccines and Immunizations, Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/vpd-vac/tetanus/default.htm#vacc . Accessed: January 29, 2008.

*Updated Who Should Get Vaccinated and When section on 1/31/2008 according to the following study, as cited by DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years—United States, 2008. MMWR. 2008;57;Q1-Q4. Centers for Disease Control and Prevention, MMWR website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm . Updated January 10, 2008. Accessed January 28, 2008.



Last reviewed February 2008 by David L. Horn, MD, FACP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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