Tetanus
DEFINITION:
A toxic illness caused by an exotoxin produced from the bacterium
Clostridium tetani.
SYMPTOMS:
There are three manifestations of tetanus. Localized, generalized
and cephalic. Localized causes pain and rigid muscles near
where the organism entered the body. Generalized causes lockjaw
or spasms of the muscles around the mouth with a stiff neck,
difficulty swallowing and headache. The muscle spasms of the
face cause a fixed smile called risus sardonicus. The muscle
spasms then expand to the entire body causing seizure-like
activity and involuntary urination and defecation. Cephalic
tetanus involves only the head and is associated with loss
of muscle control of all the muscles of the face.
CAUSES:
A bacterium called Clostridium tetani can be found in soil,
rusty objects, fresh or salt water, and feces of many animal
species. If the bacterium enters the body through an injury
or open wound, its endotoxin can be released causing disease.
The incubation period is from 3-14 days after the injury.
CONTAGION:
This
illness is not contagious from person to person.
DIAGNOSIS:
The
diagnosis is made clinically by a history of an injury or
wound with the symptoms of tetanus.
TREATMENT:
Treatment is to neutralize the toxin, eradicate the bacteria,
and use supportive measures until the illness has past. Tetanus
immunoglobulin and penicillin are used. Wounds should be meticulously
cleaned. Once the spasms begin, muscle relaxants and paralyzing
drugs can be used. A patient may need to be put on a ventilator
to help with breathing until the illness has passed.
OUTCOME:
There
is a 40-50% death rate associated with this illness.
DISCUSSION:
The
best way to combat tetanus is through prevention and prevention
is through vaccination. The vaccine is given as part of the
DaPT vaccine at two, four, and six months of age with a booster
dose at fifteen months and four years of age. Boosters of
Td (tetanus/diphtheria) can be given every ten years starting
at 10-12 years of age. If an injury occurs and 5 years or
more have passed since the last tetanus vaccine, a booster
dose should be given. This illness can be very harsh. Once
the bacterium enters the body and starts releasing its toxin,
all the problems begin. The incubation period is from 3-14
days after the injury. Localized tetanus is painful but the
fatality rate is less than 1%. The generalized form is the
most common and most severe. The painful muscle spasms can
break bones including bones along the spine, which can lead
to paralysis. Treatment is somewhat helpful but many people
still don't survive the illness even with prompt treatment.
Cephalic tetanus is unusual but it can progress to the more
severe generalized form.
ONE DOCTOR'S OPINION:
Vaccination
is the only good way to combat this illness. Other than that
people should be very careful to protect themselves by wearing
shoes and protective clothing when walking in places where
there are old, rusty nails or sharp objects, by cleaning themselves
meticulously after any injury, and by getting a booster dose
of tetanus if they sustain an injury and 5 years or more have
passed since the last tetanus booster. With proper vaccination
this illness can be avoided.
