Tetanus

Definition
Tetanus is a serious bacterial disease caused by a toxin that leads to stiffness of your
jaw muscles and other muscles. Tetanus can cause severe muscle spasms, make
breathing difficult and, ultimately, threaten your life.

Spores of the tetanus bacteria, Clostridium tetani, usually are found in the soil, but can
occur virtually anywhere. If deposited in a wound, the bacteria can produce a toxin
that interferes with the nerves controlling your muscles.

Treatment for tetanus is available, but the process is lengthy and not uniformly
effective. Tetanus may be fatal despite treatment. The best defense against tetanus is
preventing it by getting a tetanus shot and by properly caring for wounds.

Symptoms
Signs and symptoms of tetanus may appear anytime from a few days to several weeks
after tetanus bacteria enter your body through a wound. The incubation period for the
disease is usually between three days and three weeks, with an average of eight days.

Signs and symptoms of tetanus may include:

 Spasms of your jaw, neck and other muscles. As the toxin spreads to
nerves, your face and jaw muscles may be affected by strong spasms. Spasms
can also affect muscles in your chest, abdomen and back.
 Stiffness of your jaw, neck and other muscles. This is why tetanus is
commonly referred to as lockjaw. Spasms and stiffness of your jaw and neck
may lead to difficulty swallowing. Stiffness can also affect your chest,
abdominal and back muscles.
 Difficulty breathing. Severe spasms can affect respiratory muscles and make
it difficult to breathe.

Other signs and symptoms can include:

 Fever
 Muscular irritability

When to see a doctor

See your doctor to obtain a tetanus booster shot if you have a deep or dirty wound and
you haven't had a booster shot within the past five years or aren't sure of your
vaccination status. Or see your doctor about a tetanus booster for any wound if you
haven't had a booster shot within the past 10 years.
Causes
The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal
feces. When they enter a deep flesh wound, spores of the bacteria may produce a
powerful toxin, tetanospasmin, which acts on various areas of your nervous system.
The effect of the toxin on your nerves can cause muscle stiffness and spasms — the
major signs of tetanus.

Preparing for your appointment

If your symptoms are minimal, you're likely to start by seeing your family doctor.
However, if they're severe or you're concerned about an infected wound, you're more
likely to go to the emergency room.

Because appointments can be brief, and because there's often a lot of ground to cover,
it's a good idea to be well prepared for your appointment. Here's some information to
help you get ready for your appointment, and what to expect from your doctor.

What you can do

 Be aware of any pre-appointment restrictions. At the time you make the

appointment, be sure to ask if there's anything you need to do in advance.
 Write down any symptoms you're experiencing, including any that may
seem unrelated to the reason for which you scheduled the appointment.
 Write down key personal information, including when you were last
vaccinated for tetanus and what type of vaccination you had, as well as any
recent wound injuries.
 Make a list of all medications, as well as any vitamins or supplements, that
you're taking.
 Take a family member or friend along, if possible. Sometimes it can be
difficult to soak up all the information provided to you during an appointment.
Someone who accompanies you may remember something that you missed or
forgot.
 Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you
make the most of your time together. List your questions from most important to least
important in case time runs out. For tetanus, some basic questions to ask your doctor
include:

 What is likely causing my symptoms or condition?

 Are there other possible causes for my symptoms or condition?
 What kinds of tests do I need?
 Is my condition likely temporary or chronic?
 What is the best course of action?
 What are the alternatives to the primary approach that you're suggesting?
 I have these other health conditions. How can I best manage them together?
 Are there any restrictions that I need to follow?
 Should I see a specialist? What will that cost, and will my insurance cover it?
  Is there a generic alternative to the medicine you're prescribing me?
 Are there any brochures or other printed material that I can take home with
me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to
ask questions during your appointment at any time that you don't understand
something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them
may make time to go over points you want to spend time on. Your doctor may ask:

 When did you first begin experiencing symptoms?

 Have your symptoms been continuous, or occasional?
 How severe are your symptoms?
 What, if anything, seems to improve your symptoms?
 What, if anything, appears to worsen your symptoms?
 When were you last vaccinated for tetanus and what type of vaccine did you
receive?
 Have you recently had a wound?

What you can do in the meantime

If your symptoms are severe or you're concerned about an infected wound, seek
immediate medical attention.

Tests and diagnosis

Doctors diagnose tetanus based on a physical exam and the signs and symptoms of
muscle spasms, stiffness and pain. Laboratory tests generally aren't helpful for
diagnosing tetanus.

Treatments and drugs

In most cases of tetanus, the illness is severe, and there's a risk of death despite
treatment. Death may result from constriction of airways, pneumonia or instability in
the autonomic nervous system. The autonomic nervous system is the part of your
nervous system that controls your heart muscles, other involuntary muscles and
glands.

Treatment may consist of certain medications, as well as supportive care.

Medications

 Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus
immune globulin (TIG). However, the antitoxin can neutralize only toxin that
hasn't yet combined with nerve tissue.
 Antibiotics. Your doctor may also give you antibiotics, either orally or by
injection, to fight tetanus bacteria.
  Vaccine. You'll also need to receive a tetanus vaccine in order to prevent
future tetanus infection.

Supportive therapies
Tetanus infection often requires a long period of treatment in an intensive care setting.
You may need drugs to sedate you and to paralyze your muscles, and that may result
in shallow breathing that needs to be supported temporarily by a ventilator.

People who've had tetanus often recover completely. However, some people have
lasting effects, such as brain damage caused by a lack of oxygen when muscle spasms
in the throat cut off the airway.

Prevention
You can easily prevent tetanus by being immunized against the toxin. Almost all
cases of tetanus occur in people who've never been immunized or who haven't had a
tetanus booster shot within the preceding 10 years.

The vaccine
The tetanus vaccine usually is given to children as part of the diphtheria and tetanus
toxoids and pertussis (DTP) shot. This vaccination provides protection against three
diseases: diphtheria (a throat and respiratory infection), pertussis (whooping cough)
and tetanus. The latest version of this immunization is known as the diphtheria and
tetanus toxoids and acellular pertussis (DTaP) vaccine.

The DTaP vaccine consists of a series of five shots, typically given in the arm or thigh
to children at ages:

 2 months
 4 months
 6 months
 15 to 18 months
 4 to 6 years

The booster
It's recommended that adolescents get a booster shot between the ages of 11 and 18,
and that adults receive a tetanus booster shot every 10 years. If you're traveling
internationally, it's a good idea to have up-to-date immunity because tetanus may be
more common where you're visiting, especially if you're traveling to a developing
country. If you receive a deep or dirty wound and it's been more than five years since
your last booster shot, get another booster shot.

A booster of the tetanus vaccine is typically given in combination with a booster of

diphtheria vaccine. Recently, pertussis vaccine has been added to this routine
combination immunization to ensure that adults and adolescents are fully protected
against pertussis. This combination vaccine is referred to as Tdap, and it's approved
for use in teens and adults under age 64. In order to stay up-to-date with all of your
vaccinations, request that your doctor review your vaccination status on a regular
basis.
Having had a tetanus infection doesn't provide immunity. Following
recommendations for vaccinations is necessary to prevent recurrence of tetanus. If
you were never vaccinated against tetanus as a child, see your doctor about getting the
Tdap vaccine. You can't get a tetanus infection from the vaccine.

Taking care of a wound

If you have a wound, these steps will help prevent you from getting tetanus:

 Keep the wound clean. Rinse thoroughly with clean water. Clean the wound
and the area around it with soap and a washcloth. If debris is embedded in a
wound, see your doctor.
 Consider the source. Puncture wounds or other deep cuts, animal bites or
particularly dirty wounds may put you at increased risk of tetanus infection.
Get medical attention if the wound is deep and dirty, and particularly if you're
unsure of your immunization status. Your doctor may need to clean the
wound, prescribe an antibiotic and give you a booster shot of the tetanus
toxoid vaccine. If you've previously been immunized, your body should
quickly make the needed antibodies to protect you against tetanus.
 Use an antibiotic. After you clean the wound, apply a thin layer of an
antibiotic cream or ointment, such as the multi-ingredient antibiotics
Neosporin and Polysporin. These antibiotics won't make the wound heal
faster, but they can discourage bacterial growth and infection and may allow
the wound to heal more efficiently. Certain ingredients in some ointments can
cause a mild rash in some people. If a rash appears, stop using the ointment.
 Cover the wound. Exposure to the air may speed healing, but bandages can
help keep the wound clean and keep harmful bacteria out. Blisters that are
draining are vulnerable. Keep them covered until a scab forms.
 Change the dressing. Applying a new dressing at least once a day or
whenever the dressing becomes wet or dirty may help prevent infection. If
you're allergic to the adhesive used in most bandages, switch to adhesive-free
dressings or sterile gauze and paper tape.