3/25/2017 Tetanus: Symptoms, causes, and treatments - Medical News Today

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Tetanus: Symptoms, causes, and treatments

Written by Christian Nordqvist
Reviewed by Debra Sullivan, PhD, MSN, CNE, COI
Last updated: Thu 23 February 2017

Tetanus,also called lockjaw, is a serious infection caused byClostridium tetani; this

bacterium produces a toxin that affects the brain and nervous system, leading to
stiffness in the muscles.
IfClostridium tetanispores are deposited in a wound, the neurotoxin interferes with nerves that control
muscle movement.

The infection can cause severe muscle spasms, serious breathing difficulties, and can ultimately be fatal.
Although tetanus treatment exists, it is not uniformly effective. The best way to protect against tetanus is
to take the vaccine.

Contents of this article:

1. Causes

2. Symptoms

3. Prevention and vaccine

4. Diagnosis

Fast facts on tetanus

Here are some key points about tetanus. More detail and supporting information is in the main article.

Tetanus is caused by the Clostridium tetani bacterium

The early symptoms of tetanus include diarrhea (/articles/158634.php), fever (/articles/168266.php),

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and headache (/articles/73936.php)

Earlier diagnosis predicts better outcomes

Causes of tetanus
Tetanus is caused by theClostridium tetani

(https://www.ncbi.nlm.nih.gov/pubmed/18588497)bacterium.Clostridium tetanispores are able to

survive for a long time outside of the body. They are most commonly found in animal manure and
contaminated soil, but may exist virtually anywhere.

WhenClostridium tetanienter the body, they multiply rapidly and release tetanospasmin, a neurotoxin.
When tetanospasmin enters the bloodstream, it rapidly spreads around the body, causing tetanus
symptoms.

Tetanospasmin interferes with the signals traveling from the brain to the nerves in the spinal cord, and
then on to the muscles, causing muscle spasms and stiffness.

Puncture wounds -Clostridium tetanienters the body mainly through skin lesions (skin cut or puncture
wound). Thoroughly cleaning any cut helps prevent an infection from developing.

Common ways of contracting tetanus

Wounds that have been contaminated with saliva or feces

Burns

Crush injuries

Wounds that include necrotic (dead) tissue

Puncture wounds

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Rare ways of contracting tetanus

Surgical procedures

Superficial wounds

Insect bites

Compound fractures (/articles/173312.php)

Intravenous drug use

Injections into the muscle (intramuscular)

Dental infections

Symptoms of tetanus
Tetanus symptoms usually emerge about 7-10 days after initial infection; however, this can vary from 4
days to about 3 weeks, and, in some cases, it may take months.

In general, the further the injury site is from thecentral nervous system, the longer the incubation period.
Patients with shorter incubation times tend to have more severe symptoms.

Muscle symptoms- spasms and muscular rigidity (muscles become stiff). Stiffness usually starts with the
chewing muscles, hence the namelockjaw.

Muscle spasms then spread to the neck and throat, causingdysphagia(difficulty swallowing). Patients
often go on to have spasms in their facial muscles.

Breathing difficulties may result from neck and chest muscle stiffness. With some patients, abdominal
and limb muscles are also affected.

In severe cases, the spine will arch backward as the back muscles are affected - this is more common
when children are infected.

Most patients with tetanus will also have the following symptoms:

Bloody stools (feces)

Diarrhea

Fever

Headache

Sensitivity to touch

Sore throat (/articles/155412.php)

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Sweating

Tachycardia(rapid heartbeat)

Complications
If the patient does not receive treatment, the risk of life-threatening complications
(https://www.cdc.gov/tetanus/about/symptoms-complications.html) is higher - mortality rates vary
from40-76 percent (https://www.ncbi.nlm.nih.gov/pubmed/2403465)- symptoms may include:

Fractures- sometimes, in severe cases, the muscle spasms and convulsions may lead to bone fractures.

Aspiration pneumonia- if secretions or contents of the stomach are inhaled, a lower respiratory tract
infection can develop, leading topneumonia.

Laryngospasm- the larynx (voice box) goes into a spasm which can last up to a minute and cause breathing
difficulties. In severe cases, the patient can suffocate.

Tetanic seizures- if infection spreads to the brain, the patient can have epileptic-like fits (seizures).

Pulmonary embolism- a blood vessel in the lung can become blocked and affect breathing and circulation.
The patient will urgently need oxygen therapy and anti-clotting medication.

Severe kidney failure (acute renal failure)- severe muscle spasms can result in the destruction of skeletal
muscle which can cause myoglobin - a muscle protein - to leak into the urine. This can cause acute renal
failure (severe kidney failure).

Prevention of tetanus
Most cases of tetanus occur in people who have never been immunized (never had the vaccine), or who
did not have a booster shot within the preceding decade.

The tetanus vaccine

Thetetanus vaccine (https://www.cdc.gov/vaccines/vpd/tetanus/index.html)is routinely given to children
as part of the DTaP (diphtheriaand tetanus toxoids and acellularpertussis) shot. The DTaP vaccine
consists of five shots, usually given in the arm or thigh of children when they are aged:

2 months

4 months

6 months

15 - 18 months

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4 - 6 years

A booster is normally given between the ages of 11 and 18 years, and then another booster every 10 years.
If an individual is traveling to an area where tetanus is common, they should check with a doctor
regarding vaccinations.

Do I need a tetanus shot?

Anyone who receives a deep or dirty wound and has not had a booster shot over the last 5 years should
have another booster.

A patient in this situation may also be given tetanus immune globulin, which works to prevent infection.
It is important that medical attention is sought swiftly as tetanus immune globulin only works for a short
time after the injury.

Tetanus diagnosis
In many countries, the average doctor may never see a patient with tetanus. This is because the tetanus
vaccine is part of childhood immunization and the infection has become rare. In the United States in
2009, for example, there were only19 reported cases (https://www.cdc.gov/vaccines/pubs/surv-
manual/chpt16-tetanus.html)of tetanus.

The earlier a patient is diagnosed with tetanus, the more effective the treatment will be. A patient with
muscle spasms and stiffness who has recently had a wound or cut is usually diagnosed quickly.

Diagnosis may take longer with patients who inject drugs because they often have other medical
conditions. They made need a blood test for confirmation.

Anybody who experiences muscle spasms and stiffness should seek medical attention immediately.

Treatments for tetanus

Any cut or wound must be thoroughly cleaned to
prevent infection. A tetanus-prone wound should
be treated by a medical professional
immediately.

What is atetanus-prone wound? According to the

National Health Service (NHS), United Kingdom,
it is defined as:

A wound or burn that requires surgical

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intervention that is delayed for over 6 hours Wounds should be thoroughly cleaned to prevent infection.

A wound or burn that has a considerable amount of removed (devitalized) tissue

Any puncture-type injury that has been in contact with manure or soil

Seriousfractureswhere the bone is exposed to infection (compoundfractures)

Wounds or burns in patients with systemicsepsis

Any patient with a wound listed above should receive TIG (tetanus immunoglobulin) as soon as possible,
even if they have been vaccinated. Tetanus immunoglobulin contains antibodies that killClostridium
tetani. It is injected into a vein and provides immediate short-term protection against tetanus.

TIG is just short-term and does not replace the long-term effects of vaccination. Experts say thatTIG
injections (https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0012359/?report=details)can be safely
administered to pregnant and breastfeeding mothers.

Antibiotics- doctors may prescribepenicillinor metronidazole for tetanus treatment.

Theseantibioticsprevent the bacterium from multiplying and producing the neurotoxin that causes
muscle spasms and stiffness. Patients who are allergic topenicillinor metronidazole may be given
tetracycline instead.

In treating muscle spasms and stiffness, patients may be prescribed:

Anticonvulsants - such as diazepam (Valium)- relaxes the muscles to prevent spasms, reducesanxiety,and
works as a sedative.

Muscle relaxants - such as baclofen- suppresses nerve signals from the brain to the spinal cord, resulting in
less muscle tension.

Neuromuscular blocking agents - these medications block the signals from nerves to muscle fibers and are
useful in controlling muscle spasms. They include pancuronium and vecuronium.

Surgery
If the doctor thinks the tetanus prone wound is very large, they may surgically remove as much of the
damaged and infected muscle as possible (debridement).

Debridement is the act of removing dead or contaminated tissue, or foreign material. In the case of a
tetanus-prone wound (http://www.nhs.uk/chq/pages/1316.aspx?categoryid=67), the foreign material may
be dirt or manure.

Nutrition
A patient with tetanus requires a high daily calorie intake because of increased muscle activity.
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Ventilator
Some patients may need ventilator support to help with breathing if their vocal cords or respiratory
muscles are affected.

Written by Christian Nordqvist

Additional information

Article last updated on Thu 23 February 2017.

Visit our Infectious Diseases / Bacteria / Viruses (/categories/infectious_diseases) category page for the latest news on this

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All references are available in the References tab.

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