Tetanus
Tetanus, also known as lockjaw, is a bacterial infection caused by Clostridium tetani and characterized by muscle spasms. In the most common type, the spasms begin in the jaw, and then progress to the rest of the body. Each spasm usually lasts for a few minutes. Spasms occur frequently for three to four weeks.[1] Some spasms may be severe enough to fracture bones.[2] Other symptoms of tetanus may include fever, sweating, headache, trouble swallowing, high blood pressure, and a fast heart rate. Onset of symptoms is typically 3 to 21 days following infection. Recovery may take months; about 10% of cases prove to be fatal.[1]
This article is about the disease. For the physiological use of the term, see Tetanic contraction.Tetanus
Lockjaw
fever, cramped-up jaw, muscle spasms, headache, seizures, sweating, and trouble swallowing
3–21 days following exposure
Months
Break in the skin
Based on symptoms
10% risk of death
209,000 (2015)
56,700 (2015)
C. tetani is commonly found in soil, saliva, dust, and manure. The bacteria generally enter through a break in the skin, such as a cut or puncture wound caused by a contaminated object.[1][3] They produce toxins that interfere with normal muscle contractions.[4] Diagnosis is based on the presenting signs and symptoms. The disease does not spread between people.[1]
Tetanus can be prevented by immunization with the tetanus vaccine. In those who have a significant wound and have had fewer than three doses of the vaccine, both vaccination and tetanus immune globulin are recommended. The wound should be cleaned, and any dead tissue should be removed. In those who are infected, tetanus immune globulin, or, if unavailable, intravenous immunoglobulin (IVIG) is used.[1] Muscle relaxants may be used to control spasms. Mechanical ventilation may be required if a person's breathing is affected.[4]
Tetanus occurs in all parts of the world, but is most frequent in hot and wet climates where the soil has a high organic content.[1] In 2015, there were about 209,000 infections and about 59,000 deaths globally.[5][6] This is down from 356,000 deaths in 1990.[7] In the US, there are about 30 cases per year, almost all of which were in people who had not been vaccinated.[8] An early description of the disease was made by Hippocrates in the 5th century BC. The cause of the disease was determined in 1884 by Antonio Carle and Giorgio Rattone at the University of Turin, and a vaccine was developed in 1924.[1]
Diagnosis[edit]
There are currently no blood tests for diagnosing tetanus. The diagnosis is based on the presentation of tetanus symptoms, and does not depend upon isolation of the bacterium, which is recovered from the wound in only 30% of cases, and can be isolated from people without tetanus. Laboratory identification of C. tetani can be demonstrated only by production of tetanospasmin in mice.[1] Having recently experienced head trauma may indicate cephalic tetanus if no other diagnosis has been made.
The "spatula test" is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a soft-tipped instrument and observing the effect. A positive test result is the involuntary contraction of the jaw (biting down on the "spatula"), and a negative test result would normally be a gag reflex attempting to expel the foreign object. A short report in The American Journal of Tropical Medicine and Hygiene states that, in an affected subject research study, the spatula test had a high specificity (zero false-positive test results) and a high sensitivity (94% of infected people produced a positive test).[39]
Tetanus cases reported worldwide (1990–2004). Ranging from some (in dark red), to very few (in light yellow) (grey, no data).
In 2013, it caused about 59,000 deaths—down from 356,000 in 1990.[7] Tetanus, notably the neonatal form, remains a significant public health problem in non-industrialized countries, with 59,000 newborns dying worldwide in 2008 as a result of neonatal tetanus.[48][49] In the United States, from 2000 through 2007, an average of 31 cases were reported per year.[1] Nearly all of the cases in the United States occur in unimmunized individuals, or individuals who have allowed their inoculations to lapse.[1]
In animals[edit]
Tetanus is found primarily in goats and sheep. The following are clinical symptoms found in affected goats and sheep. Extended head and neck, tail rigors (tail becomes rigid and straight), abnormal gait (walking becomes stiff and abnormal), arched back, stiffness of the jaw muscles, lockjaw, twitching of eyes, drooping eyelids, difficulty swallowing, difficulty or inability to eat and drink, abdominal bloat, spasms (uncontrolled muscular contractions) before death. Death sometimes is due to asphyxiation, secondary to respiratory paralysis.[51]
Research[edit]
There is insufficient evidence that tetanus can be treated or prevented by vitamin C. This is at least partially due to the fact that the historical trials that were conducted in attempts to look for a possible connection between vitamin C and alleviating tetanus patients were of poor quality.[54]