Tetanus

Tetanus is a serious disease of the nervous system caused by a toxin-producing bacterium. The disease causes muscle contractions, particularly of your jaw and neck muscles. Tetanus is commonly known as lockjaw.

Severe complications of tetanus can be life-threatening. There's no cure for tetanus. Treatment focuses on managing symptoms and complications until the effects of the tetanus toxin resolve.

Because of the widespread use of vaccines, cases of tetanus are rare in the United States and other parts of the developed world. The disease remains a threat to people who aren't up to date on their vaccinations. It's more common in developing countries.

The average time from infection to appearance of signs and symptoms (incubation period) is 10 days. The incubation period can range from 3 to 21 days.

The most common type of tetanus is called generalized tetanus. Signs and symptoms begin gradually and then progressively worsen over two weeks. They usually start at the jaw and progress downward on the body.

Signs and symptoms of generalized tetanus include:

• Painful muscle spasms and stiff, immovable muscles (muscle rigidity) in your jaw
• Tension of muscles around your lips, sometimes producing a persistent grin
• Painful spasms and rigidity in your neck muscles
• Difficulty swallowing
• Rigid abdominal muscles

Progression of tetanus results in repeated painful, seizure-like spasms that last for several minutes (generalized spasms). Usually, the neck and back arch, the legs become rigid, the arms are drawn up to the body, and the fists are clenched. Muscle rigidity in the neck and abdomen may cause breathing difficulties.

These severe spasms may be triggered by minor events that stimulate the senses — a loud sound, a physical touch, a draft or light.

As the disease progresses, other signs and symptoms may include:

• High blood pressure
• Low blood pressure
• Rapid heart rate
• Fever
• Extreme sweating

Localized tetanus

This uncommon form of tetanus results in muscles spasms near the site of a wound. While it's usually a less severe form of disease, it can progress to generalized tetanus.

Cephalic tetanus

This rare form of tetanus results from a head wound. It results in weakened muscles in the face and spasms of the jaw muscles. It also can progress to generalized tetanus.

When to see a doctor

Tetanus is a life-threatening disease. If you have signs or symptoms of tetanus, seek emergency care.

If you have a simple, clean wound — and you've had a tetanus shot within 10 years — you can care for your wound at home.

Seek medical care in the following cases:

• You've not had a tetanus shot within 10 years.
• You are unsure of when you last had a tetanus shot.
• You have a puncture wound, a foreign object in your wound, an animal bite or a deep cut.
• Your wound is contaminated with dirt, soil, feces, rust or saliva — or you have any doubt about whether you've cleaned a wound sufficiently after such exposure. Contaminated wounds require a vaccination booster if it's been five or more years since your last tetanus shot.

The bacterium that causes tetanus is called Clostridium tetani. The bacterium can survive in a dormant state in soil and animal feces. It's essentially shut down until it discovers a place to thrive.

When the dormant bacteria enter a wound — a condition good for growth — the cells are "awakened." As they are growing and dividing, they release a toxin called tetanospasmin. The toxin impairs the nerves in the body that control muscles.

The greatest risk factor for tetanus infection is not being vaccinated or not keeping up with the 10-year booster shots.

Other factors that increase the risk of tetanus infection are:

• Cuts or wounds exposed to soil or manure
• A foreign body in a wound, such as a nail or splinter
• A history of immune-suppressing medical conditions
• Infected skin lesions in people living with diabetes
• An infected umbilical cord when a mother isn't fully vaccinated
• Shared and unsanitary needles for illegal drug use

Complications of tetanus infection may include:

• Breathing problems. Life-threatening breathing problems can occur from tightening of the vocal cords and muscle rigidity in the neck and abdomen, especially during a generalized spasm.
• Blockage of a lung artery (pulmonary embolism). A blood clot that has traveled from elsewhere in your body can block the main artery of the lung or one of its branches.
• Pneumonia. A lung infection caused by accidentally inhaling something into the lungs (aspiration pneumonia) may be a complication of generalized spasms.
• Broken bones. Generalized spasms may cause fractures of the spine or other bones.
• Death. Death from tetanus is often caused by a blocked airway during spasms or damage to the nerves that regulate breathing, heart rate or other organ functions.

You can prevent tetanus by being vaccinated.

Vaccination for children

The tetanus vaccine is given to children as part of the diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). Diphtheria is a serious bacterial infection of the nose and throat. Acellular pertussis, also called whooping cough, is a highly contagious respiratory infection.

Children who do not tolerate the pertussis vaccine may receive the alternative vaccine called DT.

The DTaP is 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

Vaccination for children ages 7 to 18

A booster shot is recommended for children at age 11 or 12. This booster is called the Tdap vaccine. If your child didn't get a booster shot as this age, talk to your doctor about appropriate options.

Vaccination for adults age 19 and older

A booster shot is recommended for adults once every 10 years. This may be one of two vaccines, Tdap or Td. If you weren't vaccinated against tetanus as a child or are unsure about your vaccination status, see your doctor about getting the Tdap vaccine.

Vaccination during pregnancy

A booster is recommended during the third trimester of a pregnancy, regardless of the mother's vaccination schedule.

Other recommendations

• Ask your doctor to review your vaccination status regularly.
• Check whether you are current on your vaccination schedule if you are planning international travel.

Doctors diagnose tetanus based on a physical exam, medical and vaccination history, and the signs and symptoms of muscle spasms, muscle rigidity and pain. A laboratory test would likely be used only if your doctor suspects another condition causing the signs and symptoms.

A tetanus infection requires emergency and long-term supportive care while the disease runs its course, often in an intensive care unit. Any wounds are cared for and the healthcare team will make sure that the ability to breathe is protected. Medicines are given that ease symptoms, target the bacteria, target the toxin made by the bacteria and boost immune system response.

The disease progresses for about two weeks, and recovery can last about a month.

Wound care

Care for your wound requires cleaning to remove dirt, debris or foreign objects that may be harboring bacteria. Your care team will also clear the wound of any dead tissue that could provide an environment in which bacteria can grow.

Medications

• Antitoxin therapy is used to target toxins that have not yet attacked nerve tissues. This treatment, called passive immunization, is a human antibody to the toxin.
• Sedatives that slow the function of the nervous system can help control muscle spasms.
• Vaccination with one of the standard tetanus vaccinations helps your immune system fight the toxins.
• Antibiotics, given either orally or by injection, may help fight tetanus bacteria.
• Other drugs. Other medications might be used to regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine might be used for this purpose as well as for sedation.

Supportive therapies

Supportive therapies include treatments to make sure your airway is clear and to provide breathing assistance. A feeding tube into the stomach is used to provide nutrients. The care environment is intended to reduce sounds, light or other possible triggers of generalized spasms.

Proper wound care is important for any cut or wound. Seek medical care if you have a puncture wound, a deep cut, an animal bite, a foreign object in your wound, or a wound contaminated with dirt, soil, feces, rust or saliva.

If you're unsure when you last had a tetanus vaccine, seek medical care. Contaminated or more-serious wounds require a vaccination booster if it's been five or more years since your last tetanus shot.

If you have a minor wound, these steps will help prevent infections:

• Control bleeding. Apply direct pressure to stop bleeding.
• Clean the wound. After the bleeding stops, rinse the wound with a saline solution, bottled water or clear running water.
• Use antibiotics. Apply a thin layer of an antibiotic cream or ointment to discourage bacterial growth and infection.
• Cover the wound. Bandages can keep the wound clean and keep harmful bacteria out. Keep the wound covered until a scab forms. If you cannot clean the wound thoroughly, do not cover it and instead seek medical care.
• Change the dressing. Rinse the wound, apply antibiotic ointment, and replace the bandage at least once a day or whenever the dressing becomes wet or dirty.
• Manage adverse reactions. If the antibiotic causes a rash, stop using it. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and paper tape.