Tetanus

Tetanus is caused by the micro-organism Clostridium tetani. It produces a potent neurotoxin, secreted at the site of injury, that acts on the central nervous system leading to the muscular contraction characteristic of the illness. No person to person transmission.

Clostridium tetani spores enter the body through puncture wounds contaminated with soil, animal and human faeces, through lacerations, burns, by injected contaminated street drugs.

Reservoir

Clostridium tetani is widely distributed in cultivated soil and in the gut of humans and animals. Spores are found on contaminated fomites.

Incubation period

3 - 21 days (may range from one day to several months). The average is 10 days.

Signs and Symptoms

• Stiffness followed by painful muscular contractions. They usually begin near the site of injury and often become generalised.
• Stiffness of jaw (also called lockjaw)
• Stiffness of abdominal and back muscles
• Contraction of facial muscles
• Fast pulse (tachycardia)
• Fever
• Sweating
• Difficulty swallowing

Diagnosis

Primarily clinical diagnosis. Laboratory tests play little role.

Treatment

• Patient is hospitalised, may need to be admitted to intensive care unit.
• Use of intravenous tetanus immune globulin.
• Use of intravenous penicillin in large doses for 10 - 14 days. (Metronidazole or tetracycline can also be used)
• Adequate wound debridement.
• Careful attention to airway and muscle spasm.
• Recovery from tetanus may not result in immunity; a second attack can occur. Primary immunization is indicated after recovery.

Control and Prevention

Educate the public on:

1. the necessity of complete immunization with tetanus toxoid,
2. the kinds of injury particularly liable to be complicated by tetanus,
3. the need for active and/or passive prophylaxis.

Tetanus toxoid is recommended for universal use regardless of age, important for workers in contact with soil, sewage, and domestic animals, members of the military forces, police men and others with risk of traumatic injury.