What are the other Names for this Condition? (Also known as/Synonyms)

• Clostridium Tetani Infection
• Lockjaw
• Trismus

What is Tetanus? (Definition/Background Information)

• Tetanus is a serious but preventable disease that affects the nervous system and muscles of the body. Individuals with Tetanus experience painful muscle spasms and stiffness that begins in the jaw or neck
• Tetanus is most commonly seen in the developing countries. It is caused by a toxin produced by the bacterium Clostridium tetani, which enters the body through puncture wounds in the skin
• An early diagnosis and treatment of Tetanus, through antibiotics and antitoxins, is necessary to avoid severe and fatal complications. Without proper treatment, the prognosis of Tetanus is poor and can be fatal
• The condition can be prevented by obtaining Tetanus vaccinations at the recommended periods, for children and adults

Who gets Tetanus? (Age and Sex Distribution)

• A Tetanus infection can occur at any age, but it is more often seen in older adults
• The condition affects both males and females equally
• All ethnic groups and races can be affected; however, there is a higher incidence rate in developing countries (outside of the United States and Europe)
• Neonatal Tetanus is known to occur worldwide in newborn babies, both in the developed and developing countries, as many women are not adequately immunized against the toxin produced by Clostridium tetani

What are the Risk Factors for Tetanus? (Predisposing Factors)

The risk factors for Tetanus include:

• Absence of immunization or inadequate immunization against Clostridium tetani
• Penetrating puncture wounds from foreign objects, such as a nails or splinters or glass shards
• Wound contamination with dirt or feces
• Umbilical stumps in newborns, which can be infected from inadequately immunized mothers
• Injured tissues, crush injuries, compound fractures
• Burns
• Surgical wounds
• Insect bites
• Dental infections
• Intravenous drug use
• Gunshot wounds
• Working in agricultural industry, where contact with animal feces (particularly horse manure) is more common

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Tetanus? (Etiology)

The cause of Tetanus is due to an infection by Clostridium tetani, which is a bacteria found in soil, dust, and animal feces.

• The bacterium can enter the body through puncture wounds in the skin, leading to an infection
• Clostridium tetani produces the tetanospasmin neurotoxin, which spreads throughout the body through the bloodstream. This potent neurotoxin impairs nerve signals from the spinal cord to the muscles
• The tetanospasmin neurotoxin causes the characteristic muscle spasms, stiffness, and other serious symptoms associated with Tetanus

What are the Signs and Symptoms of Tetanus?

The most common signs and symptoms of Tetanus include: 

• Stiffness or cramping in the muscles of the jaw and neck, commonly known as “Lockjaw”
• Difficulty swallowing
• Stiffness or tightening of the abdominal muscles
• Painful whole body spasms
• Fever and sweating
• Rapid heart rate and elevated blood pressure

The incubation period of Tetanus is typically around 8 days. However, it can vary anywhere from 3-21 days. A higher risk of death is associated with a shorter incubation period.

How is Tetanus Diagnosed?

A diagnosis of Tetanus includes:

• A comprehensive physical examination
• An evaluation of the medical and immunization history, specifically for the Tetanus vaccine
• An examination of the common signs and symptoms, such as muscle spasms and stiffness of the jaw and neck
• Laboratory tests are not commonly used due to the difficulty in detecting the bacterium Clostridium tetani and the neurotoxin

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Tetanus?

The possible complications of Tetanus include:

• Respiratory failure due to muscle spasms negatively affecting one’s ability to breathe or speak (laryngospasm)
• Cardiac arrest due to an insufficient supply of oxygen
• Pneumonia
• Permanent disability due to prolonged immobility from the use of sedatives to control muscle spasms
• Severe spasms leading to broken bones, such as the spine
• Permanent brain damage in infants
• Abnormal heart rhythms and hypertension
• Secondary infections from extended hospitalizations 

How is Tetanus Treated?

The treatment options for Tetanus include:

• The use of medications:
  • Antitoxin therapy, such as Tetanus immune globulin (TIG) or intravenous immune globulin (IVIG) to neutralize the tetanospasmin toxin produced by C. tetani
  • Antibiotic therapy, through oral or injected doses, to kill C. tetani producing the neurotoxin causing Tetanus
  • Sedatives to control muscle spasms
  • Tetanus vaccine in order to prevent future infection by the bacteria
• Proper wound care by cleaning wounds of dirt, foreign objects, and dead tissue to prevent further growth of Clostridium tetani
• Supportive therapies during prolonged hospitalization, such as being placed on a ventilator to assist with breathing after sedative treatment

Note: Having Tetanus once, does not produce lifetime immunity to the effects of the neurotoxin.

How can Tetanus be Prevented?

The preventative measures for Tetanus include:

• Immunization against the Tetanus toxin:
  • The Tetanus vaccine is part of the DTaP (Diphtheria, Tetanus, and acellular Pertussis) immunization vaccinations
  • Young children should receive a series of 4 doses of DTaP vaccine at the ages of 2 months, 4 months, 6 months, between 15-18 months, and a booster dose between 4-6 years of age
  • After completing the childhood DTaP primary vaccine series, a Tetanus, diphtheria, and pertussis (Tdap) booster is recommended for adolescents between the ages of 11 and 12 years
  • A Tetanus and diphtheria (Td) booster shot should be given every 10 years throughout adulthood
• Proper wound care by immediately tending to any type of skin wound, particularly a deep puncture wound, which could possibly be contaminated with feces, soil, or saliva. Early and proper wound care can help prevent an infection by Clostridium tetani and reduce the likelihood of Tetanus

What is the Prognosis of Tetanus? (Outcomes/Resolutions)

• Currently, there is no cure for Tetanus; however, it is easily preventable with immunizations that are available against the Tetanus toxin
• With a lack of proper treatment, Tetanus can become a serious condition that requires months of hospitalization for a full recovery
• Recovery from Tetanus involves symptomatically managing any complications, until the toxin no longer affects the nervous system and muscles
• A majority of cases occur in individuals who have never been immunized, or who fail to receive a Tetanus booster shot every 10 years
• Approximately 10% of the cases are fatal, due to a delayed or absence of treatment

Additional and Relevant Useful Information for Tetanus:

• Neonatal Tetanus used to be a giant killer of newborn children, especially due to unclean or unhygienic deliveries in the developing nations (Africa and Asia). However, according to the WHO, the death rate due to this condition has declined greatly in the last few years
• In the US, about 50 cases of Tetanus are reported each year