Tetanus Causes, Symptoms, Diagnosis, Treatment, Prevention

Tetanus Causes, Symptoms, Diagnosis, Treatment, Prevention

What is tetanus?

Tetanus is a serious, sometimes fatal, disease of the central nervous system that is caused by an infection of a wound with spores of the bacterium, Clostridium tetani. The spores live in the soil. When spores enter the body through a wound, they can multiply and produce a toxin that affects the nerves that control muscle activity. Around one in 10 people infected with bacteria that causes tetanus will die.

Where do tetanus bacteria grow in the body?

Contaminated wounds are the sites where tetanus bacteria multiply. Deep wounds or those with devitalized (dead) tissue are particularly prone to tetanus infection.

Puncture wounds, such as those caused by nails, splinters, or insect bites, are favorite locations of entry for the bacteria. The bacteria can also be introduced through burns, any break in the skin, and injection-drug sites. Tetanus can also be a hazard to both the mother and newborn child (by means of the uterus after delivery and through the umbilical cord stump).

The potent toxin that is produced when the tetanus bacteria multiply is the major cause of harm in this disease.

Causes of tetanus

Tetanus is caused by a toxin produced by a bacterium called C. tetani, which is found in soil and animal faeces. It can cause a tetanus infection if it enters your body through a wound or a cut. You’re most likely to develop an infection if you have a wound that was caused by something dirty, such as a knife or nail, or an animal bite. Babies can get neonatal tetanus via a healing umbilical stump that hasn't been cleaned properly or that has been cut with an instrument that isn't sterile.

Most people who get tetanus haven't been immunised, or haven't had their tetanus booster. If you haven't been immunised or you haven't had your booster, you can get tetanus if:

  • you have a wound and it becomes infected – this may be minor such as a scratch or cut, or you may have had a piercing
  • you inject drugs or medicines using a needle that isn't sterile and has tetanus bacteria on it
Tetanus can’t be passed from person to person.

Risk factors of Tetanus

Age >60 years, lack of immunisation, poverty, drug addiction.

Wounds contaminated with garden soil or manure and those caused by rusty metals are particularly dangerous.

It can also complicate burns, ulcers, gangrene, snakebite, frostbite, otitis media, septic abortion, childbirth.
It can also occur following IM injections in surgery.

Tetanus neonatorum is associated with poor obstetric techniques. This is particularly the case with the practice of applying cow dung or clarified butter to the cut surface of the umbilical cord, in both Africa and India.

Symptoms of tetanus

Tetanus infection may result in several different patterns of illness.

Generalised tetanus

This is the most common type of tetanus and can be life-threatening. You may be infected with the tetanus bacteria for between three and 21 days before having symptoms. The symptoms (once they appear) may include:

  • jaw muscle spasms or stiffness (lockjaw)
  • muscle stiffness or pain, which usually starts in your neck, shoulders and back
  • spasms or convulsions of your body (that can last for up to two weeks), which may be painful and can affect your breathing or digestion
  • fever
  • sweating
  • difficulty swallowing and breathing
  • headache
With intensive medical support, eight to nine out of 10 people survive.

Localised tetanus

If you have localised tetanus, bacteria only affect the muscles near the wound where they entered your body. This causes your muscles to go hard and you may have painful spasms. Localised tetanus is rare. It can be treated and isn't usually life-threatening.

Cephalic tetanus

This is another rare form of tetanus. It’s most common in children and affects people who have had a head injury or an ear infection. Cephalic tetanus affects the nerves that run from your brain to other parts of your body and may cause paralysis of parts of your face. Cephalic tetanus may develop into generalised tetanus and can be life-threatening.

Neonatal tetanus

This affects newborn babies in less developed countries, particularly in Asia and Africa, and is often fatal. The symptoms are similar to generalised tetanus and occur within two weeks of birth. Babies with neonatal tetanus may:

  • not feed well and not put on weight
  • appear stiff or rigid
  • have spasms

Complications of Tetanus

Complications in severe generalised tetanus:

  • Aspiration pneumonia
  • Laryngospasm, which may lead to asphyxia
  • Fractures from sustained contractions and convulsions
  • Respiratory embarrassment with tachypnoea, and intermittent apnoea
  • Autonomic nervous involvement leading to hypertension, dysrhythmias and cardiac arrest
  • Tetanic seizures mimicking epilepsy - frequency and severity related to the severity of illness, and indicate poor prognosis
  • Pulmonary embolus particularly in drug abusers and the elderly.

Diagnosis of tetanus

If you have had a wound as described above, you should seek urgent medical attention. If you have a recent wound and muscle stiffness or spasms, starting near the wound and progressing elsewhere, this could indicate the initial symptoms of tetanus and you will need immediate medical attention.

The diagnosis of tetanus is usually based on the characteristic symptoms and signs. It may be confirmed by taking a blood test that looks for traces of the toxin in your blood.

Treatment for tetanus

Tetanus is a life-threatening disease and sometimes, death will occur even with prompt medical attention. 

Treatment for tetanus may include:
  • antitoxin (called tetanus immunoglobulin) – to neutralise any tetanus toxin that is circulating and not yet attached to nerve tissue
  • hospitalisation
  • anti-convulsive medications
  • antibiotics
  • life support – for example, the person may be placed on an artificial respirator if they have severe breathing problems
  • vaccination – having tetanus does not make you immune, so you should be immunised.
The best way to reduce the risk of tetanus is by immunisation. You should also avoid skin injuries, for example, by wearing gloves while gardening. 

Seek medical advice for dirty wounds or wounds where the skin has been penetrated. The doctor may advise a tetanus booster shot depending on how long it is since your last tetanus dose. If you have not had any previous immunisations against tetanus, a full course of three doses should be given. If the doctor thinks the type of wound you have might encourage the growth of tetanus bacteria, you might also receive tetanus immunoglobulin.

Prevention of tetanus

There is an immunisation programme in place to prevent tetanus. You need five separate injections to be fully protected. The first three doses are usually given to babies when they are two, three and four months old. The tetanus vaccine is combined with the diphtheria, whooping cough (pertussis) and polio vaccines. Children then have a booster when they are between three and five, and another one around 10 years later.

If you weren't immunised as a child, you can start the course of injections at any age. And if you are a woman, you can have the vaccine while you're pregnant.

If you have a wound with any dirt in it, seek medical advice. If you have a cut or weeping wound, such as a burn, you may need a booster dose of tetanus vaccine as a precaution. You may also be given a dose of tetanus immunoglobulin which is a protein (antibody) to help your body fight any tetanus infection you might develop. Ask your doctor for more advice.

Things to remember

Tetanus is a serious bacterial disease that causes muscle spasms and breathing problems.

If you get a tetanus-prone wound and you haven’t been immunised in the last 10 years (five years for pregnant women), you should visit your doctor as soon as possible.

The best prevention against tetanus is immunisation.

What should I do if I get a puncture injury?

Minor wounds: Clean the wound thoroughly with soap and warm water. Leave the wound uncovered, if possible.

Severe injuries: - See a health care provider for evaluation and treatment (stitches, antibiotics, or a Td booster shot).

Pay attention to any signs of infection such as redness or warmth of the wound, swelling, tenderness, or fever. If signs of infection develop, consult your health care provider.

If I am injured, how do I know if I need a tetanus shot?

  • For a minor injury - Get a tetanus shot if your last tetanus shot was over 10 years ago.
  • For a complicated or contaminated wound (including puncture wounds) - Get a tetanus shot if your last tetanus shot was over 5 years ago.

Where can I get a tetanus shot?

  • Most health care providers give tetanus shots.
  • Your local health department.
  • Hospital emergency rooms

What are the side effects of tetanus immunization?

Side effects of tetanus immunization occur in approximately 25% of vaccine recipients. The most frequent side effects are usually quite mild (and familiar) and include soreness, swelling, and/or redness at the site of the injection. More significant reactions are extraordinarily rare. The incidence of this particular reaction increases with decreasing interval between boosters.

What is passive immunization (by way of specialized immunoglobulin)?

In individuals who exhibit the early symptoms of tetanus or in those whose immunization status is unknown or significantly out of date, the tetanus immunoglobulin (TIG) is given into the muscle surrounding the wound with the remainder of the dose given into the buttocks.