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. Some spasms may be severe enough to fracture bones. 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.

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. They produce toxins that interfere with normal muscle contractions. Diagnosis is based on the presenting signs and symptoms. The disease does not spread between people.

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. Muscle relaxants may be used to control spasms. Mechanical ventilation may be required if a person's breathing is affected.

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. In 2015, there were about 209,000 infections and about 59,000 deaths globally. This is down from 356,000 deaths in 1990. In the US, there are about 30 cases per year, almost all of which were in people who had not been vaccinated. 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.

The tetanus bacillus enters the body and multiplies at the site of an injury. It is an anaerobic bacterium, meaning that it flourishes where oxygen is not present, i.e. in deep wounds. The onset of the disease is marked by fatigue, soreness and irritability. Within a few days there develops a stiffness around the jaw and a laboured breathing. As swallowing becomes difficult, the mouth fuses shut and the victim suffers prolonged, violent and agonisingly painful contractions of the voluntary muscles of the jaw, neck, abdomen and extremities. Despite intensive pharmacological and therapeutic research, the prognosis for each case of tetanus is doubtful and the death rate is high. The infectious agent Clostridium tetani is excreted by infected animals, especially horses.

Medical experts point out that tetanus can never be completely eradicated because it is not spread person-to-person, but rather through exposure to the tetanus bacterium, found in soil everywhere. Therefore elimination of maternal and neonatal tetanus – the most frequent occurence – defined as less than 1 case of tetanus for every 1,000 births.

A cheap and highly effective vaccine for tetatus has been available for over 70 years. But the obstacles to distributing the vaccine are many. In countries most at risk, extreme poverty is pervasive, along with malnutrition, disease, illiteracy, limited communication and transportation infrastructures, and only the most rudimentary national healthcare system. There are also dangerous traditional practices, including the common remedy of using cow dung – often loaded with tetanus bacteria – to heal fresh wounds.

Tetanus is an acute disease caused by toxins released by the Clostridium tetani bacterium. It causes painful spasms of the muscles, locking the jaw. Infection occurs when bacteria enter open sores and cuts. Death ensues when breathing is restricted, as happens in over half the cases of infection. The immediate source of infection may be soil, dust, or animal and human faeces.