Tetanus

What is tetanus?

Tetanus is a rare illness caused by a bacterium called Clostridium tetani. Unlike a good many other bacterial infections, you cannot get tetanus through exposure to someone who has already developed it. However, these bacteria are commonly present in the environment around us in the form of spores. They are particularly abundant in dust and soil and even manure. These bacterial spores can get into our bodies when we hurt ourselves as the protective barrier provided by the skin is breached.

When these bacteria enter the body, they release a toxin that affects normal muscular function. In fact, the toxin triggers muscle spasms or contractions. One of the most common manifestations of this is that the patient’s jaw tightens up and refuses to move normally, making it difficult to breathe, speak and eat. This symptom is known as lockjaw and it is one of the most classic signs of tetanus. So much so that, in common parlance, the term ‘lockjaw’ is used interchangeably with the more accurate term ‘tetanus’.

What causes it?

Our skin is our largest organ and our first line of defense against pollutants, environmental toxins, allergens and pathogens like the Clostridium tetani bacteria.

Hence, any condition that compromises the integrity of the skin provides opportunities for harmful substances and microbes to enter the body and give rise to illness.

We often tend to neglect minor abrasions, cuts and puncture wounds since they heal over easily.

But even the smallest of breaks in the skin is sufficient for C. tetani bacteria to enter.

In fact, it is now a common practice for infants and young children to receive tetanus vaccines as part of routine immunization. As adults, it is important to renew this immunization by taking tetanus booster shots. Considering the abundant presence of the pathogen in our environment and the relative frequency of injuries that we suffer on a regular basis, tetanus should actually be much more common than it actually is. The fact that accounts for its rarity is that the governments and medical health providers have been stressing on the importance of administering this vaccine to young children. Most cases of the illness are seen in those individuals who have either never received the vaccine or those who have neglected to take booster shots as adults.

Tetanus can affect individuals of any age. However, it is common among newborns when the umbilical cord is cut off since the bacteria can enter the body through this route. Hence, tetanus vaccination is recommended for individuals of all ages. It is particularly important for young children and infants.

Here are some risk factors for tetanus:

• Failing to take the vaccine.
• Failure to take booster shots.
• Having open wounds or burns.
• Having chronic sores in the skin as a result of disorders like psoriasis and eczema.
• Insect bites.
• Tattoo needles.
• Wounds contaminated with soil, dust or animal feces.
• Contamination through surgery.
• Infection through intravenous drug use.

What happens to patients with tetanus?

Spores are the inactive form that bacteria take when they are forced into an inhospitable environment. Bacterial spores can often survive high and low temperatures and fluctuations in environmental pH as well.

In the case of C. tetani, the spores become activated when they enter the human body. Having found a congenial environment, the bacteria then begin to multiply rapidly.

These bacteria produce a potent neurotoxin known as tetanospasmin or, simply, the tetanus toxin.

When this toxin is released into the body, it is capable of impairing nerve function to the extent of causing muscle contractions or spasms. Hence, the tetanus toxin is described as spasmogenic in nature.

If the bacterial spores have indeed managed to infiltrate your body, you will eventually begin to experience symptoms although this will not happen immediately. In most kinds of infections, there is a space of time between the actual exposure and the onset of symptoms. This is known as the incubation period of the pathogen. According to the Centers For Disease Control and Prevention, C. tetani bacteria require an average incubation period of 10 days to a fortnight in order to give rise to tetanus in the human body. However, there are recorded instances of the incubation period being as short as 3 days in some cases and more than a month in others.

In any case, if you have developed tetanus, you can expect to see a few or more of the following symptoms:

• Fever.
• Sweating.
• A sensation of tightness when attempting to open the jaw.
• Pain in the jaw.
• The jaw may deviate towards one side.
• Inability to bite, chew, speak or breathe normally.
• Stiffness in the body.
• Muscle spasms.
• Elevated heart rate.

What are some complications that one should be aware of?

In the initial stages, the toxin blocks the movement of voluntary muscles.

One of the early signs of tetanus is the progressive rigidity of the jaw. The patient loses the ability to move their jaw normally and the jaw, so to speak, locks up tightly.

As the disease escalates, rigidity spreads across the trunk and the limbs, accompanied by uncontrollable spasms.

In fact, the spasms may be so violent that the patient may end up with bone fractures. When the toxin blocks the movement of muscles necessary for respiration, the patient dies from the inability to actually breathe.

Tetanus is feared because it can be fatal. As we have just seen, left untreated, the patient may succumb to the illness. Even otherwise, the inability to move the jaw can make it difficult to perform important functions such as breathing, eating and speaking until treatment is made available. The patient is unable to brush and floss, leaving the oral cavity unclean and perfectly congenial for the overgrowth of bacteria that can then give rise to a variety of dental problems like tooth decay and gum disease.

How is tetanus diagnosed and treated?

There are no specific laboratory investigations that can be used to confirm a diagnosis of tetanus. Instead, the doctor will have to rely on symptoms to make the diagnosis. When a patient presents with a rigid, immobile jaw or limited mobility of the jaw, the first suspicion will be tetanus. It would be helpful if the patient recalls recently suffering any injuries that might have led to the infection in the first place.

If the patient is already struggling to breathe when they are admitted for medical care, they may require artificial respiratory support in the form of a ventilator. Spasms can be controlled with the help of sedatives.

Generally, the patient will be given tetanus antitoxin in order to neutralize the bacterial toxin in the body. It cannot, however, reverse the effects of toxins that have already managed to bind to nerve tissue. Instead, it prevents the illness from worsening and arrests its progress. Antibiotics can help to kill the bacteria responsible for producing the toxin. It is also a matter of priority to ensure that the wound is properly cared for, cleaned, sterilized and dressed.

Prevention

As with other severe illnesses, prevention of tetanus is preferable to treatment. As a rule, parents must remember to get their children vaccinated against tetanus at an early age. Growing up, and as adults, we must remember to take tetanus booster shots to renew the body’s ability to defend itself against C. tetani toxin. Additionally, it is always a good practice to ask for a tetanus shot when you have suffered a wound or a burn or if you have been injured by rusted items like nails.

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