Tetanus: Causes, Symptoms, Treatment and prevention

How do you get tetanus? 

Know the symptoms, causes, treatment and prevention

On getting an injury or open wound, our elders or neigbors advise us to go get your tetanus shot and that's fairly true. If we wont get those shots we would be risking ourselves for tetanus.  So let us learn in detail about tetanus. Tetanus can be actually fatal and life-threatening infection, although very rare, it proves to be one of the killer diseases in infants.  

WHO has included it in the list of 6 killer diseases and planned active immunisation against it in the form of trivalent vaccine DPT (diphtheria, pertussis and tetanus). 

What is Tetanus?

Tetanus is sometimes, a fatal bacterial infection caused by bacterium, Clostridium tetani,and its spores. The spores are too microscopic and they can actually attack our nervous system if they gain entry into the blood stream.  The infection causes stiffness in the jaw and neck muscles and stimulate severe muscle spasms and hence is termed lock jaw. It may cause serious damage to the nervous system and increase breathing difficulty. 

Tetanus is also called lock jaw. 

Tetanus is most commonly seen among the newborn infants and the mothers during or after delivery, if they lack the successful tetanus vaccine during pregnancy.( 2 doses)  

Unhygienic practices of child birth in underdeveloped countries may put both mother and baby at risk for tetanus infection. 

Newborns get tetanus infection though the umbilical stump, when handled without aseptic techniques. 

The bacterial spores are found present in the soil, manure, saliva and dust. The bacteria can also be seen in the intestines of humans. 

Clostridium tetani produce harmful toxin that can irritate and cause damage to the nervous system. The toxin interferes with normal muscle contractions and initiate sudden spasms. Some spasms can be too severe that they can cause bone fracture. 

Tetanus is a vaccine-preventable infection. Successful vaccinations along with boosters can protect you from tetanus infection. 

How do the bacteria responsible for tetanus enter our body? 

Clostridium tetani and its spores can gain entry through following sites:

• Open wounds
• Deep wounds
• Cuts or abrasions
• Deep burns
• During delivery of baby/childbirth 
• Umbilical stump of newborn baby

What are the different types of tetanus infection? 

There are four types of tetanus infection based on the clinical findings by experts. 

1. Generalised tetanus
2. Neonatal or newborn tetanus
3. Cephalic(head) tetanus
4. Local tetanus

Generalised tetanus is the most common almost 80% seen in people with tetanus infection. 

It starts with signs such as trismus or lock jaw, risus sarcodinus or facial contractions causing a grinning face, elevated temperature, low blood pressure, increased heart rate, opisthotonus or general body spasm that has a typical look like the neck and back arched upwards the body with arms reaching up the body and clenched fists. Even minor events like loud noises, sudden air blow or touch or light may trigger sudden involuntary muscle spasms. It is a characteristic feature of tetanus called' tetany.'

Neonatal tetanus is a tetanus infection in neonates or newborns. See Newborn. It is seen in newborns whose mother are not being vaccinated for the two shots of tetanus vaccine during pregnancy. Using unsterile instrument to cut the cord of the newborn post birth can also cause neonatal tetanus, if the baby does not have acquired passive immunity from mother. 

Neonatal tetanus can be one of the causes of neonatal death. The symptoms of neonatal tetanus may be seen on an average around 7 days. The incubation period may be between 3-14 days.  The newborn can be seen excessively crying and not sucking nipple actively. There may be irritability and sudden ridigity of the body and extremities. 

Cephalic tetanus is a tetanus infection that starts following a head injury. It is a rare type of tetanus that involves the facial muscles and jaw muscles. The symptoms can become severe and turn into a generalised tetanus. 

Local tetanus is a tetanus infection that has occurrence in the area locally surrounding the wound. This can also turn into a generalised tetanus if not treated early. 

Can tetanus spread from human-to-human? 

No. Tetanus cannot spread from one person to another. It is spread by direct contact of the open wound by contaminated soil, dung, manure or saliva. Using contaminated or non-sterile equipment to cut the umbilical cord may cause spread of bacteria in newborn via infected umbilical stump. 

The chances of neonatal tetanus are more when the mother is not vaccinated during pregnancy. Thus the newborn lacks the passive immunity that would have been acquired from the mother.  Newborns of non-vaccinated mothers are more susceptible to get tetanus infection. 

What are the signs and symptoms of tetanus infection? 

The tetanus bacteria and their spores may gain entry through a cut or deep open wound or during delivery of the baby. It may take up to 2 days to 21 days to show the signs and symptoms of tetanus. The average incubation period of tetanus is around 10 days, which can be a little earlier in newborn and infants.  in most cases the symptoms may take 10-14 days to appear. 

The first spasm occurs in the jaw and then progress down towards the rest of the body parts including neck, throat, upper back, belly, upper arms, thighs and both lower extremities.  People with tetanus may get sudden muscle spasms on slight triggers by noise, touch, light, etc. 

The signs and symptoms of generalised tetanus are as follows:

• stiffness in the jaw and neck
• difficulty or inability to open the mouth due to stiff muscles(lock jaw)
• painful muscle cramps in the jaw and neck
• difficulty in swallowing 
• sudden jerks or muscle spasms that can spread to the back, extremities and abdomen
• reflex stimulation to noises,sudden muscle spasms occur due to triggers such as noises, touch or light
• facial spasms causing persistent grin on the face. 
• increased heart rate and blood pressure changes
• headache
• fever with profuse sweating
• nausea, vomiting and diarrhea
• seizure episodes

What are the symptoms of tetanus in a newborn? 

In newborns the bacteria or spores get transferred via their umbilical cord stump post-birth. In newborns symptoms of tetanus may appear within 3 days to 2 weeks or even earlier. 

Symptoms of tetanus in newborn are:

• Excessive crying
• Fever, rapid heart rate
• Sudden irritability 
• Muscle spasms of neck and jaw
• Difficulty sucking at nipple
• Unable to swallow the breast milk

What are the causes of Tetanus? 

Tetanus is caused by bacteria. Clostridium tetani is the causative agent of tetanus. 

The spores of the bacteria live for years in the sut, soil, manure, etc. and they lie dormant there. Once an open wound gets touched by soil or manure or dust containing these spores, they gain entry into the cells of the wound and start multiplying.  These spores need human cells or living environment to thrive. In the human cells, they start producing a neurotoxin called tetanosplasmin. It is the toxin that irritates the nerve cells that control the movement of body. The toxin spreads rapidly near by the wound and may extend towards the brain and spine. 

The far the site of wound or injury, the more the incubation period of tetanus.  

What are the risk factors of tetanus? 

Tetanus usually does not occur in people who have vaccinated themselves or pregnant ladies who get their tetanus shots during antenatal period. 

Newborns are also vaccinated with DPT or DT or tetanus vaccine after birth as per the WHO immunisation schedule. 

Certain risk factors may help cause tetanus: 

• Not getting your tetanus vaccines and scheduled boosters is the biggest risk factor for tetanus
• Exposure of open wound to contaminated soil or manure
• Non-vaccinated mother 
• Use of non-sterile surgical instruments to cut the umbilical cord
• People having foot ulcer or skin infection related to diabetes
• Cuts or wounds that do not heal and are infected
• Presence of foreign object in the open wound (for example a tiny piece of glass or wood)

How is tetanus diagnosed? 

Tetanus is diagnosed on the basis of history and physical assessment of the symptoms present.  The doctor may ask about the history of cuts/wounds, duration of injury and other related details. There are no specific tests that confirm the diagnosis of tetanus. 

The diagnosis is made by examining the typical symptoms of tetanus. 

What is the treatment of tetanus infection? 

Once tetanus is suspected or diagnosed, the person must be immediately admitted in a hospital for prompt treatment. 

The treatment of tetanus is:

• Treatment with human tetanus immunoglobin 
• Management of wound; wound care and maintenance of aepsis
• Giving antibiotics
• Giving muscle relaxants to control the muscle spasms 
• Tetanus vaccination
• Rest and evaluation in the hospital

Can you prevent yourself from tetanus? 

Yes. Tetanus can be prevented with vaccines and booster doses at regular intervals.

• Vaccines are effective in preventing tetanus. Get your child and yourself vaccinated for tetanus as per the immunisation schedule. 
• Take good care of the wound: whenver you get injured,make sure to wash the wound with large amount of water and apply antiseptic lotion over it. Seek medical help and get the wound dressed with sterile dressing. 
• Medication after injury: Get yourself a medication human tetanus immunoglobulin that prevents you from any tetanus causing spores or bacteria that may be present on an untidy or contaminated wound.  
• All pregnant women must be encouraged to get tetanus toxoid vaccines to ensure safe child birth and prevent tetanus infection to themselves and their newborn babies. 
• Newborn babies must be vaccinated for the tetanus vaccine as per the WHO immunisation schedule for infants.