Tetanus Health Dictionary

A serious, sometimes fatal, disease of the central nervous system caused by infection of a wound with spores of the bacterium CLOSTRIDIUM TETANI. The spores live mainly in soil and manure but are also found elsewhere, including in the human intestine. When the spores infect poorly oxygenated tissues they multiply and produce a toxin that acts on the nerves controlling muscle activity. The most common symptom of this is trismus (commonly known as lockjaw). Other symptoms include stiffness of the abdominal and back muscles, and contraction of facial muscles, producing a fixed grimace. There may also be a fast pulse, slight fever, and profuse sweating. Painful muscle spasms then develop, and may result in asphyxia if they affect the larynx or chest wall. The spasms usually subside after 10 to 14 days.

About half a million cases of tetanus occur worldwide each year, but fewer than 20 occur in the. The diagnosis is made from the symptoms and signs, and a course of tetanus antitoxin injections is started. Most people recover completely if treated promptly.

Prevention of tetanus in the relies on the DPT vaccination being given routinely during childhood; booster shots are given every 10 years.

Also called LOCKJAW, this is a bacterial infection of the nervous system. Increased excitability of the SPINAL CORD results in painful and prolonged spasms of the voluntary muscles throughout the body, rapidly leading to death unless treated.

Causes The disease is caused by the bacillus Clostridium tetani, found generally in earth and dust and especially in places where animal manure is collected. Infection usually follows a wound, especially a deeply punctured or gunshot wound, with the presence of some foreign body. It is a hazard in war and also among farmers, gardeners and those in the construction industry. The bacillus develops a toxin in the wound, which is absorbed through the motor nerves into the spinal cord where it renders the nerves excitable and acutely sensitive to mild stimuli.

Symptoms Most commonly appearing within four to ?ve days of the wound, the patient’s symptoms may be delayed for several weeks – by which time the wound may have healed. Initially there is muscle sti?ness around the wound followed by sti?ness around the jaw, leading to lockjaw, or trismus. This extends to the muscles of the neck, back, chest, abdomen, and limbs, leading to strange, often changing, contorted postures, accompanied by frequent seizures – often provoked by quite minor stimuli such as a sudden noise. The patient’s breathing may be seriously affected, in severe cases leading to ASPHYXIA; the temperature may rise sharply, often with sweating; and severe pain is common. Mental clarity is characteristic adding to the patient’s anxiety. In severe infections death may be from asphyxia, PNEUMONIA, or general exhaustion. More commonly, the disease takes a chronic course, leading to gradual recovery. Outcome depends on several factors, chie?y the patient’s immune status and age, and early administration of appropriate treatment.

Tetanus may occur in newborn babies, particularly when birth takes place in an unhygienic environment. It is particularly common in the tropics and developing countries, with a high mortality rate. Local tetanus is a rare manifestation, in which only muscles around the wound are affected, though sti?ness may last for several months. STRYCHNINE poisoning and RABIES, although similar in some respects to tetanus, may be easily distinguished by taking a good history.

Prevention and treatment The incidence of tetanus in the United Kingdom has been almost abolished by the introduction of tetanus vaccine (see IMMUNISATION). Children are routinely immunised at two, three and four months of age, and boosters are given later in life to at-risk workers, or those travelling to tropical parts.

Treatment should be started as soon as possible after sustaining a potentially dangerous wound. An intravenous injection of antitoxin should be given immediately, the wound thoroughly cleaned and PENICILLIN administered. Expert nursing is most important. Spasms may be minimised by reducing unexpected stimuli, and diazepam (see BENZODIAZEPINES; TRANQUILLISERS) is helpful. Intravenous feeding should be started immediately if the patient cannot swallow. Aspiration of bronchial secretions and antibiotic treatment of pneumonia may be necessary.

An infective disease due to the toxins of Clostridium tetani

(lockjaw) n. an acute infectious disease, affecting the nervous system, caused by the bacterium Clostridium tetani. Infection occurs by contamination of wounds by bacterial spores. Bacteria multiply at the site of infection and produce a toxin that irritates nerves so that they cause spasmodic contraction of muscles. Symptoms appear 4–25 days after infection and consist of muscle stiffness, spasm, and subsequent rigidity, first in the jaw and neck then in the back, chest, abdomen, and limbs; in severe cases the spasm may affect the whole body, which is arched backwards (see opisthotonos). High fever, convulsions, and extreme pain are common. If respiratory muscles are affected, a *tracheostomy or intubation and ventilation is essential to avoid death from asphyxia. Mortality is high in untreated cases but prompt treatment is effective. An attack does not necessarily confer complete immunity. Immunization against tetanus is effective but temporary. —tetanic adj.