TETANUS

TETANUS

tetanus

Tetanus is a neurological disorder caused by bacteria called Clostridium tetani, characterized by muscle tone and spasms. Once the bacteria enters the body, they produce a powerful protein poison (toxin) known as tetanospasmin that causes painful muscle contractions. Tetanus is also called “lockjaw”. It often causes a person’s neck and jaw muscles to lock, making it hard to open the mouth or swallow.

CAUSES OF TETANUS

Clostridium tetani

Tetanus is an infection caused by an anaerobic, motile gram positive rod bacterium called Clostridium tetani. The organism is everywhere in the environment including soil, in the inanimate area, dust, in animal faces and manure. The bacteria enters the body through puncture / broken skin as spores and then develop into bacteria. Certain breaks in the skin are more likely to get infected with tetanus bacteria. These include:

• Wounds contaminated with dirt, poop (feces).
• Wounds caused by an object puncturing the skin (puncture wounds), like a nail or needle
• Burns
• Crush injuries
• Injuries with dead tissue

How do tetanus transmitted?

Contrast other vaccine-preventable diseases, tetanus does not spread from person to person. The bacteria are usually found in soil, dust, and manure and enter the body through broken skin usually cuts or puncture wounds caused by contaminated objects. Due to Clostridium tetani being anaerobic bacterium it live mostly in environment that lack oxygen.

SIGNS AND SYMPTOMS OF TETANUS

jaw lock

Typically, the patient with tetanus first notice an increase of muscle tone on masseter muscle is often called “lockjaw” or "trismus" due to these signs of this infection is tightening of the jaw muscles. The duration of onset of infection after injury is seven (7) days; fifteen percent (15%) of cases occur within three (3) days ten percent (10%) after fourteen (14) days.  and Tetanus infection can lead to serious health complications, including difficult to open the mouth and unable to swallowing or breathing.

Symptoms of tetanus include:

• Jaw cramping
• Headache
• Unstable blood pressure 
• Sudden, involuntary muscle tightening (muscle spasms)
• Generalized pain that is painful muscle stiffness all over the body
• Difficult in swallowing
• Jerking or staring (seizures)
• Fever 
• Profuse sweating
• Fast heart rate

How do tetanus diagnosed?

Doctors make diagnosis of tetanus based only on clinical manifestations of tetanus because currently there is no laboratory tests for tetanus, so only symptoms of tetanus and history of patient on immunization lead to diagnosis of illness. 

TREATMENT FOR TETANUS

The therapy for tetanus aim to eliminate source of toxin, neutralize released toxin, reduce and prevent muscle spasms while manage condition of the patient and provide support on respiratory complications until full recovery. Respiratory care with or without mechanical ventilation is require to the hypo-ventilation patient. Management of patient with tetanus involve Antibiotics medications like benzathine penicillin, benzyl penicillin, metronidazole, erythromycin and clindamycin may be administered  to eliminate vegetative bacteria which are the one release toxin. Dosage for penicillin is 500 mg every 6 hours or 1 gram every 12 hours. Also Antitoxin is recommended to neutralize toxin in the blood, antitoxin like Human tetanus immune globulin (TIG) at dose of 3000 to 6000 units intramuscular is recommended. Muscle spasm management is also essential to control pain and reduce risk of respiratory muscle contractions, agents like Diazepam, benzodiazepine, magnesium and GABA agonist are widely used. Patients who recovering from tetanus should be actively immunized.     

PREVENTION MEASURES FOR TETANUS

Prevention of tetanus is usually by proper wound care and active immunization pf tetanus toxoid; recovering patient, unimmunized, partially immunized and high risk individuals should receive vaccine. Three doses of vaccine are recommended for adults: 4 to 8 weeks apart for the first and second doses, third dose should be given 6 to 12 months after second dose, and last dose is known as booster dose should given every 10 years. For prevention of neonatal tetanus, maternal / mother vaccination even during pregnancy is required.