Tetanus is a serious disease, which is caused by a bacterium. It leads to painful muscle cramps, starting in the face. The respiratory muscles can also be affected and then a dangerous situation is created, which can even lead to death. The disease is most common in countries with warm climates.
Cause
Tetanus is caused by the bacterium Clostridium tetani, which is commonly found in soil and road dirt. A person can be infected by a dirty wound. This is a wound in which, for example, road dirt, soil or fecal residues of animals have been got into. A person can also be infected by a bite from an animal. Especially wounds that are small but deep pose a risk, because the bacteria thrive well in a low-oxygen environment. Burns are also notorious, especially in developing countries. After infection, it takes an average of three to twenty-one days before the first symptoms occur. Tetanus is not contagious from human to human.
Symptoms
The tetanus bacteria produce toxins that damage tissues. This causes:
- Stiffness in the vicinity of the infection.
- Worsening muscle cramps as a result of triggers, such as loud noises, touches, cold, moving.
- Lockjaw, difficulty swallowing, respiratory problems.
- Cramp in all skeletal muscles, sometimes so bad that a person is warped backwards like a hoop and cannot breathe anymore.
Without treatment, tetanus is always fatal.
Diagnosis
The diagnosis of tetanus is made on the basis of the symptoms, such as general muscle stiffness, reinforced reflexes, lockjaw and the characteristic cramps (spasms). There is usually no prior injury. It should always be asked if and when the patient has been vaccinated for tetanus. Occasionally, the tetanus bacterium can be isolated from the wound material.
Treatment
People with tetanus are given various medications:
- Injections of anti-tetanus immunoglobulin. This drug ensures that the toxic substance, produced by the tetanus bacterium, cannot reach the nervous system.
- Antibiotics against bacteria that might still be there.
- Optionally muscle relaxants for cramps.
People who already have symptoms from the disease, such as cramping attacks, should be admitted to the hospital immediately. There they get muscle relaxant medicines and artificial ventilation. Because swallowing is often not possible, they receive nutrition through a nasogastric probe (a tube that runs through the nose into the stomach) or through an infusion. In order to drain urine, a urinary catheter is needed.
A vaccine is available for tetanus, to prevent people from getting the disease.
Prognosis
The mortality rate due to tetanus is worldwide fifty percent. Death is most common in very young children, very old people and users of intravenous drugs. The prognosis is bad when symptoms worsen rapidly or treatment is delayed. Complications, such as bone fractures, high blood pressure and heart rhythm disorders, may arise then, caused by damage to the muscular and nervous system. Sometimes, patients survive only by prolonged anesthesia or artificial ventilation. However, this can cause thrombosis or pneumonia, which can also be fatal.
Considerations
- For optimal protection, it is recommended to be vaccinated for tetanus every ten years. Vaccination for tetanus is standard combined with vaccination for polio and diphtheria (DTP vaccine).
- The risk of tetanus can be limited by cleaning each wound thoroughly and thereby removing all dead tissue and foreign elements. It may be necessary to surgically remove foreign material and damaged tissue.
