Tetanus is a serious infectious disease that affects the skeletal muscle fibers. It was once considered a witchcraft disease as it caused prolonged spasms in the affected person. Thus, many misconceptions and superstitions were related to this disease, till the actual cause came to light. Let us have a look at tetanus in detail in the following paragraphs.
What is Tetanus?
Tetanus is a medical condition that is caused by Clostridium tetani. It is a very serious ailment that affects the nervous system. The bacteria produce a toxin that leads to severe muscle contractions. These contractions lead to locking of the muscles in the jaw and neck. Thus, it was also called as the lockjaw disease.
The bacteria are present in fertile soil and their spores remain viable for many decades. Thus, any person whose wound is infected with soil contaminated with Clostridium tetani can develop a tetanus infection. Other than soil, these bacteria are also found in dust, manure, animal and human feces.
What is Tetanospasmin?
The toxins produced by the bacteria that causes muscle spasms is called as tetanospasmin. It is one of the most potent and deadly toxins produced by a microorganism. When the bacteria or its endospore gain entry into a deep wound or puncture wound, it becomes viable. It starts producing the toxin that enters the bloodstream.
Once it gets into the blood, it starts reaching the nerves and the spine. It takes around 3 to 21 days for the toxins to affect the nerves. It starts blocking the nerve signals that affects muscle relaxation. The first nerves that are affected leading to spasms in the jaw and the face. Gradually, the muscles in the back, hands, arms, legs are affected. The toxins then reaches the respiratory muscles and affects the ability to breath. The mouth and jaw are locked that affects the person’s ability to swallow.
Cause of Tetanus
Infection by Clostridium tetani leads to release in toxin that causes tetanus.
Symptoms of Tetanus
The first sign of tetanus is lockjaw, that is, locking of the jaw muscles. Soon, the muscles of the neck will get stiff. The patient will no longer be able to swallow. The muscles of the abdomen get rigid. Slowly, the patient will develop spasms that can be triggered by sound and even touch. The patient will develop fever and start sweating profusely.
The spasms are so strong that they can cause arched back. This condition is called as opisthotonos. Powerful muscle contractions occur called as tetany. The force of these contractions is so strong, that it can lead to muscle tears and even fracture the spine. Spasms also affect the the bladder and bowels leading to loss of control to urinate and defecate.
Most of the patients suffer from generalized tetanus. Here patients suffer from:
- Facial spasms
- Stiff neck
- Swallowing difficulty
- Rigidity of leg muscles
- Profuse sweating
- Spasms that cause opisthotonus
Newborn babies can also be affected by tetanus. This occurs due to the unstable methods of cutting the umbilical cords. In many developing countries the mothers are never vaccinated or immunized against tetanus. Thus, the cut of umbilical cord leads to infection of the newborn with tetanus. The newborn develops the following symptoms:
- Poor feeding
- Rigid muscles spasms
Another form of tetanus called cephalic tetanus is a very rare form of the disease. It affects the ear leading to cranial nerve palsies. Local tetanus causes rigidity of only those muscles that are close to the site of infection. It is a milder case of tetanus that has only 1% fatality rate.
Diagnosis of Tetanus
Tetanus cannot be detected with any blood test. The condition is diagnosed based on the symptoms seen. The ‘spatula test’ is generally carried out to check for tetanus. A sterile, instruments are touched to the pharyngeal wall. If the person is infected, he/she will suffer from jaw contraction leading to biting down at the spatula inserted in the mouth. If there is no infection, the person will just suffer from a normal gag reflex.
Treatment for Tetanus
Tetanus infection is incurable. However, with advance medical care and supportive treatments available, it is easier to manage the symptoms. The first line of treatment is wound care. The wound is cleaned and any dirt, dead tissue, etc. is removed.
Medications such as antibiotics to fight the infection, antitoxins to neutralize the toxin and sedatives are given to keep the muscle spasms in control. The patient is even given a vaccine shot to prevent any future infection.
Severe infection requires intensive care. The patient is given:
- Intrathecal injections of human tetanus immunoglobulin
- Intravenous infusion of magnesium
- Muscle relaxants
- The patient kept on mechanical ventilators
- The airway is maintained to avoid respiratory failure
- Nutrition in the form of liquid is given through a tube attached to the stomach
Till one does not regrow their nerve endings, it is impossible to get rid of the effects of the tetanus toxin. This takes several months and the patient may develop complications. These complications include permanent disability, brain damage as well as cerebral palsy in infants. Severe tetanus infections lead to death due to loss of ability to breath.
Prevention of Tetanus
Vaccination with tetanus toxoid is the best way to prevent tetanus. A booster dose taken every 10 years helps maintain the immunity. Children under the age of 7 years are given DPT/DTaP vaccine that also keeps them safe from diphtheria and pertussis infection.
This was all about tetanus. This is a very scary infection that lead to strange body spasms that people in the past thought was an effect of witchcraft and black magic. However, today we know it is tetanospasmin that causes the spasms and contractions. It is important to seek immediate medical help when one gets hurt or is wounded. Never delay treatment, if you have never been vaccinated against tetanus.
Written by: Saptakee sengupta
Date last updated: February 23, 2015