Tetanus is a serious infection caused by bacterium Clostridium Tetani. It is a disease that affects nervous system due to the release of potent neurotoxin. The toxin released by this germ can lock a person in steely grip, bend his back like a bow, and cause severe painful muscle spasm. Finally the toxin terminates patient’s existence with single swift of airway obstruction.
The bacteria usually enter through wound that is contaminated with soil, feces, manure or unsterilized needles and surgical instruments. The disease is prevalent all over world although its incidence has dramatically reduced due to use of effective tetanus vaccine. However, it still remains an important cause of morbidity and mortality in developing countries, especially in children below the age of 5 years.
Treatment of tetanus infection is empirical. Antibiotics, tetanus immunoglobulin, muscle relaxants and clean dressing of wound etc are done till the toxin effect is exhausted.
What Is The Cause Of Tetanus Disease?
Tetanus infection is caused by clostridium species of bacteria called Clostridium tetani.
Tetanus develops in four characteristic situations. In first case it can occur in newborn if the umbilical cord is cut with unsterile instrument. In second case it can occur in patients suffering from ear infection where the spores can enter into if the ear is probed with wire or matchstick. In third case, the organism can enter in a woman through genitals if proper sterile methods are not taken during examination. Lastly, in more than 50 percent of patient the cause is through injury. Even trivial injury can cause tetanus if the person is not vaccinated.
Tetanus mostly occurs in person who is not vaccinated against it or is incompletely vaccinated. Tetanus can develop after a puncture wound, burns, gunshot injury, surgical wound, infected foot ulcer, compound fractures, infection in teeth etc. Applying cow dung over wound is greatest risk for development of tetanus. This method even today is common in many developing countries.
Signs And Symptoms Of Tetanus Infection
It may take 10 to 21 days for tetanus to occur after the bacteria enter into the body through wound. This period is called incubation period. Common signs and symptoms of tetanus are as follows:
- Lock jaw (trismus) is usually the first symptom. It occurs due to spasm and stiffness of jaw muscles.
- Neck stiffness
- Difficulty in swallowing.
- Stiffness of chest muscles that reduces ability to breathe or cough.
- Board like rigid abdomen.
- Opisthotonus or body becomes into bow shape due to muscle spasm.
- Sound, light, even draft of air can produce severe muscle spasms that are extremely painful.
- Increased irritability and restlessness.
- Profuse sweating
- Rapid heartbeats
- Airway obstruction due to contraction of thoracic and muscles of pharynx.
- Typical grimacing of face (risus sardonicus).
By the end of first week tetanus develops into its maximum. Continues for another two weeks and then reduces its intensity over a further four weeks. However, in severe form of tetanus patient can die due to spasm of the air passage.
Treatment Guidelines For Tetanus
Diagnosis of tetanus is done from clinical examination of the symptoms, history of immunization. There is no cure for tetanus. The principle of treatment is to halt production of toxin in the wound, clean the wound to eliminate the germs as many as possible, to neutralize toxin liberated by the bacteria, and keep the patient alive till the effect of toxin is completely vanished.
In majority of cases patient needs to be hospitalized preferably in intensive care unit. Treatment consists of administration of antibiotics, use of anti tetanus serum, intravenous sedation to control spasm. Patient needs to be nursed in quiet room to avoid sound and light that may produce spasms of muscles.