http://www.mayoclinic.

com/health/tetanus/DS00227
19 : 05 24 sept 2011

tetanus

Definition
Tetanus is a serious bacterial disease that affects your nervous system, leading to painful
muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with
your ability to breathe and, ultimately, threaten your life. Tetanus is commonly known as
"lockjaw."Thanks the tetanus vaccine, cases of tetanus are rare in the United States and the
developed world. The incidence of tetanus is much higher in less-developed countries.
Around a million cases occur worldwide each year.Tetanus can be treated, but not always
effectively. Fatality is highest in individuals who haven't been immunized and in older adults
with inadequate immunization wherever they may live. In countries with low vaccine rates,
infants also are at high risk of severe illness and death.
Symtomps :Signs and symptoms of tetanus may appear anytime from a few days to several
weeks after tetanus bacteria enter your body through a wound. The average incubation
period is seven to eight days.
Common signs and symptoms of tetanus, in order of appearance, are:
Spasms and stiffness in your jaw muscles
Stiffness of your neck muscles
Difficulty swallowing
Stiffness of your abdominal muscles
Painful body spasms, lasting for several minutes, typically triggered by minor occurrences,
such as a draft, loud noise, physical touch or light
Other signs and symptoms may include:
Fever
Sweating
Elevated blood pressure
Rapid heart rate
Cause:
The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces.
When they enter a deep flesh wound, spores of the bacteria may produce a powerful toxin,
tetanospasmin, which actively impairs your motor neurons, nerves that control your muscles.
The effect of the toxin on your nerves can cause muscle stiffness and spasms the major
signs of tetanus.

Risk factors:

In addition, certain factors are necessary for tetanus bacteria to proliferate in your body.
These include:
Lack of immunization or inadequate immunization failure to receive timely booster shots
against tetanus
A penetrating injury that results in tetanus spores being introduced to the wound site
The presence of other infective bacteria
Injured tissue
A foreign body, such as a nail or splinter
Swelling around the injury
Tetanus cases have developed from the following types of injuries:
Puncture wounds including from splinters, body piercings, tattoos, injection drugs
Gunshot wounds
Compound fractures
Crush injuries
Burns
Surgical wounds
Ear infections
Dental infections
Animal bites
Infected foot ulcers in people with diabetes
Infected umbilical stumps in newborns born of inadequately immunized mothers


Complication:

Once tetanus toxin has bonded to your nerve endings it is impossible to remove. Complete
recovery from a tetanus infection requires the growth of new nerve endings and can take up
to several months.
Complications of tetanus infection may include:
Disability. Treatment for tetanus typically involves the use of powerful sedatives to control
muscle spasms. Prolonged immobility due to the use of these drugs can lead to permanent
disability. In infants, tetanus infections may cause lasting brain damage, ranging from minor
mental deficits to cerebral palsy.
Death. Severe tetanus-induced (tetanic) muscle spasms can interfere with your breathing,
causing periods in which you can't breathe at all. Respiratory failure is the most common
cause of death. Lack of oxygen may also induce cardiac arrest and death. Pneumonia is
another cause of death.

Test and diagnosis:

Doctors diagnose tetanus based on a physical exam, medical and immunization history, and
the signs and symptoms of muscle spasms, stiffness and pain. Laboratory tests generally
aren't helpful for diagnosing tetanus.

Treantments and medicine:

Since there's no cure for tetanus, treatment consists of wound care, medications to ease
symptoms and supportive care.
Wound care
Cleaning the wound is essential to preventing growth of tetanus spores. This involves
removing dirt, foreign objects and dead tissue from the wound.
Medications
Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus immune globulin.
However, the antitoxin can neutralize only toxin that hasn't yet bonded to nerve tissue.
Antibiotics. Your doctor may also give you antibiotics, either orally or by injection, to fight
tetanus bacteria.
Vaccine. Having tetanus once doesn't make you immune to the bacteria afterward. So you'll
need to receive a tetanus vaccine in order to prevent future tetanus infection.
Sedatives. Doctors generally use powerful sedatives to control muscle spasms.
Other drugs. Other medications, such as magnesium sulfate and certain beta blockers, may
be used to help regulate involuntary muscle activity, such as your heartbeat and breathing.
Morphine may be used for this purpose as well as sedation.
Supportive therapies
Tetanus infection often requires a long period of treatment in an intensive care setting. Since
sedatives may result in shallow breathing, you may need to be supported temporarily by a
ventilator.
Prevention:

You can easily prevent tetanus by being immunized against the toxin. Almost all cases of
tetanus occur in people who've never been immunized or who haven't had a tetanus booster
shot within the preceding 10 years.
The primary vaccine series
The tetanus vaccine usually is given to children as part of the diphtheria and tetanus toxoids
and acellular pertussis (DTaP) vaccine. This vaccination provides protection against three
diseases: diphtheria (a throat and respiratory infection), pertussis (whooping cough) and
tetanus.
The DTaP vaccine consists of a series of five shots, typically given in the arm or thigh to
children at ages:
2 months
4 months
6 months
15 to 18 months
4 to 6 years
The booster
A booster of the tetanus vaccine is typically given in combination with a booster of diphtheria
vaccine (Td). In 2005, a tetanus, diphtheria and pertussis (Tdap) vaccine was approved for
use in teens and adults under age 65 to ensure continuing protection against pertussis.
It's recommended that adolescents get a dose of Tdap, preferably between the ages of 11
and 12, and that a Td booster be given every 10 years thereafter. If you've never received a
dose of Tdap, substitute it for your next Td booster dose and then continue on with Td
boosters.
If you're traveling internationally, it's a good idea to have up-to-date immunity because
tetanus may be more common where you're visiting, especially if you're traveling to a
developing country. If you receive a deep or dirty wound and it's been more than five years
since your last booster shot, get another booster shot.
In order to stay up to date with all of your vaccinations, request that your doctor review your
vaccination status on a regular basis.
If you were never vaccinated against tetanus as a child, see your doctor about getting the
Tdap vaccine. You can't get a tetanus infection from the vaccine.