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Tetanus Vaccine - Symptoms & Treatment

Tetanus, sometimes called lock-jaw, is an acute disease caused by a neurotoxic exotoxin of the bacteria, Clostridium tetani. It is an acute exotoxin-mediated infection caused by the anaerobic, spore-forming, gram-positive bacillus Clostridium tetani. Usually, such infection is systemic; less often, localized.

Tetanus is fatal in up to 60% of non­immunized persons, usually within 10 days of onset. When symptoms develop within 3 days after exposure, the prognosis is poor.

Causes

Tetanus is caused by a bacterium, which lives in soil and manure. The bacterium enters the body through an open wound for example, one caused by animal bites, burns or from treading on objects from outdoors such as a rusty nail. Once the bacterium enters the wound (this can be a scratch, but it will prefer deep wounds), it produces a poison known as tetanospasmin which spreads throughout the body and affects the nerves which control muscle activity.

Signs and symptoms

Tetanus often begins with muscle spasms in the jaw and face, together with difficulty swallowing and stiffness or pain in muscles in the neck, shoulder, or back. The muscle spasms can be severe and can quickly spread to muscles of the abdomen, upper arms, and thighs.

The symptoms of tetanus usually appear anywhere from 3 to 14 days after the person has become infected.

Diagnosis

Frequently, diagnosis must rest on clinical features and a history of trauma and no previous tetanus immunization. Blood cultures and tetanus antibody tests are often negative; only one-third of patients have a positive wound culture. Cerebrospinal fluid pressure may rise above normal. Diagnosis also must rule out meningitis, rabies, phenothiazine or strychnine toxicity, and other conditions that mimic tetanus.

Treatment

Within 72 hours after a puncture wound, a patient with no previous history of tetanus immunization first requires tetanus immune globulin (TlG) or tetanus antitoxin to confer temporary protection. Next, he needs active immunization with tetanus toxoid. A patient who has not received tetanus immunization within 5 years needs a booster injection of tetanus toxoid.

If tetanus develops despite immediate postinjury treatment, the patient will require airway maintenance and a muscle relaxant, such as diazepam, to decrease muscle rigidity and spasm. If muscle contractions aren't relieved by muscle relaxants, a neuromuscular blocker may be needed. The patient with tetanus needs high-dose antibiotics(penicillin administered I.V., if he's not allergic to it).

Prevention

Effective vaccines are available for tetanus. The vaccine is an inactivated cell-free tetanus toxin (toxoid) which is available in Australia as DTP, CDT, and Td (ADT). DTP is a combined diphtheria, tetanus and pertussis vaccine. Tetanus immunisation should normally be part of the standard childhood vaccination schedule. Although immunity following complete vaccination is long lasting, maintenance of immunity with booster doses at 10 year intervals is recommended.

Tetanus immunoglobulin (TIG) provides passive protection where an unimmunised person has sustained a tetanus-prone wound. Tetanus immunoglobulin is also available for the management of clinical tetanus. This product is prepared from human plasma containing high antibody levels to the tetanus toxin.