Tetanus

Tetanus
(Lockjaw & Tetanus Vaccination)

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Medical Author: David Perlstein, MD, FAAP
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

• What is tetanus?
• Where do tetanus bacteria grow in the body?
• How does the tetanus toxin cause damage to the body?
• What is the incubation period for tetanus?
• What is the course of the tetanus disease? What are the symptoms and signs of tetanus?
• How is tetanus treated?
• How is tetanus prevented?
• What is the schedule for active immunization ("tetanus shots")?
• What are the side effects of tetanus immunization?
• What is passive immunization (by way of specialized immunoglobulin)?
• Tetanus At A Glance

What is tetanus?

Tetanus is an acute, often-fatal disease of the nervous system that is caused by nerve toxins produced by the bacterium Clostridium tetani. This bacterium is found throughout the world in the soil and in animal and human intestines.

Where do tetanus bacteria grow in the body?

Contaminated wounds are the sites where tetanus bacteria multiply. Deep wounds or those with devitalized (dead) tissue are particularly prone to tetanus infection.

Puncture wounds such as those caused by nails, splinters, or insect bites are favorite locations of entry for the bacteria. The bacteria can also be introduced through burns, any break in the skin, and injection-drug sites. Tetanus can also be a hazard to both the mother and newborn child (by means of the uterus after delivery and through the umbilical cord stump).

The potent toxin that is produced when the tetanus bacteria multiply is the major cause of harm in this disease.

How does the tetanus toxin cause damage to the body?

The tetanus toxin affects the site of interaction between the nerve and the muscle that it stimulates. This region is called the neuromuscular junction. The tetanus toxin amplifies the chemical signal from the nerve to the muscle, which causes the muscles to tighten up in a continuous ("tetanic" or "tonic") contraction or spasm. This results in either localized or generalized muscle spasms. Tetanus toxin can affect neonates to cause muscle spasms, inability to nurse, and seizures. This typically occurs within the first two weeks after birth and can be associated with poor sanitation methods in caring for the umbilical cord stump of the neonate. Of note, because of tetanus vaccination programs, only three cases of neonatal tetanus have been reported since 1990, and in each of these cases, the mothers were incompletely immunized.

What is the incubation period for tetanus?

The incubation period between exposure to the bacteria in a contaminated wound and development of the initial symptoms of tetanus ranges from two days to two months, but it's commonly within 14 days of injury.

What is the course of the tetanus disease? What are the symptoms and signs of tetanus?

During a one- to seven-day period, progressive muscle spasms caused by the tetanus toxin in the immediate wound area may progress to involve the entire body in a set of continuous muscle contractions. Restlessness, headache, and irritability are common.

The tetanus neurotoxin causes the muscles to tighten up into a continuous ("tetanic" or "tonic") contraction or spasm. The jaw is "locked" by muscle spasms, giving the name "lockjaw" (also called "trismus"). Muscles throughout the body are affected, including the vital muscles necessary for normal breathing. When the breathing muscles lose their power, breathing becomes difficult or impossible and death can occur without life-support measures. Even with breathing support, infections of the airways within the lungs can lead to death.

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