This is an acute disease induced by an exotoxin of the tetanus bacillus characterized by generalized spasm. Tetanus is a serious bacterial disease that affects muscles and nerves. It is popularly known as “Lock Jaw”. It is characterized by muscle stiffness that usually involves the jaw and neck and progresses to other parts of the body.
Cause of Tetanus
The causative organism is the tetanus bacillus known as clostridium tetani which is found in the soil and gains access into the systemic circulation through wound contamination. The incubation period is usually 3-21 days.
Signs and Symptoms of Tetanus
Symptoms typically appears within 14 days of infection and they include:
- Muscle spasm especially the jaw, or lockjaw.
- Muscle stiffness
- Opisthotonus: Here, the affected individual holds his/her body in an abnormal position. The back is arched with their head thrown backward. For example, if the person is lying on their back in a bed, when experiencing opisthotonos, the back of the head and heels only touch the bed they are on.
- Devil’s smile (risus sardonicus): This occurs from the spasms of the muscles of the face and muscles of the angle of the mouth. The person grins.
- Fever and sweating
- Difficulty swallowing
- Respiratory difficulties
Diagnosis of Tetanus
There is no specific laboratory test used to confirm Tetanus. Diagnosis can be based on physical examination, medical history, vaccination history and clinical manifestations such as muscle spasms, stiffness, pain and fever. Although, a laboratory test may be carried out to rule out diseases with similar symptoms.
Management of Tetanus
Treatment of tetanus depends on the severity of the condition:
- Tetanus immune globulin (TIG) or Tetanus Antitoxin: this is to neutralize or prevent the effect of neurotoxinins and tetanus toxoid to boost the immunity to fight against the invading organism.
- Antibiotics: Drugs such as penicillin are prescribed to combat the bacteria in the system.
- Sedatives and Muscle Relaxants: Such as Diazepam are used to control spasms.
- Tracheostomy or Intubation and Mechanical Ventilation: This can be done to meet up with oxygen requirement.
- Nursing patient in a calm dark environment to prevent irritation and spasm.
- Bed sides is padded and rails are raised to prevent falls and injury from restlessness.
- Catheterization: This is done to collect urine to monitor input and output. To also prevent fluid retention.
- Patient is fed parenterally if there is spasm, to prevent aspiration.
- Proper cleaning and dressing of infected wounds.
- Tetanus vaccination.
Prevention of Tetanus
Tetanus can be prevented through immunization programme with DTP (Diphtheria, Tetanus and Pertussis). DTP prevent against diphtheria, tetanus and whooping cough. Vaccination against tetanus using tetanus-toxoid-containing vaccines before exposure is the best protective and preventive measure. Tetanus toxoid is an effective, safe and inexpensive vaccine that can be given to all ages, pregnant women and immunocompromised individuals. The tetanus vaccination schedule is as follow:
|TT-1||At first contact with health worker|
|TT-2||1 month after the first dose|
|TT-3||Six months after TT-2|
|TT-4||One year after TT-3|
|TT-5||One year after TT-4|
Tetanus booster shots are needed every 10 years to ensure immunity.
Complications of Tetanus
- Aspiration Pneumonia: An infection of the lungs caused by inhaling food, liquid or particles into the lungs.
- Asphyxia: This occurs when the body is deprived of enough oxygen.
- Apnea: This is temporary cessation of breathing, especially during sleep.
- Elevated blood pressure
- Respiratory failure