Tetanus, also called Lockjaw, is a serious disease cause by a bacterial toxin called Clostridium tetani. It attacks the nervous system, leading to painful muscle contractions in the jaw and neck that make it difficult to breathe or swallow, and can prove fatal. 

Spread

Clostridium tetani is found in soil, dust, and in human and animal intestinal tracts. 

The bacteria has spores that produce two different toxins. The first is called tetanolysin, which causes tissue destruction in localized areas. The other is tetanospasmin, which is what causes clinical tetanus. 

The spores of the bacteria develop once they get into the body through broken skin. Puncture wounds by nails or needles, wounds contaminated with dirt, feces, or saliva are the most common ways people get the virus. Flesh wounds from burns, or dead tissue from chronic sores and infections can also let the infection in. Crush injuries that lead to exposed bone can also welcome the bacteria.

Less commonly, tetanus bacteria has also developed after insect or animal bites, surgical procedures, dental infections, intravenous drug use, and intramuscular injections. Tetanus can even spread over clean superficial wounds, where only the very top layer of skin is scraped off, though that instance is very rare. Gunshot wounds can also expose people to tetanus. 

The incubation period for the virus varies depending on the contamination of the wound, the distance the injury site is from the central nervous system, and and seriousness of the disease. The average time between exposure and illness is 10 days, typically ranging between 3 days and 3 weeks. However, some cases have occurred after a single day, or after several months. 

Symptoms and Diagnosis

The first sign of tetanus is tightness and spasming of the muscles in the jaw. That’s how tetanus got the nickname “lockjaw.” Those phenomena then spread to the neck and throat, lead to trouble swallowing and even breathing.

Involuntary muscle spasming also happens in the stomach and facial muscles. In some people, their limbs are affected as well. In children and some adults, the spine may begin to arch backward as the muscles in the back start to be affected. 

In some cases, the spasms can become so severe, they may cause the spine or other bones to break. Those spasms can also stop a person from breathing. Respiratory failure is the leading cause of death after tetanus. The lack of oxygen from the spasms can also lead to fatal cardiac arrest.

Most people with tetanus also experience bloody stools and diarrhea, fever and sweating, headache, sensitivity to touch, and a rapid heartbeat. 

Treatment

The earlier the diagnosis, the better outcome you can expect. If you have a puncture wound, a fracture with an exposed bone, or a wound or burn that was exposed for more than 6 hours before surgical intervention, you should get receive tetanus immunoglobulin. Doctors may surgically remove part of the infected muscle if the contaminated tissue is particularly large.

Doctors will prescribe an antibiotic to prevent the bacteria from multiplying and creating the neurotoxin that causes muscle spasms. 

Muscle relaxants, neuromuscular blocking agents, and anticonvulsants will be prescribed if spasms and stiffness have already sent in. If the respiratory muscles and vocal cords are affected, you may need to be put on a ventilator. 

Once the toxin has reached your nerve endings and bonded, it can’t be removed. To recover, new nerve endings have to grow. That process can take several months. 

Vaccine

There is a vaccine for tetanus, which includes a primary immunization course of three to five initial doses, and a booster shot every decade thereafter. It’s usually given to children as part of the “diphtheria and tetanus toxoids and acellular pertussis” (DTaP) vaccine. The shot is administered in the arm or thigh at age 2 months, 4 months, 6 months, 15-18 months, and 4-6 years. A DtaP dose is then given again between ages 10 and 12, and then throughout the lifetime every ten years. If you’re traveling internationally, you should make sure your immunity shots are up to date. 

The bacteria isn’t communicable between humans, so getting a vaccination doesn’t produce the herd immunity sought after from most other vaccines. However, getting it can protect individuals, and is also passed down through the mother’s placenta. 

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