Tetanus, commonly known as Lockjaw, is rare in the United States, with less than 50 cases reported annually. It is much more common in undeveloped areas of the world, with an average of 1 million cases occurring annually worldwide. Though rare in the United States, it is a serious disease that affects the nerves and muscles.
Tetanus is a disease caused by infection with Clostridium tetani, a dangerous bacterium that is present in soil and feces. Infection with the bacteria leads to the development of dangerous neurotoxin, known as tetanospasmin, that can spread throughout the entire body and cause widespread general muscle spasms. The disease can inhibit the ability to breathe and can be life-threatening. It is commonly referred to as Lockjaw because it often targets the muscles of the jaw and neck, making it difficult or impossible to open the jaw, swallow and breathe.
The symptoms of tetanus vary depending on the severity of the infection. The response to infection from the bacteria varies, and symptoms may occur anywhere from two days after exposure to up to four weeks. On average, the incubation period for tetanus is generally one week. The most common symptoms of tetanus are:
- Muscle stiffness in the jaw
- Muscle spasms in the jaw
- Stiff neck muscles
- Difficulty swallowing
- Stiff abdominal muscles
- Body spasms, often painful, lasting for several minutes
Other less common symptoms that may or may not occur with tetanus include:
- Increase in blood pressure
- Elevated heart rate
If you develop any of these symptoms after experiencing a wound, especially one that may have been contaminated with dirt, soil, feces or saliva, it is important that you contact your physician immediately. This is especially important if you are not up to date with your tetanus shots or if you are unsure of your tetanus vaccination status.
The majority of cases of tetanus in the United States occur as a result of a cut or deep puncture wound that becomes contaminated with the tetanus bacteria. Occasionally, an individual with a tiny cut that is not noticeable can still go on to develop tetanus. However, the majority of cases of tetanus that occur in the United States are the result of a wound that is deep or dirty, or a burn, a crushing injury, gangrene or frostbite. Punctures to the skin that occur from non-sterile needles such as those used for body piercings, tattoos and drug use are also susceptible to tetanus.
When the tetanus bacteria enters the wound, the spores from the bacteria travel through the bloodstream and invade the motor neurons throughout the body. They impair the ability of the nerves to function properly, making them unable to control the muscles. The result is muscle spasms and muscle stiffness.
In order for the tetanus bacteria to enter into the bloodstream, conditions have to be just right. There are certain risk factors that can contribute to the development of tetanus. They include:
- Not being immunized against tetanus
- An injury that penetrates the skin and introduces tetanus into the body through the wound
- Other infective bacteria present at the wound site
- Injury to body tissues
- Introduction into the body of a foreign substance, such as a splinter or nail
- Swelling around the wound
Although tetanus can develop as a result of many different kinds of injuries, the following are the most common ways that tetanus occurs in the United States:
- Puncture wounds
- Body piercings, tattoos and IV drugs with unsanitary needles
- Gunshot wounds
- Compound fractures
- Crushing injuries
- Surgical wounds
- Ear infections
- Dental infections
- Animal bites
- Foot ulcers in diabetics that become infected (see: Diabetic Foot Pain And Complications)
- Umbilical cord stumps in newborns that become infected
Diagnosis of tetanus occurs after a complete physical examination is performed by the doctor. This includes a complete medical history, an immunization history and an evaluation of the symptoms such as muscle spasms, muscle stiffness and pain. Blood tests and other laboratory tests are usually ineffective at diagnosing tetanus.
There is no cure for tetanus. Treatment includes caring for the wound, prescribing medications to relieve symptoms and pain, and providing supportive therapy and overall care. When an injury occurs, caring for the wound is essential. The wound must be cleaned well to remove dirt, foreign matter and dead tissue to prevent the growth of tetanus spores. Medications that may be prescribed for tetanus include:
- Antitoxins to neutralize the toxins that have not bonded to nerves
- Antibiotics to fight the tetanus bacteria
- Vaccine to prevent future tetanus infections
- Sedatives to control muscle spasms
- Medications such as morphine to regulate heartbeat and breathing
Puncture wounds, animal bites and other deep injuries increase your risk of developing a tetanus infection. Seek medical attention of you have one of these conditions and are unsure of your vaccination status. If you have a wound that is unclean, keep it open and un-bandaged so that you do not trap the bacteria in the wound. Your doctor will clean the wound and may prescribe an antibiotic.
For minor wounds that have a lower risk of tetanus, there are simple steps you can take to reduce your risk of developing tetanus even more. They include:
- Controlling the bleeding by applying direct pressure
- Keeping the wound clean by rinsing it after the bleeding has stopped and cleaning the area with soap and a clean cloth
- Applying a thin layer of a topical antibiotic cream, gel or ointment to discourage the growth of bacteria and prevent infection
- Covering the wound to keep it clean and prevent bacteria from getting in
- Changing the dressing often, at least once per day or any time it becomes wet or dirty
The best way to prevent tetanus is to stay up-to-date with tetanus vaccines and boosters. Booster shots should be given to adults every 10 years. Children receive their tetanus vaccine as part of their regularly scheduled childhood vaccinations.
When the tetanus bacterium travels through the bloodstream and bonds to the nerve endings, there is no way to remove the toxins from the nerves. In order for an individual to completely recover from a tetanus infection, new nerve endings have to grow, which can take several months. Complications that can occur as a result of tetanus include:
- Brain damage in infants
- Cerebral palsy in infants
- Death due to interference with muscles used for breathing resulting in respiratory failure
Tetanus is a serious but largely preventable disease. Almost all of the cases of tetanus in the United States occur in individuals who are not vaccinated against the tetanus bacteria. If you experience a puncture wound or a deep wound and you have not received your tetanus vaccine or are unsure of your vaccination status, contact your doctor.