Tetanus (Lock Jaw)

Tetanus is an acute illness of the nervous system caused by the toxin of the clostridium tetani bacteria and characterized by painful muscle spasms especially of the jaw, thus the term ‘lock jaw’.

Most cases occur as a result of puncture wounds or lacerations. Soil and excrement contain the bacteria clostridium tetani. When a wound is contaminated, this bacterium grows and produces the tetanus toxin which binds irreversibly to neural junctions causing illness. The bacteria are killed by iodine or hydrogen peroxide.

Where does it occur?

It occurs worldwide, but incidence is highest in developing countries. Drug abusers are at risk for tetanus from wounds at injection sites.

How is it transmitted?

The organism and its toxin are introduced into the body through wounds contaminated with soil, animal or human excrement.

Is it contagious from person to person?

It is not contagious from person to person.

What is the risk for travelers?

The risk is generally low unless one develops injuries with wounds that are contaminated.

How soon after exposure will one develop symptoms?

Symptoms commonly develop within 2 weeks of exposure.

What are the signs and symptoms?

The symptoms of tetanus are characterized by intensely painful muscle spasms and usually begin with the jaw (lock jaw) and neck muscles. Patients may also have contractions of the muscles of the eye and forehead that give them a frown and tenseness of the abdomen. Episodes of spasms involve arching of the back, extension of the legs and flexing of the arms (opisthotonous) that are set off by noise etc and are intensely painful. During these spasms the diaphragm muscle can be rendered rigid and airways obstructed resulting in respiratory failure.

A form of tetanus that only affects the nerves controlling facial muscles also occurs with findings of grimacing etc.

Sometimes the spasm is localized to the muscles close to the site of injury.

Are there any lab tests to diagnose the illness?

Diagnosis is made based on physical symptoms of the patient; lab tests do not reliably diagnose this illness. The bacteria and its toxin are not reliably cultured.

Is there any treatment?

Specific treatment involves administration of tetanus immune globulin, antibiotics like metronidazole and wound debridement. Supportive measures of airway protection, muscle relaxants and sedatives are crucial. Active immunization with tetanus toxoid must also be instituted.

What preventive measures can be taken?

Update your tetanus toxoid immunization prior to travel and meticulously clean all wounds, preferably with hydrogen peroxide or iodine.

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