A bacterial infection of the nervous system. Increased excitability of the SPINAL CORD results in painful and prolonged spasms of the voluntary muscles throughout the body, rapidly leading to death unless treated.
The disease is caused by the bacillus Clostridium tetani, found generally in earth and especially in places where animal manure is collected. Infection usually follows a wound, especially a deeply punctured or gunshot wound, with the presence of some foreign body. It is a hazard in war and also among farmers, gardeners and those in the construction industry. The bacillus develops a toxin in the wound, which is absorbed through the motor nerves into the spinal cord where it renders the nerves excitable and acutely responsive to mild stimuli.
Most commonly appearing within four to five days of the wound, these may be delayed for several weeks, by which time the wound may have healed. Initially there is muscle stiffness around the wound followed by stiffness around the jaw, leading to trismus (‘lockjaw’). This extends to the muscles of the neck, back, chest, abdomen, and limbs, leading to strange, often changing, contorted postures, accompanied by frequent seizures – often provoked by quite minor stimuli such as a sudden noise. The patient's breathing may be seriously affected, in severe cases leading to ASPHYXIA; the TEMPERATURE may rise sharply, often with sweating; and severe pain is common. Often the disease takes a chronic course, leading to gradual recovery. Outcome depends on several factors, chiefly the patient's immune status and age, and early administration of appropriate treatment.
Tetanus may occur in newborn babies, particularly when birth takes place in an unhygienic environment in the tropics. It has a high mortality rate. Local tetanus is a rare manifestation, in which only muscles around the wound are affected, though stiffness may last for several months.
The incidence of tetanus in the developed world has been almost abolished by the introduction of tetanus vaccine (see IMMUNISATION).
Treatment should be started as soon as possible after sustaining a potentially dangerous wound. Tetanus toxoid and an injection of antitoxin may be given, the wound thoroughly cleaned and PENICILLIN administered. Spasms may be minimised by reducing unexpected stimuli, and diazepam (see BENZODIAZEPINES; TRANQUILLISERS) is helpful. Full intensive care may be necessary.