tetanus


Also found in: Dictionary, Thesaurus, Encyclopedia, Wikipedia.
Related to tetanus: tetanus vaccine

Tetanus

 

Definition

Tetanus is a rare but often fatal disease that affects the central nervous system by causing painful muscular contractions. It begins when tetanus bacteria enter the body, usually through a wound or cut exposed to contaminated soil. Tetanus is easily preventable through vaccination.

Description

Tetanus is rare in the United States, with nearly all cases occurring in adults who were not vaccinated as children. About 100 cases are reported each year; 63% of these occur in people over the age of 50. The number of tetanus cases in the United States has steadily decreased since the 1940s (500 to 600 cases per year); the number of reported cases has remained at approximately 50 to 100 cases per year since the mid-1970s. In 1999, however, the lowest number of annual cases to date was reported (33, or 0.02 per 100,000).
Tetanus causes convulsive muscle spasms and rigidity that can lead to respiratory paralysis and death. It is sometimes called "lockjaw" because one of the most common symptoms is a stiff jaw, unable to be opened. Sometimes, tetanus affects only the part of the body where the infection began, but in almost all of reported cases, it spreads to the entire body. The incubation period from the time of the injury until the first symptoms appear ranges from two to 50 days. Symptoms usually occur within five to 10 days. When symptoms occur early, the chance of death is increased. Tetanus is not contagious.

Causes and symptoms

Tetanus is caused by a bacteria called Clostridium tetani, whose spores (the dormant form) are found in soil, street dust, and animal (or even human) feces. Tetanus spores germinate in the body, producing a highly poisonous neurotoxin in the blood, spreading to the nervous system. The infection is usually transmitted through deep puncture wounds or cuts or scratches that are not cleaned well. Between 1997 and 1999, approximately 64% of tetanus cases in the United States were associated with such wounds as punctures, lacerations, or abrasions. Many people associate tetanus with rusty nails and other dirty objects, but any wound can be a source. Less common ways of getting tetanus are animal scratches and bites, surgical wounds, dental work, and therapeutic abortion. About 18% of cases reported between 1997 and 1999 were a result of intravenous drug use. Cases have also been reported in people with no known wound or medical condition.
The first symptom of tetanus is often a stiff or "locked" jaw that prevents the patient from opening his/her mouth or swallowing. This is also called trismus and results in a facial expression called a sardonic smile (or risus sardonicus). Stiffness of the neck and other muscles throughout the body and uncontrollable spasms often follow. Sometimes these convulsions are severe enough to cause broken bones. The bacterial toxin (tetanospasmin) affects the nerve endings, causing a continuous stimulation of muscles. Other symptoms include irritability, restlessness, loss of appetite, and drooling. People with tetanus that is localized experience pain and tingling only at the wound site and spasms in nearby muscles.
In the underdeveloped world, neonatal tetanus accounts for about one-half of tetanus deaths and is related to infection of the umbilical stump in a baby born of an unimmunized mother. The Centers for Disease Control and Prevention (CDC) estimate that over 270,000 deaths occur annually worldwide as a result of neonatal tetanus. In contrast, only two cases of neonatal tetanus in the United States were reported to the CDC between 1989 and 1999. Mothers who have been adequately immunized against tetanus protect their newborns by passing the antibody through the placenta.

Diagnosis

Tetanus is diagnosed by the clinical symptoms and a medical history that shows no tetanus immunization. Early diagnosis and treatment is crucial to recovery from tetanus.

Treatment

Tetanus is a life-threatening disease that requires immediate hospitalization, usually in an intensive care unit (ICU). Treatment can take several weeks and includes antibiotics to kill the bacteria and shots of antitoxin to neutralize the toxin. It also includes muscle-relaxing drugs to control muscle spasms or barbiturates for sedation. In severe cases, patients are placed on an artificial respirator. Recovery can take six weeks or more. After recovery, since the levels of circulating toxin are too low to stimulate natural antibody production, the patient must still be immunized against this disease to prevent reinfection.

Prognosis

Up to 30% of tetanus victims in the United States die. Early diagnosis and treatment improves the prognosis. Neonatal tetanus has a mortality rate of more than 90%.

Prevention

Pre-exposure vaccination

Tetanus is easily preventable through vaccination. All children should have a series of five doses of DTaP, a combined vaccine that offers protection against diphtheria, tetanus, and pertussis, before the age of seven, according to the Centers for Disease Control and Prevention's national immunization guidelines, the Advisory Committee on Immunization Practices, the Committee on Infectious Diseases of the American Academy of Pediatrics, and the American Academy of Family Physicians. Children will not be admitted to school without proof of this and other immunizations.
The DTaP (diptheria, tetanus, accellular pertussis) vaccine should be given at ages two months, four months, six months, 15 to 18 months, and four to six years. DTaP is the preferred vaccine for children up to the age of seven in the United States; it has fewer side effects than DTP and can be used to complete a vaccination schedule begun with DTP. DTaP was first approved by the Food and Drug Administration (FDA) in September 1996. In December 1996, it was approved for use in infants. Between the ages of 11 and 13, children should have a booster for diphtheria and tetanus, called Td.
Adults should have a Td booster every 10 years. Statistics from the Centers for Disease Control and Prevention (CDC) show that fewer than half of Americans 60 years of age and older have antibodies against tetanus. The CDC suggests adults may be revaccinated at mid-decade birthdays (for example, 45, 55). Adults who have never been vaccinated against tetanus should get a series of three injections of Td over six to 12 months and then follow the 10-year booster shot schedule.
Side effects of the tetanus vaccine are minor: soreness, redness, or swelling at the site of the injection that appear anytime from a few hours to two days after the vaccination and go away in a day or two. Rare but serious side effects that require immediate treatment by a doctor are serious allergic reactions or deep, aching pain and muscle wasting in the upper arms. These symptoms could start from two days to four weeks after the shot and could continue for months.
In early 2001, a shortage of the tetanus vaccine became evident after the pharmaceutical company Wyeth-Ayerst Laboratories decided to stop production of the tetanus vaccine, leaving Aventis-Pasteur as the sole manufacturer of the vaccine. As a result, hospitals were provided with only a minimal amount of the drug on a weekly basis—enough to vaccinate patients with potentially infected wounds and other priority cases. Despite stepped-up production efforts on the part of the manufacturer, however, a spokesperson for Aventis-Pasteur predicted that the shortage would last until the end of 2001, as the vaccine takes 11 months to produce.

Post-exposure care

Keeping wounds and scratches clean is important in preventing infection. Since this organism grows only in the absence of oxygen, wounds must be adequately cleaned of dead tissue and foreign substances. Run cool water over the wound and wash it with a mild soap. Dry it with a clean cloth or sterile gauze. To help prevent infection, apply an antibiotic cream or ointment and cover the wound with a bandage. The longer a wound takes to heal, the greater the chance of infection. If the wound doesn't heal, or, it is red, warm, drains, or swells, consult a doctor.
Following a wound, to produce rapid levels of circulating antibody, a doctor may administer a specific antitoxin (human tetanus immune globulin, TIG) if the individual does not have an adequate history of immunization. The antitoxin is given at the same sitting as a dose of vaccine but at separate sites. Some individuals will report a history of significant allergy to "tetanus shots." In most cases, this occurred in the remote past and was probably due to the previous use of antitoxin derived from horse serum.

Key terms

Clostridium — A genus of deadly bacteria that are responsible for tetanus and other serious diseases, including botulism and gangrene from war wounds. Clostridia thrives without oxygen.
DTaP — Diphtheria and tetanus toxoids and accellular pertussis combination vaccine.
DTP — Diphtheria, tetanus, and whole-cell pertussis vaccine.
Td — Tetanus and diphtheria vaccine.
Toxin — A poisonous substance that flows through the body.
Wound — Any injury that breaks the skin, including cuts, scratches, and puncture wounds.

Resources

Periodicals

Landers, Susan J. "Tetanus vaccine shortage leads to rationing." American Medical News. March 19, 2001. 〈http://www.ama-assn.org/sci-pubs/amnews/pick_01/hlsb0319.htm〉.

Other

"Tetanus." Centers for Disease Control and Prevention. http://www.cdc.gov/nip/publications/pink/tetanus.pdf.

tetanus

 [tet´ah-nus]
2. a highly fatal disease caused by the bacillus Clostridium tetani, characterized by muscle spasms and convulsions. The bacilli are prevalent in rural areas and grow in the intestines of humans and other animals. They are found in soil and dust, and are spread by animal and human feces, entering the body through a break in the skin, particularly a puncture wound, such as one caused by a nail, splinter, insect bite, or gunshot. Occasionally, the original wound appears trivial and heals quickly; more often, there is obvious infection. Because of the characteristic jaw stiffness, it is also known as lockjaw. adj., adj tetan´ic.
Symptoms. Stiffness of the jaw is usually the first definite indication of tetanus. Difficulty in swallowing, stiffness of the neck, restlessness, irritability, headache, chills, fever, and convulsions are also among the early symptoms. Muscles in the abdomen, back, neck, and face may go into spasm. If the infection is severe, convulsions are set off by slight disturbances, such as noises and drafts. During convulsions, there is difficulty in breathing and the possibility of asphyxiation.
Treatment. If there is any suspicion of contamination by tetanus bacilli, emergency treatment should be obtained. This may include an adequate dose of antitoxin or a booster injection of tetanus toxoid (see below) to counteract any possible tetanus infection. Because of the possible danger of hypersensitivity to horse serum antitoxin, tetanus immune globulin (derived from human instead of horse serum) is preferred when available. In any case, the wound area must be carefully cleaned, and all dead tissue and foreign substances removed.



During a tetanus attack, sedatives are often given to reduce the frequency of convulsions. antibiotics may also be used to help combat secondary infection. hyperbaric oxygenation (oxygen under high pressure) has also been used to treat tetanus.
Prevention. The most important weapon against tetanus is adequate immunization. Tetanus toxoid in combination with diphtheria toxoid and pertussis vaccine (DTP) is given at two months of age and repeated at four months, six months, 18 months, and four to six years of age.



At the time of injury tetanus toxoid is given, either as an initial immunizing dose or as a booster for previous immunization, unless the patient has received a booster or completed the initial immunization within the past five years. Patients who have been actively immunized within the past ten years are given a booster unless they have received a booster within the past five years. Patients who have not been previously immunized may require passive immunity with homologous tetanus immune serum as well as active immunization, especially if the wound is severe, neglected, or over 24 hours old.
Patient Care. Because the toxin from Clostridium tetani attacks the central nervous system it is extremely important to provide a nonstimulating environment for patients with tetanus. The room must be kept dark and quiet, and drafts of cold air, noises, and other external stimuli must be avoided because they may precipitate convulsive muscle spasms. As for any patient subject to convulsions, maintenance of a safe environment is essential. Prevention of injury to and assessment of a patient with convulsive seizures are discussed under convulsion.



Fluids and nourishment usually are given intravenously during the acute stage of the disease. The patient's intake and output are carefully measured and recorded. Sedatives and antibiotic drugs are administered as ordered to reduce irritability and to combat secondary bacterial infections.

As long as the patient is acutely ill and likely to suffer from convulsive seizures, someone should be in constant attendance. Signs of respiratory difficulty, changes in pulse and blood pressure, and frequent and prolonged muscle spasms should be reported immediately. A tracheostomy set should be readily available in the event severe dyspnea should develop.
cephalic tetanus (cerebral tetanus) a rare form of infectious tetanus with an extremely poor prognosis; it may occur following an injury to the head or face or in association with otitis media in which Clostridium tetani is a constituent of the flora of the middle ear and it is characterized by isolated or combined dysfunction of the cranial nerves, especially the seventh cranial. It may remain localized or progress to generalized tetanus.
neonatal tetanus (tetanus neonato´rum) a severe form of infectious tetanus occurring during the first few days of life caused by such factors as unhygienic practice in dressing the umbilical stump or in circumcising male infants and the lack of maternal immunization.
physiological tetanus a state of sustained muscular contraction without periods of relaxation caused by repetitive stimulation of the motor nerve trunk at frequencies so high that individual muscle twitches are fused and cannot be distinguished from one another; called also tetanic or tonic contraction and tetanic or tonic spasm.

tet·a·nus

(tet'ă-nŭs), Avoid the misspelling/mispronunciation tetnus. Do not confuse this word with tetany.
1. A disease marked by painful tonic muscular contractions, caused by the neurotropic toxin (tetanospasmin) of Clostridium tetani acting on the central nervous system. Compare: lockjaw, trismus.
2. A sustained muscular contraction caused by a series of nerve stimuli repeated so rapidly that individual muscular responses are fused, producing a sustained tetanic contraction.
[L. fr. G. tetanos, convulsive tension]

tetanus

/tet·a·nus/ (tet´ah-nus)
1. an acute, often fatal, infectious disease caused by a neurotoxin (tetanospasmin) produced by Clostridium tetani, whose spores enter the body through wounds. There are two forms: generalized tetanus, marked by tetanic muscular contractions and hyperreflexia, resulting in trismus (lockjaw), glottal spasm, generalized muscle spasm, opisthotonos, respiratory spasm, seizures, and paralysis; and localized tetanus, marked by localized muscular twitching and spasm, which may progress to the generalized form.
2. a state of muscular contraction without periods of relaxation.

neonatal tetanus , tetanus neonato´rum tetanus of very young infants, usually due to umbilical infection.

tetanus

(tĕt′n-əs)
n.
1. An acute, often fatal disease characterized by spasmodic contraction of voluntary muscles, especially those of the neck and jaw, and caused by the toxin of the bacterium Clostridium tetani, which typically infects the body through a deep wound. Also called lockjaw.
2. Physiology A state of continuous muscular contraction, especially when induced artificially by rapidly repeated stimuli.

tet′a·nal (tĕt′n-əl) adj.

tetanus

[tet′ənəs]
Etymology: Gk, tetanos, extreme tension
an acute, potentially fatal infection of the central nervous system caused by the exotoxin tetanospasmin, elaborated by the anaerobic bacillus, Clostridium tetani. More than 50,000 people a year die of tetanus infection worldwide. The toxin is a neurotoxin and one of the most lethal poisons known. C. tetani infects only wounds that contain dead tissue. The bacillus is a common resident of the superficial layers of the soil and a normal inhabitant of the intestinal tracts of cows and horses; therefore barnyards and fields fertilized with manure are heavily contaminated.
observations The bacillus may enter the body through a puncture wound, abrasion, laceration, or burn; via the uterus into the bloodstream in septic abortion or postpartum sepsis; or through the stump of the umbilical cord of the newborn. The dead tissue of the area is low in oxygen. This is the environment essential for the replication of C. tetani. The infection occurs in two clinical forms: one with an abrupt onset, high mortality, and a short incubation period (3 to 21 days); the other with less severe symptoms, a lower mortality, and a longer incubation period (4 to 5 weeks). Wounds of the face, head, and neck are the ones most likely to result in fatal infection. The disease is characterized by irritability, headache, fever, and painful spasms of the muscles resulting in lockjaw, risus sardonicus, opisthotonos, and laryngeal spasm; eventually every muscle of the body is in tonic spasm. The motor nerves transmit the impulses from the infected central nervous system to the muscles. There is no lesion; even at autopsy no organic lesion is seen and the cerebrospinal fluid is clear and normal.
interventions Prompt and thorough cleansing and debridement of the wound are essential for prophylaxis. A booster shot of tetanus toxoid is given to previously immunized people; tetanus immune globulin and a series of three injections of tetanus toxoid are given to those not immunized. People who are known to have been adequately immunized within 5 years do not usually require immunization. Treatment of people who have the infection includes maintenance of an airway, administration of an antitoxin as soon as possible, sedation, control of the muscle spasms, and assurance of a normal fluid balance. The room is kept quiet, and benzodiazepines may be given to reduce hypertonicity; penicillin G is administered for infection; and a tracheostomy is performed and oxygen given for ventilation.
nursing considerations The nurse may encourage everyone to be actively immunized against the infection. The vaccine is safe and effective.

lockjaw

(1) Tetanus, see there.
(2) Trismus, see there.

tetanus

Lockjaw Infectious disease Acute infection by the anaerobic spore-forming bacillus Clostridium tetani, manifest by uncontrolled muscle spasms due to tetanospasmin; it is often fatal, especially at the extremes of age, and preventable by immunization Epidemiology C tetani is ubiquitous, and may infect virtually any open wound; no longer a major health problem in socioeconomically advanced countries or the US–incidence ± 0.035/105, in developing nations, it is a 'top 10' killer, causing ±1 million deaths/yr Substrate Tetanus develops in a menagerie of mishaps from minor mayhem to sloppy abortions, ♀ circumcision, and so on, rolling rural romanticism into a reality sandwich Clinical ±2 wk incubation, followed by localized or generalized weakness, cramping, dysphagia, trismus–lockjaw, ↑ muscle rigidity–eg, risus sardonicus, opisthotonus, laryngospasm, and ± death Management Benzodiazepines–↓ anxiety, sedation, anticonvulsant, muscle relaxant facilitating GABA-inhibitory transmission in the brain stem and spinal cord, ventilatory support, tetanus immune globulin Vaccine The tetanus vaccine is 96% effective; in the US rates of immunity to tetanus ranges from 80% in white ♂ to < 20% in Mexican-American ♀; immunity is ↑ in those with a ↑ education and income. See Clostridium tetani. Cf Tetany Neurology Tonic muscle contraction, see there.

tet·a·nus

(tet'ă-nŭs)
1. A disease marked by painful tonic muscular contractions, caused by the neurotropic toxin (tetanospasmin) of Clostridium tetani acting on the central nervous system.
2. A sustained muscular contraction caused by a series of nerve stimuli repeated so rapidly that the individual muscular responses are fused, producing a sustained tetanic contraction.
See also: emprosthotonos, opisthotonos
[L. fr. G. tetanos, convulsive tension]

tetanus

A serious infection of the nervous system caused by the organism Clostridium tetani which gains access to the body by way of penetrating wounds. The organism produces a powerful toxin which causes muscles to contract violently, and an early sign is spasm of the chewing muscles (trismus) so that there is great difficulty in opening the mouth (‘lockjaw’). Spasm spreads to the muscles of the face and neck, producing a snarling, mirthless smile (‘risus sardonicus’), and to the back muscles which become rigid. In severe cases, the back becomes strongly arched backwards. There is also fever, sore throat and headache. Death may occur from exhaustion or ASPHYXIA. Tetanus is treated with human antitetanus immunoglobulin and large doses of antibiotics or METRONIDAZOLE. A recent study of 120 patients showed that the intrathecal route for immunoglobulin was more effective than the intramuscular route. Spasms are controlled by intravenous DIAZEPAM but it may be necessary to paralyse the patient temporarily with curare and maintain respiration artificially. Tetanus is easily prevented by immunization with tetanus toxoid. Compare TETANY.

tetanus

  1. a sustained contraction of muscle due to the fusion of many small contractions (twitches) that follow one another in very rapid succession.
  2. a disease produced by toxins from the bacterium Clostridium tetani which usually enters the body through a wound, producing spasm of the voluntary muscle, especially of the jaw (lockjaw) . Bacterial tetanus can be treated by administering antitetanus serum containing ready-made ANTIBODIES, or by antitetanus vaccine which induces the formation of antibodies by the recipient.

tetanus

disease caused by the bacterium Clostridium tetani , an anaerobic spore-forming micro-organism present in the intestines of domestic animals and humans and commonly found in soil, dust and manure. Potentially the most serious of all sports-related infections due to the presence of the spores in many sports fields. Important in sports where the athlete comes into contact with soil (e.g. grass pitches); cuts and grazes can not only allow entry of the bacteria but also facilitate their growth and neurotoxin production. Active immunization with tetanus toxoid (TT) is available as part of routine programmes, as regular booster doses and when risk is increased.

tetanus

severe painful muscular spasms and eventual paralysis, caused by exposure to Clostridium tetani neurotoxin

tetanus,

n a spastic/paralytic condition of the central nervous system caused by an exotoxin known as tetanospasmin produced by
Clostridium tetani, an anaerobic bacillus that enters the body through an abrasion, puncture wound, burn, or laceration; characterized by headache, irritability, and painful muscle spasms that cause risus sardonicus, lockjaw, laryngeal spasm, and opisthotonos. Can be fatal.
Enlarge picture
Tetanus: characteristic muscle spasms.

tet·a·nus

(tet'ă-nŭs)
1. Disease marked by painful tonic muscular contractions, caused by the neurotropic toxin (tetanospasmin) of Clostridium tetani acting on central nervous system.
2. Sustained muscular contraction caused by a series of nerve stimuli repeated so rapidly that individual muscular responses are fused, producing a sustained tetanic contraction.
[L. fr. G. tetanos, convulsive tension]

tetanus (tet´ənəs),

n an acute, potentially fatal infection of the central nervous system caused by tetanospasmin, which is an exotoxin, elaborated by an anaerobic bacillus,
C. tetani.
tetanus and diphtheria toxoids (Td),
n an active immunizing agent containing detoxified tetanus and diphtheria toxoids that slowly produce an antigenic response to the diseases. Typically administered as part of the immunization series of preschool children.

tetanus

a highly fatal disease of all animal species caused by the neurotoxin of Clostridium tetani. The bacterial spores are deposited in tissue, usually by traumatic injury, retained placenta or endometrial injury and under anaerobic conditions vegetate. Clinical features of the disease are remarkably similar in all species but there are differences in susceptibility to the disease. The muscle spasms cause a stiff gait, rigid posture (sometimes called 'sawhorse stance'), extension or elevation of the tail, protrusion of the third eyelid and trismus (lockjaw). Horses show flaring of the nostrils. In dogs, spasms of facial muscles cause abnormally erect ears and retraction of the lips that resembles the 'risus sardonicus' seen in humans with tetanus. Stimulation precipitates generalized muscle contractions and tetanic spasms or convulsions. The disease can be prevented by immunization with tetanus toxoid or the use of antitoxin, but this is done routinely only in humans and horses.

tetanus antitoxin
see tetanus antitoxin.
idiopathic tetanus
a loosely defined syndrome of outbreaks of tetanus in young cattle without a wound being found; current practice is to refer to such outbreaks as being caused by the ingestion of pre-formed tetanus toxin.
localized tetanus
tetany occurs predominantly in one limb, closest to the site of entry of the organism, but then usually spreads to the opposite limb and then the whole body. Seen in dogs and particularly cats.
tetanus toxin
see tetanus toxin.
tetanus toxoid
see toxoid.
References in periodicals archive ?
However, because tetanus spores remain in the environment and tetanus cannot be eradicated similar to polio and smallpox, preventive measures must be sustained, officials cautioned.
Attending the events in New York marked Emma's personal support of the continued commitment of Pampers and UNICEF in the fight to eliminate maternal and newborn tetanus (MNT) around the world.
Before the vaccination program began in October, the Kenyan bishops' conference publicly questioned whether a tetanus crisis existed.
Some who got the tetanus shot lived years longer than those who didn't.
The results were far better for patients who got the mini-shot of tetanus.
Samuel Muthenji expressed surprise at the sudden suspicion about the vaccine: "The campaign against tetanus has been going on for some time.
To reduce the risk of tetanus you should thoroughly clean wounds and treat them with antiseptic.
We report a rare case of a severe tetanus disease complicated by a heart failure with a third degree atrioventricular block resulting in a cardiac arrest and asystole.
Nine of the 11 monkeys that died with characteristic symptoms of tetanus in 2008 died during the breeding season (November and December).
Bushra said that six identified vaccine preventable diseases including pneumonia, meningitis, tetanus, tuberculosis, whooping cough, measles and polio must be necessarily administered to all children in accordance to scheduled period following birth of the concerned child.