Tetanus (Lockjaw)

Tetanus is an acute infectious disease of the nervous system caused by a microorganism that usually enters the body through an open wound or cut. The infectious agent, Clostridium tetani, is a type of bacterium, or bacillus, that reproduces by forming spores. These spores are found almost everywhere, but especially in soil, dust, and the manure of cows, horses, and other plant-eating animals.

Anyone who sustains a severe burn or deep puncture wound is vulnerable to tetanus; so too are intravenous drug users. Farmers, gardeners, and others who work with the soil are especially susceptible. In underdeveloped countries, newborns sometimes contract a form of the disease called tetanus neonatorum, when the spores enter the umbilicus. The practice of covering a cut umbilicus with mud increases the risk of this type of tetanus.

As tetanus bacilli invade the bloodstream, they produce a toxin that causes intermittent spasms of the voluntary muscles. An early symptom is jaw stiffness, quickly followed by headache, restlessness, and irritability. The facial expression may freeze and the muscles of the arms, legs, and neck go into spasms. Opening the mouth or moving the jaw may become difficult or impossible, hence the well-known name of lockjaw.

As the infection advances, throat-muscle spasms may interfere with speech and swallowing, and sphincter spasms may cause urine retention. When the breathing muscles are affected, tetanus becomes life threatening.

Diagnostic Studies and Procedures

Tetanus can usually be diagnosed solely on the basis of symptoms, especially if they follow a recent injury or wound. However, blood tests and analysis of cerebral spinal fluid may be ordered to rule out the possibility of other diseases, such as meningitis (inflammation of the membranes covering the brain and spinal cord) and encephalitis (inflammation of the brain).

Medical Treatments

Prevention is the best medical approach to tetanus. All infants should be immunized against the disease. If an injured person has never been immunized or has not received a tetanus booster shot in the last five years, an injection of tetanus immune globulin is given as a preventive measure. Depending upon previous immunizations, tetanus toxoid may also be given in three doses.

Immediate and thorough cleansing of a deep puncture wound is critical. This should be followed by a 10-day course of penicillin or tetracycline, which kills C. tetani and also helps prevent or cure other infections.

If tetanus develops, hospitalization is necessary. Serum antitoxin may be administered and diazepam (Valium) or similar medications may be given to control seizures and muscle spasms. An antibiotic, either penicillin or tetracycline, is also administered.

The patient should be kept in a quiet room with vigilant nursing care to watch for breathing difficulty and other complications. In severe cases, a tracheotomy -- an opening into the windpipe, or trachea -- is made and a breathing tube inserted to prevent suffocation. The patient must be turned frequently and forced to cough to clear the lungs and prevent pneumonia. Intravenous feeding, a rectal tube, and a bladder catheter may be necessary.

Even with treatment, tetanus has a high mortality rate -- about 50 percent worldwide and somewhat lower in the United States, provided that intensive treatment has been started promptly.

Alternative Therapies

Tetanus always demands prompt and intensive medical treatment. During recovery, physical therapy and various types of massage may aid in the rehabilitation process.

Self-Treatment

To prevent tetanus, make sure that you have a tetanus booster every 10 years. Seek immediate medical attention for any deep puncture or dirt-contaminated wound. Even if it seems relatively minor, you may not be able to remove all the dirt yourself.

Wear sturdy-soled shoes when walking in a barn or an open pasture where contaminated animal dung presents a potential source of infection. Also, be sure to wear protective gloves when gardening or working with soil.

Although tetanus is rare in the United States, when it occurs, the victim is often a middle-aged or older gardener who has not had booster shots.

Other Causes of Tetanus

Symptoms Acute meningitis, encephalitis, and other central nervous system infections can produce muscle spasms, seizures, and stiffness similar to those of tetanus. However, these conditions also alter mental alertness, which is not a characteristic of tetanus.