Tetanus

Infectious Agent

Clostridium tetani , a spore-forming, anaerobic, gram-positive bacterium. Bacteria are ubiquitous in the environment.

Transmission

Contact with nonintact skin, usually via injuries from contaminated objects. “Tetanus-prone” wounds include those contaminated with dirt, human or animal excreta, or saliva; punctures; burns; crush injuries; or injuries with necrotic tissue.

Epidemiology

Distributed worldwide; more common in rural and agricultural regions, areas where contact with soil or animal excreta is likely, and areas where immunization is inadequate. Tetanus can affect any age group.

Clinical Presentation

Incubation period is 10 days (range, 3–21 days). Acute symptoms typically include muscle rigidity and spasms, often in the jaw and neck. Symptoms of less common forms of tetanus (localized or cephalic) can include muscle spasms confined to the injury site, head or face lesions, and flaccid cranial nerve palsies. Progression from these forms to generalized tetanus may occur. Severe tetanus can lead to respiratory failure and death. Case-fatality ratios are high even where modern intensive care is available.

Diagnosis

Diagnosis is made clinically; no confirmatory laboratory tests are available. Tetanus is a nationally notifiable disease.

Treatment

Tetanus requires hospitalization, treatment with human tetanus immune globulin (TIG), a tetanus toxoid booster, agents to control muscle spasm, aggressive wound care, and antibiotics. Metronidazole is the most appropriate antibiotic. The wound should be debrided widely and excised if possible.

Prevention

Ensure adequate immunity to tetanus by completing the childhood primary vaccine series with tetanus toxoid, a booster dose during adolescence, and at 10-year intervals thereafter during adulthood. For heavily contaminated wounds, a booster dose may be given if more than 5 years have elapsed since the last dose. For detailed information regarding the tetanus vaccine, visit www.cdc.gov/vaccines/vpd-vac/tetanus. Additional tetanus prophylaxis with TIG may be required in wounded patients.

CDC website: www.cdc.gov/tetanus

Bibliography

  1. CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR Morb Mortal Wkly Rep. 2011 Jan 14;60(1):13–5.  [PMID:21228763]
  2. Farrar JJ, Yen LM, Cook T, Fairweather N, Binh N, Parry J, et al. Tetanus. J Neurol Neurosurg Psychiatry. 2000 Sep;69(3):292–301.  [PMID:10945801]
  3. World Health Organization. Tetanus vaccine. Wkly Epidemiol Rec. 2006 May 19;81(20):198–208.  [PMID:16710950]

Author

Tejpratap S. P. Tiwari