Tetanus: Causes, Symptoms and Treatment

What Is Tetanus? (Lockjaw Explained)

• Tetanus is a serious disease of the nervous system caused by a toxin produced by the bacterium Clostridium tetani.
• The toxin affects the nerves and leads to painful muscle stiffness and spasms, especially in the jaw and neck. Due to this characteristic jaw stiffness, tetanus is commonly referred to as lockjaw.

 Why Tetanus is a Preventable yet Deadly Disease?

• Tetanus is a preventable yet deadly disease because it can be easily avoided through vaccination, but once it develops, it can cause severe, life-threatening complications.

What are the Causes and Pathogens of Tetanus?

• Tetanus is caused by the an infection with the bacterium Clostridium tetani, which is commonly found in soil, dust, and manure.
• Clostridium tetani is an anaerobic, spore-forming bacterium that enters the body through wounds and produces tetanospasmin, a powerful neurotoxin.

Clostridium tetani and Tetanospasmin Toxin: How Tetanus Affects the Nervous System

• Tetanospasmin enters peripheral nerve endings at the neuromuscular junction and is transported retrogradely along motor neurons to the central nervous system.
• In the CNS, the toxin blocks inhibitory neurotransmitters (GABA and glycine), leading to loss of muscle relaxation, resulting in muscle rigidity, spasms, and autonomic instability.

How Does Tetanus Transmit?

How Tetanus Enters the Body?

• Clostridium tetani spores are commonly found in soil, dust, and animal manure
• These spores are harmless in the environment but develop into bacteria once they enter the body through broken skin
• Tetanus spores enter through cuts, wounds, or broken skin
• The bacteria grow in deep or dirty wounds with little oxygen

What are the Common Sources of Tetanus Infection?

• Tetanus spores usually enter through cuts, wounds, or injuries
• Infection is more likely in:
  • Wounds contaminated with dirt, faeces, or saliva
  • Puncture wounds (e.g., from nails, needles, or splinters)
  • Damaged tissue from burns, crushing, or frostbite

What are the Risk Factors of Tetanus?

• Cuts or wounds exposed to soil, dust, or manure.
• Foreign objects like nails or splinters in wounds.
• Weakened immunity from medical conditions or age.
• Diabetes or chronic skin infections.
• Newborns of unvaccinated mothers (umbilical cord infection).
• Shared or unsanitary needles (IV drug use).
• Incomplete vaccination or lack of boosters.
• Adults over 65 with waning vaccine protection.

What are the Different Types of Tetanus?

Tetanus is classified into 4 categories:

1. Generalized tetanus

• Most common type (85–90% of cases)
• Causes lockjaw, neck stiffness, and whole-body muscle spasms
• Symptoms appear 7–21 days after infection
• Severe and life-threatening

2. Neonatal tetanus

• Occurs in newborns within 28 days of birth
• Caused by unclean delivery or umbilical cord care
• More common in developing countries
• High death rate but preventable by maternal vaccination

3. Localized tetanus

• Rare form
• Muscle spasms only near the wound site
• Usually mild but can progress to generalized tetanus

4. Cephalic tetanus

• Rarest type
• Follows head injury or ear infection
• Affects face and jaw muscles (cranial nerves)
• Can progress to generalized tetanus

What are the Signs and Symptoms of Tetanus?

Early Symptoms of Tetanus

• Stiff neck muscles
• Jaw muscle spasms and rigidity (lockjaw)
• Stiffness in abdominal muscles
• Difficulty swallowing
• Painful muscle spasms lasting several minutes, often triggered by loud noises, touch, light, or wind
• Fever and sweating
• High blood pressure
• Rapid heart rate

Life-Threatening Complications of Tetanus

Tetanus is a serious illness. If left untreated, it can lead to complications such as:

• Respiratory Disorders
• Pneumonia
• Broken bones
• Death
• Cardiac problems
• Seizures

How is Tetanus Diagnosed?

Clinical Diagnosis

• Tetanus is mainly diagnosed based on symptoms and patient history.
• No specific lab test is usually required.

Differential Conditions

Tetanus can be difficult to identify because it is rare, and its symptoms can resemble other conditions. Key conditions to consider include:

• Oropharyngeal abscess – jaw stiffness, trouble swallowing
• Stroke – nerve problems, no full-body spasms
• Meningitis – neck stiffness, no typical tetanic spasms
• Strychnine poisoning – muscle spasms, no autonomic symptoms
• Botulism – flaccid paralysis, not rigid muscles
• Hypocalcemia – muscle spasms without sweating or fast heartbeat
• Neuroleptic malignant syndrome – rigidity, fever, altered mental status, linked to medication

How Can Tetanus be Treated?

Immunization

• Tetanus can be prevented through vaccination.
• After completing the childhood vaccine series, booster shots provide protection for at least 10 years.
• Adults who haven’t received booster doses in the last 10 years are at higher risk.
• Newborns whose mothers were not fully vaccinated are at risk for neonatal tetanus.

Tetanus Immunoglobulin (TIG)

• TIG is used when tetanus bacteria enter a wound (cut, puncture, burn, frostbite) and you haven’t completed the full vaccine series.
• It is recommended for wounds that are contaminated with soil or faeces or have dead tissue.
• People with a weakened immune system may need TIG even if their vaccines are up to date.
• TIG works by giving your body ready-made antibodies against tetanus (passive protection) until your own immune system can produce antibodies.

Antibiotics and Wound Management

• Wound care: Clean or debride the wound to remove bacteria and prevent more toxin production.
• Medications:
  • Tetanus antitoxin (TIG) to neutralize toxin
  • Antibiotics like metronidazole to kill remaining bacteria
  • Muscle relaxers or benzodiazepines to control spasms

Supportive Care and Intensive Management

• Monitor vital signs: Track heart rate, blood pressure, and breathing.
• Maintain airway: Spasms can block breathing; severe cases may need intubation, tracheostomy, or mechanical ventilation.
• Control muscle spasms: Use muscle relaxants and sedation; may also need medications to stabilize the autonomic nervous system.
• Minimize triggers: Keep the patient in a quiet, dimly lit room to reduce spasms.
• Nutrition and fluids: Provide IV fluids and feeding if swallowing is difficult.
• Prevent complications: Monitor for pneumonia, fractures, and blood pressure changes.
• ICU care: Severe cases require intensive monitoring and treatment in the ICU.

What are the Prevention and Control Mechanisms for Tetanus?

Tetanus Vaccination: Schedule and Booster Doses

• DTaP – for young children

Schedule:

• 2 months
• 4 months
• 6 months
• 15–18 months
• 4–6 years

Tdap – for preteens

• Given once between 11–12 years

Tdap – for pregnant women

• During each pregnancy, ideally between 27–36 weeks

Tdap – for adults

• Anytime if they have never received Tdap

Maintaining Clean Wound Care

• Prevents tetanus infection by removing dirt, debris, and dead tissue where bacteria can grow.
• Reduces toxin production, which decreases the severity of tetanus.

Elimination of Maternal and Neonatal Tetanus

• Maternal tetanus vaccination protects both mother and baby from tetanus during pregnancy.
• Clean delivery practices (sterile instruments, safe umbilical cord care) prevent infection in newborns.
• Eliminating maternal and neonatal tetanus reduces infant deaths and improves overall maternal and child health.

What is the Public Health Perspective on Tetanus?

Global Burden of Tetanus

• The incidence and death rates of tetanus have decreased worldwide due to vaccination and improved healthcare.
• High-SDI countries have lower rates of tetanus cases and deaths.
• Low-SDI countries have higher rates, with newborns being the highest-risk group for tetanus.

Role of Immunization Programs and Skilled Birth Attendance

• Routine vaccination of children and booster doses in adults significantly reduce tetanus cases.
• Maternal immunization protects both mothers and newborns from tetanus.
• Skilled birth attendance and clean delivery practices prevent neonatal tetanus by reducing umbilical cord infections.

Frequently Asked Questions (FAQs)

Is Tetanus Curable?

• There is no cure for tetanus but early treatment can be life-saving. Treatment focuses on controlling symptoms and preventing complications while the body recovers from the toxin’s effects.

How Long Does Tetanus Vaccine Last?

• After completing the childhood tetanus vaccine series, booster shots provide protection for at least 10 years.

Can Tetanus Occur More Than Once?

• Yes, tetanus can occur more than once. People who recover from tetanus do not develop natural immunity, and therefore can become infected.

Common Myths Related to Tetanus

1. Can rust cause tetanus?

• No, rust does not cause tetanus but— spores do

2. Can you get tetanus from clean wounds?

• Yes, we can get tetanus from clean wounds as well. So, it is always necessary to take precautionary actions.

3. Does recovery give immunity?

• No, recovery does not give immunity.

References and For More Information

• https://www.who.int/news-room/fact-sheets/detail/tetanus
• https://www.cdc.gov/tetanus/causes/index.html
• https://www.ncbi.nlm.nih.gov/books/NBK482484/
• https://emedicine.medscape.com/article/229594-overview?form=fpf
• https://www.cedars-sinai.org/health-library/diseases-and-conditions/t/tetanus.html
• https://www.health.harvard.edu/diseases-and-conditions/tetanus-a-to-z
• https://my.clevelandclinic.org/health/diseases/23582-tetanus-lockjaw
• https://www.mayoclinic.org/diseases-conditions/tetanus/symptoms-causes/syc-20351625
• https://www.cdc.gov/tetanus/causes/index.html
• https://www.ncbi.nlm.nih.gov/books/NBK482484/
• https://myhealth.alberta.ca/Alberta/Pages/Tetanus-Immune-Globulin-(TIG).aspx
• https://www.ijidonline.com/article/S1201-9712(23)00532-5/fulltext