Tetanus

Tetanus is a bacterial infection caused by Clostridium tetani and characterized by muscle spasms. The onset of symptoms is typically 3 to 21 days following infection. Recovery may take months; cases without treatment are usually fatal.

Signs and Symptoms

• Spasms, beginning in the jaw and then progressing to the rest of the body.
  • Each spasm usually lasts for a few minutes.
  • Spasms occur frequently for three to four weeks.
  • Some spasms may be severe enough to fracture bones.
• Fever
• Sweating
• Headache
• Trouble swallowing
• Hypertension
• Tachycardia
• Restlessness and irritability
• Breathing problems

Muscle spasms

Tetanus often begins with mild spasms in the jaw muscles—also known as lockjaw. Chest, neck, back, abdominal muscles, and buttocks may be affected. Back muscle spasms often cause arching, called opisthotonus. Sometimes, the spasms affect muscles utilized during inhalation and exhalation, which can lead to breathing problems. Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups, called tetany or tetanic seizure. These episodes can cause fractures and muscle tears.

Incubation Period

The incubation period of tetanus may be up to several months but is usually about ten days. In general, the farther the injury site is from the central nervous system, the longer the incubation period. Shorter incubation periods will have more severe symptoms.

Treatment

• First priority is cleaning and debriding wounds. Foreign bodies and necrotic tissue must be removed. If necrosis is found, exploratory surgery is recommended.
• Antibiotics should be administered in all symptomatic cases.
  • The first-line antibiotic of choice is metronidazole, as it is highly effective against C. tetani and does not exacerbate spasms.
  • An alternative is penicillin. It is slightly less effective and may provoke spasms due to interactions at GABAA receptors.
  • Additional options for broader coverage in polymicrobial infections include vancomycin, doxycycline, and ceftriaxone.
• The immune system can be assisted in clearing C. tetani spores with the use of tetanus immunoglobulins. In severe cases, intrathecal administration improves outcomes.
• Tetanus toxoid can be administered for active immunization, but is only useful if administered early in the course of infection.
• Spasms can be eased with benzodiazepines or, in severe cases, paralytics.
• Ventilatory support may be required in severe cases.
• Autonomic dysfunction can be treated with corrective drugs as needed:
  • For hypertension: antihypertensives
  • For hypotension: antyhypotensives
  • For bradycardia: cardiac stimulants such as atropine or epinephrine
  • For tachycardia: beta-blockers
  • Hypothermia and hyperthermia can be treated conventionally