Definition

Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and, ultimately, threaten your life. Tetanus is commonly known as "lockjaw." Thanks to the tetanus vaccine, cases of tetanus are rare in the United States and the developed world. The incidence of tetanus is much higher in less developed countries. Around a million cases occur worldwide each year. There's no cure for tetanus. Treatment focuses on managing complications until the effects of the tetanus toxin resolve. Fatality is highest in individuals who haven't been immunized and in older adults with inadequate immunization.

Symptoms
Signs and symptoms of tetanus may appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The average incubation period is seven to eight days. Common signs and symptoms of tetanus, in order of appearance, are: Spasms and stiffness in your jaw muscles Stiffness of your neck muscles Difficulty swallowing Stiffness of your abdominal muscles Painful body spasms lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light Other signs and symptoms may include: Fever Sweating Elevated blood pressure Rapid heart rate

When to see a doctor See your doctor to obtain a tetanus booster shot if you have a deep or dirty wound and you haven't had a booster shot within the past five years or aren't sure of when your last booster was. Or see your doctor about a tetanus booster for any wound especially if it may have been contaminated with dirt, animal feces or manure if you haven't had a booster shot within the past 10 years or aren't sure of when you were last vaccinated.

Causes
The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores of the bacteria may produce a powerful toxin, tetanospasmin, which actively impairs your motor neurons, nerves that control your muscles. The effect of the toxin on your motor neurons can cause muscle stiffness and spasms the major signs of tetanus.

Risk factors
By Mayo Clinic staff In addition, certain factors are necessary for tetanus bacteria to proliferate in your body. These include: Lack of immunization or inadequate immunization failure to receive timely booster shots against tetanus A penetrating injury that results in tetanus spores being introduced to the wound site The presence of other infective bacteria Injured tissue A foreign body, such as a nail or splinter Swelling around the injury Tetanus cases have developed from the following types of injuries: Puncture wounds including from splinters, body piercings, tattoos, injection drugs Gunshot wounds Compound fractures

Crush injuries Burns Surgical wounds Injection drug use Ear infections Animal bites Infected foot ulcers Infected umbilical stumps in newborns born of inadequately immunized mothers

Complications
By Mayo Clinic staff Once tetanus toxin has bonded to your nerve endings it is impossible to remove. Complete recovery from a tetanus infection requires the growth of new nerve endings and can take up to several months. Complications of tetanus infection may include: Broken bones. The severity of spasms may cause the spine and other bones to break. Disability. Treatment for tetanus typically involves the use of powerful sedatives to control muscle spasms. Prolonged immobility due to the use of these drugs can lead to permanent disability. In infants, tetanus infections may cause lasting brain damage, ranging from minor mental deficits to cerebral palsy. Death. Severe tetanus-induced (tetanic) muscle spasms can interfere with your breathing, causing periods in which you can't breathe at all. Respiratory failure is the most common cause of death. Lack of oxygen may also induce cardiac arrest and death. Pneumonia is another cause of death.

Symptoms Causes Risk factors Complications Preparing for your appointment Tests and diagnosis

Treatments and drugs Lifestyle and home remedies Prevention

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Preparing for your appointment

By Mayo Clinic staff If your wound is small and clean but you're concerned about infection or whether you're immune from tetanus, start by seeing your family doctor. If your wound is severe or you're experiencing symptoms of tetanus infection (or your infant is), seek emergency care. What you can do If possible, let your doctor know the following information: When, where and how you received the injury (or any recent injury, if a wound isn't obvious)

Your immunization status, including when you received your last tetanus booster shot (a record of vaccines you've received and when) would be helpful)

How you've been caring for the wound Any chronic illness or pre-existing condition you may have, such as diabetes, heart disease or pregnancy If seeking care for an infant other than your own, let the doctor know the mother's country of origin, her immune status and how long she's been in the United States For tetanus, some basic questions to ask your doctor include:

What is the best course of action? What are the alternatives to the primary approach you're suggesting? I have these other health conditions. How can I manage them together? Do I need to see a specialist? Are there restrictions I need to follow? Is there a generic alternative to the medicine you're prescribing? Are there any brochures or other printed material that I can take with me? What websites do you recommend? What to expect from your doctor If a wound is obvious, your doctor will inspect it. He or she will likely ask you a number of questions, including:

Have you experienced any tentanus symptoms and, if so, when did they start? Have your symptoms been continuous or occasional? How severe are your symptoms? What, if anything, seems to improve or worsen your symptoms? When were you last vaccinated for tetanus and what type of vaccine did you receive? Have you recently had a wound (if not obvious)?

Tests and diagnosis

By Mayo Clinic staff

Doctors diagnose tetanus based on a physical exam, medical and immunization history, and the signs and symptoms of muscle spasms, stiffness and pain. Laboratory tests generally aren't helpful for diagnosing tetanus.

Treatments and drugs

By Mayo Clinic staff Since there's no cure for tetanus, treatment consists of wound care, medications to ease symptoms and supportive care. Wound care Cleaning the wound is essential to preventing growth of tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound. Medications Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus immune globulin. However, the antitoxin can neutralize only toxin that hasn't yet bonded to nerve tissue. Antibiotics. Your doctor may also give you antibiotics, either orally or by injection, to fight tetanus bacteria. Vaccine. Having tetanus once doesn't make you immune to the bacteria afterward. So you'll need to receive a tetanus vaccine in order to prevent future tetanus infection. Sedatives. Doctors generally use powerful sedatives to control muscle spasms. Other drugs. Other medications, such as magnesium sulfate and certain beta blockers, may be used to help regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine may be used for this purpose as well as sedation. Supportive therapies Tetanus infection often requires a long period of treatment in an intensive care setting. Since sedatives may result in shallow breathing, you may need to be supported temporarily by a ventilator.

Lifestyle and home remedies

By Mayo Clinic staff Puncture wounds or other deep cuts, animal bites or particularly dirty wounds may put you at increased risk of tetanus infection. Get medical attention if the wound is deep and dirty, and particularly if you're

unsure of your immune status. Leave unclean wounds open to avoid trapping bacteria in the wound with a bandage. Your doctor may need to clean the wound, prescribe an antibiotic and give you a booster shot of the tetanus toxoid vaccine. If you've previously been immunized, your body should quickly make the needed antibodies to protect you against tetanus. If you have a minor wound, these steps will help prevent you from getting tetanus: Control bleeding. If the wound is bleeding, apply direct pressure to control the bleeding. Keep the wound clean. After the bleeding has stopped, rinse the wound thoroughly with clean running water (or saline solution if available). Clean the area around the wound with soap and a washcloth. If debris is embedded in a wound, see your doctor. Use an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment, such as the multi-ingredient antibiotics Neosporin and Polysporin. These antibiotics won't make the wound heal faster, but they can discourage bacterial growth and infection and may allow the wound to heal more efficiently. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment. Cover the wound. Exposure to the air may speed healing, but bandages can help keep the wound clean and keep harmful bacteria out. Blisters that are draining are vulnerable. Keep them covered until a scab forms. Change the dressing. Apply a new dressing at least once a day or whenever the dressing becomes wet or dirty to help prevent infection. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and paper tape.

Prevention
By Mayo Clinic staff You can easily prevent tetanus by being immunized against the toxin. Almost all cases of tetanus occur in people who've never been immunized or who haven't had a tetanus booster shot within the preceding 10 years. The primary vaccine series The tetanus vaccine usually is given to children as part of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. This vaccination provides protection against three diseases: a throat and respiratory infection (diphtheria), whooping cough (pertussis) and tetanus.

The DTaP vaccine consists of a series of five shots, typically given in the arm or thigh to children at ages: 2 months 4 months 6 months 15 to 18 months 4 to 6 years The booster A booster of the tetanus vaccine is typically given in combination with a booster of diphtheria vaccine (Td). In 2005, a tetanus, diphtheria and pertussis (Tdap) vaccine was approved for use in teens and adults under age 65 to ensure continuing protection against pertussis, too. It's recommended that adolescents get a dose of Tdap, preferably between the ages of 11 and 12, and that a Td booster be given every 10 years thereafter. If you've never received a dose of Tdap, substitute it for your next Td booster dose and then continue on with Td boosters. If you're traveling internationally, it's a good idea to have up-to-date immunity because tetanus may be more common where you're visiting, especially if you're traveling to a developing country. If you receive a deep or dirty wound and it's been more than five years since your last booster shot, get another booster shot. To stay up to date with all of your vaccinations, ask your doctor to review your vaccination status regularly. If you were never vaccinated against tetanus as a child, see your doctor about getting the Tdap vaccine.

Tetanus
(Lock Jaw, Lockjaw, Clostridium tetani) In this factsheet: The Facts on Tetanus Causes of Tetanus Symptoms and Complications of Tetanus Diagnosing Tetanus Treating and Preventing Tetanus

The Facts on Tetanus

Tetanus is a condition caused by a nerve toxin that is produced by the bacterium Clostridium tetani, a cousin of the bacteria that cause gangrene and botulism. It remains a serious worldwide public health problem, killing over 500,000 people each year. In developed countries, however, the introduction of a vaccine in the 1950s has all but eradicated this disease. The cases of tetanus that do occur are often seen in those who either have not been vaccinated or have failed to keep their immunizations up to date, as protection from the vaccine declines over time. Canada now averages about 4 cases a year. Only 5 people have died of tetanus in this country since 1980.

Causes of Tetanus
Clostridia are anaerobic bacteria, meaning they thrive best in the absence of oxygen. They're commonly found in soil, but can also be found in the lower intestines of mammals. They can produce spores that can survive for years. Anyone who cuts himself or herself with a dirty object is at risk of getting Clostridium tetani in the wound. The bacteria are only really dangerous if they're in wound tissue that's cut off from a good oxygen supply. "Crush" wounds and deep puncture wounds are good candidates for such infections, as are burns, surgical wounds, and punctures with dirty needles. Most cases of tetanus in North America are found in older people following surgery and in intravenous drug users who reuse unclean syringes. There's also the occasional case of tetanus linked to childbirth. The mother can develop infection in the uterus, and the baby in the stump of the umbilical cord. As the bacteria grow and multiply, they produce a nerve toxin. As with botulism, it's the toxin that does the damage, not the organisms themselves. The toxin binds to nerve endings that normally serve to calm the muscles. In the absence of receiving such calming signals, the muscles contract and become rigid and very sensitive to external input, leading to spasms.

Symptoms and Complications of Tetanus

Symptoms may appear anywhere from 2 days to 6 weeks after the wound has been infected, but the typical incubation period (time between infection and symptoms) is 5 to 10 days. Symptoms can be mild or severe and include: chills difficulty swallowing headache irritability jaw and neck stiffness low fever restlessness sore throat stiff arms and legs Symptoms soon progress to classic tetanus: difficulty opening the jaw - that's why tetanus is sometimes called "lockjaw" muscle spasms in the back, neck, or abdomen

People with tetanus often develop a fixed expression with a tight, stretched smile and arched eyebrows. They often go into painful whole-body spasms when slightly disturbed, for example by fluffing their pillow. They may sweat a great deal during these spasms. They may be unable to speak because of spasms in the chest or throat - these can also make breathing difficult. Rigidity in the bladder and bowels can cause retention of urine and constipation. Blue lips or nail beds are a sign of depressed breathing, meaning theres too little oxygen or too much carbon dioxide in the blood. People with tetanus are usually mentally alert. The pulse can be fast, but fever is rarely very high. Sometimes the face is unaffected and the spasms are confined to muscles near the wound. In this case, there is a better chance of a full recovery. Sometimes the face is unaffected and the spasms are confined to muscles near the wound. In this case, there is a better chance of a full recovery. Complications of tetanus can include pneumonia, broken bones, skin sores, muscle tears, and low blood pressure.

Tetanus
(Lock Jaw, Lockjaw, Clostridium tetani) In this factsheet: The Facts on Tetanus Causes of Tetanus Symptoms and Complications of Tetanus Diagnosing Tetanus Treating and Preventing Tetanus

Diagnosing Tetanus
The bacteria can't always be detected in the wound, but the particular combination of symptoms and a recent wound usually paints a clear picture of tetanus. Meningitis and encephalitis (brain infections) can cause similar spasms and rigidity, but they usually interfere with senses such as hearing, while tetanus doesn't. Taking a sample of cerebrospinal fluid (CSF) allows the doctor to rule out both of these diseases.

Treating and Preventing Tetanus

People with tetanus need to be in an intensive care unit so they can receive treatment and continuous monitoring. Treatment of tetanus usually includes: supportive care medications to control muscle spasms antibiotics and tetanus immune globulin to manage the infection wound treatment vaccination Supportive care: The biggest threat is to breathing. People who get tetanus usually have mechanically assisted ventilation through a breathing tube. This may involve a tracheostomy, which is a tube inserted directly through a hole cut in the throat.

Because people with tetanus may not be able to swallow, they are usually given nourishment either intravenously or through a nasogastric (NG) tube, which is inserted through the nose, past the throat, and into the stomach. A catheter (tube) may also be inserted in the bladder to drain it. Medications to control muscle spasms: Medications such as benzodiazepines (e.g., midazolam, diazepam), dantrolene, or baclofen are given to reduce muscle spasms*. Antibiotics and tetanus immune globulin: As the consequences of tetanus are due to a toxin produced by the bacteria, an injection of antitoxin is given to the patient. This antitoxin is an antibody preparation that will bind any remaining toxin and prevent it from binding to the nerve cells. They may also need tetanus immune globulin (a blood product from an immune person). Antibiotics (e.g., metronidazole, penicillin) are used to kill the tetanus bacteria, the source of the toxin, but they are too slowacting to be the only treatment. If there is an open wound where the tetanus bacteria are thriving, then that wound is surgically cleaned to physically remove any tetanus bacteria. Vaccination: In people who develop tetanus, the amount of bacteria causing the disease is too small to lead to an effective immune response. This means that these people could get tetanus again. All people who have had tetanus should also receive a tetanus vaccination as part of treatment. Tetanus is a preventable disease, thanks to the development of a vaccine. When you see a doctor for a cut that might be dirty or infected, the preventive treatment you get depends on your vaccination status. The tetanus vaccine provides good protection for 5 years. Its effectiveness then slowly tails off. For clean, minor wounds, people who have been vaccinated in the last 10 years don't need any treatment. People who were vaccinated more than 10 years ago get a booster shot of the vaccine, which consists of a weakened form of the tetanus toxin. For deep or dirty wounds, people who received their last tetanus booster more than 5 years ago will need another booster shot. Those who have never been vaccinated, or have an uncertain vaccination history, need tetanus immune globulin. They also need to be vaccinated against tetanus. People with deep, dirty wounds who have a suppressed immune system (e.g., people with HIV or other immune system problems) will be given tetanus immune globulin. Children today are normally vaccinated at 2, 4, and 6 months, then again at 18 months and once more around age 4 to 6. Most children will receive a vaccine that protects against tetanus, diphtheria, pertussis, polio, and Hib ( Haemophilus influenzae type b) for the doses given at 2, 4, 6, and 18 months of age. A vaccine that protects against tetanus, diphtheria, pertussis (whooping cough), and polio is usually given at 4 to 6 years of age. A further shot, with the adult diphtheriatetanus-pertussis vaccine, is recommended around age 14 to 16. Adults should continue to get booster shots every 10 years to minimize the risk of tetanus. Other vaccination schedules may be used for adults or children over 7 years of age who have not been previously vaccinated. Talk to your health care provider for more information. You can also reduce your risk of tetanus by cleaning all wounds thoroughly, rinsing them with clean water and washing the area around the wound with soap and water. If the wound is deep and dirty, see your doctor. You might consider wearing knee and elbow pads during sports that are likely to involve violent contact with the ground. Avoid going barefoot while outside of your house. This will help to prevent infection from accidentally stepping on sharp, dirty objects.