Tetanus: Causes, Symptoms, Transmission, Treatment and Prevention

Tetanus is an infectious, non-contagious bacterial disease that affects the nervous system. It is contracted through cuts or wounds contaminated with the bacterium Clostridium tetani. The bacteria's spores can enter through deep wounds or cuts, such as those caused by nails or knives, but even a scratch can provide a point of entry.

People with crush injuries, burns, or frostbite are at risk for tetanus. The tetanus bacterium is present worldwide and is commonly found in soil, dust, and manure.

The bacterium produces a toxin that causes severe muscle spasms, leading to "lockjaw" due to muscle contractions, which makes it difficult to open the mouth or swallow. In severe cases, tetanus infections can lead to death by suffocation.

Tetanus is a medical emergency that requires immediate treatment in a hospital. Fortunately, tetanus can be prevented by using a vaccine, but it does not provide permanent immunization. Tetanus booster vaccines are needed every 10 years to ensure immunity.

Mode of transmission

The bacterium called Clostridium tetani causes tetanus. The spores of this bacterium can be found in dust, soil, and animal feces. Spores are small reproductive bodies produced by certain organisms. They are often resistant to heat.

A person can become infected when these spores enter the bloodstream through a deep cut or wound. The bacteria's spores then spread to the central nervous system and produce a toxin called tetanospasmin. This toxin is a poison that blocks nerve signals from the spinal cord to the muscles, leading to severe muscle spasms.

Tetanus can be transmitted through:

• Wounds (apparent/inapparent, minor/major) contaminated with soil, manure, or dust
• Puncture wounds from splinters, thorns, nails, cattle horns, etc. (even after the wound has closed spontaneously)
• Animal bite wounds
• Wounds with retention of foreign bodies in tissues
• Lacerated wounds with crushed tissues
• Wounds with devitalized tissues
• Wounds sustained during traffic accidents
• Infected wounds
• Umbilical cord wounds caused by the use of non-sterile instruments or the application of improvised dressings to the umbilical wound
• Open fractures
• Empirical abortion
• Areas where surgical procedures have taken place
• Second or third-degree burns
• Infected chronic varicose ulcers

Symptoms

Symptoms appear slowly and worsen over time. Tetanus symptoms usually appear about 7-14 days after the initial infection.

Common initial symptoms of tetanus are headache and jaw muscle stiffness, followed by neck stiffness, difficulty swallowing, abdominal muscle rigidity, spasms, sweating, and fever. In the case of severe muscle contractions, death can occur due to asphyxiation, cardiac arrest, or spinal fractures.

Other symptoms of tetanus include:

• fast heart rate
• excessive sweating
• high blood pressure
• pneumonia
• bone fractures
• brain damage

The incubation period – the time interval between exposure to the bacterium and the onset of the disease – ranges from 3 to 21 days.

In newborns, difficulties in sucking or muscle contractions or seizures may occur.

Diagnosis

The doctor will perform a physical exam to check for symptoms of tetanus, such as muscle stiffness or painful spasms.

Unlike other diseases, tetanus is not diagnosed through laboratory tests. However, your doctor may perform some lab tests to help rule out diseases with similar symptoms, such as meningitis, a bacterial infection that affects the brain and spinal cord, or rabies, a viral infection that causes brain swelling.

Treatment

Immediate wound care is important. People with tetanus require prompt treatment with immunoglobulin to neutralize the toxin, medication to control spasms, antibiotics, and supportive care. An additional vaccine may be necessary.

Recovery from a tetanus infection may not lead to permanent immunity. Another infection could occur if immunization is not ensured shortly after the person's condition has stabilized.

Prevention

Active immunization is done using a tetanus vaccine that provides durable protection for at least 10 years. The adsorbed tetanus vaccine (Tetanus Toxoid) is recommended regardless of age. Vaccination is indicated especially for the following groups of people:

• workers who come into contact with soil
• people working in sewage and drinking water supply systems
• workers in animal farms
• military or police personnel
• adults with diabetes
• the elderly
• the homeless
• intravenous drug users
• travelers to endemic areas

Prophylaxis with antibiotics is indicated for wounds at risk of superinfection, such as: contaminated penetrating wounds, abdominal trauma, fractures, or animal bite wounds. For injuries requiring surgery, antibiotics should be administered 2 hours before the surgical intervention.

References
https://www.healthline.com/health/tetanus
https://www.immune.org.nz/diseases/tetanus
https://www.health.gov.on.ca/en/pro/programs/immunization/docs/hcp_fact_sheets_tetanus.pdf
https://www.medicalnewstoday.com/articles/163063#what-is-tetanus
https://www.catena.ro/tetanos-cauze-simptome-tratament-si-preventie
https://www.cnscbt.ro/index.php/metodologii/tetanos/452-metodologie-supraveghere-tetanos/file