Tetanus

Essentials

• Tetanus is prevented by vaccination and careful treatment of contaminated wounds.
• The disease must be identified early in unvaccinated patients

Definition

• Tetanus is a severe systemic infection in the unvaccinated individual caused by Clostridium tetani, which can be found in high concentrations in the soil and in normal intestinal flora.

Symptoms

• First, a local wound infection in which the bacteria multiply and produce toxin.
• Within days or weeks, a generalized systemic infection with spasms of skeletal muscles, most often beginning at the mandibular joint (trismus, also called lockjaw)
• Localized tetanus consists of muscle rigidity and painful spasms close to the site of injury.
• In spite of intensive care, mortality is high.

Diagnosis

• Depends mostly on history and clinical features. The usefulness of aspirate Gram-stain and culture is limited.

Treatment Diazepam for Treating Tetanus, Vitamin C for Treating Tetanus

• Making the airway secure, supportive care with antimicrobials, anticonvulsive medications and sedation require intensive care in most cases.
• Human antitetanus immunoglobulin and debridement of the wound are the cornerstones of treatment.
• Metronidazole orally or i.v. is the drug of choice. The dose for adults is 500 mg × 3 and for children 30 mg/kg daily in three doses. G penicillin is an alternative.
• Active immunization should be initiated during convalescense.

Prevention

• In most developed countries, a universal immunization is effective and the boosters are given every 10 or 20 years, depending on local programmes and the person's age.
  • Td vaccine gives protection also against diphtheria.
  • Find out about local recommendations.
• The wounds are to be thoroughly cleaned.

Booster vaccination after trauma

• Depends on the wound and the person's immunization level; see table T1
• Frequent vaccinations increase the probability of local reactions.