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Tetanus: Treatment, symptoms, advice and help

About tetanus

Tetanus is a disease caused by the bacteria Clostridium tetani, characterized by a prolonged contraction of muscles in the body.

Tetanus: Incidence, age and sex

The incidence of tetanus varies widely throughout the world; it is uncommon in UK and most cases occur in people over the age of 65 years who have not been immunised against tetanus. Unhygienic childbirth practices in the developing world and inadequate immunization of mothers causes neonatal tetanus. Often, nonmedical abortions and lack of attention to penetrating wounds are responsible for tetanus.

Signs and symptoms of tetanus: diagnosis

The most common form of initial complaint is trismus, that is, difficulty in opening the jaws. Pain and difficulty in swallowing and stiffness of neck, abdominal or thoracic musculature is seen. Persistent trismus is responsible for risus sardonicus, a classic finding of tetanus. Tonic spasms of the back muscles may result in severe opisthotonos-arching of the back. Symptoms resolve slowly during the ensuring 2 to 4 weeks.

Causes and prevention of tetanus

Tetanus is an infection caused by a bacterium called Clostridium tetani. Clinical tetanus is caused by the exotoxin tetanospasmin elaborated by bacteria .It is a potent neurotoxin that attacks the muscles and nervous system. Tetanus bacteria (germs) live in the soil and dirt. The bacteria may get into the body through a cut or a wound in the skin.

Tetanus is completely preventable by active immunization. Tetanus toxoid consists of inactivated tetanus toxin treated with chemicals or heat to decrease the toxic effect, but to retain its antigenic power.

Tetanus: Complications

Painful spasms affect all voluntary muscles and may involve the larynx, a complication that can be fatal. The forceful spasms may produce fractures of vertebrae or other bones and hemorrhage into muscles. These spasms are extraordinarily painful. Labile hypertension tacharrhythmias, fever from sympathetic overactivity or from super infections, such as pneumonia may occur.

Tetanus in the newborn is a serious disease. Mortality is high, with infants dying of such complications as pneumonia, pulmonary hemorrhage, CNS hemorrhage and laryngeal spasms.

Tetanus: Treatment

Specific therapy includes intramuscular administration of tetanus immune globulin (TIG) to neutralize circulating toxin. Oral or intravenous metronidazole, 30mg/kg/day given every 6 hours for 10 to 14 days. or parenteral penicillin G,100,000 U/kg/day given every 4 to 6 hours is given. Local wound care, including surgical debridement, is essential. Foreign bodies must be removed, and wounds must be irrigated well and left open. Supportive care of tetanus patients involves nursing care, ventilatory support in an intensive care setting of a tertiary-care center, minimizing external stimuli, controlling hypertension and maintaining intravenous hydration. Sedation and muscle relaxation should be instituted, usually with diazepam. Maintenance of adequate nutrition and hydration is mandatory skin care. Patient must be immunized to prevent further disease because the amount of toxin required to produce disease is far less than that needed to stimulate immunity.