1. Tetanus
Tetanus is an infectious disease caused by contamination of wounds from the bacteria Clostridium tetani,
or the spores they produce that live in the soil, and animal feces.
Tetanus occurs when a wound becomes contaminated with Clostridium tetanibacterial spores. Infection
follows when spores become activated and develop into gram-positive bacteria that multiply and produce
a very powerful toxin (tetanospasmin) that affects the muscles. Tetanus spores are found throughout the
environment, usually in soil, dust, and animal waste. The usual locations for the bacteria to enter the body
are puncture wounds, such as those caused by rusty nails, splinters, or insect bites. Burns, any break in
the skin, and IV drug access sites are also potential entryways for the bacteria. Tetanus is acquired
through contact with the environment; it is not transmitted from person to person.
Tetanus results in severe, uncontrollable muscle spasms. For example, the jaw is "locked" by muscle
spasms, causing the disease to sometimes be called "lockjaw." In severe cases, the muscles used to
breathe can spasm, causing a lack of oxygen to the brain and other organs that may possibly lead to
death.
Tetanus Causes
Clostridium tetani is a gram-positive rod-shaped bacterium that is found worldwide in soil; it is usually in
its dormant form, spores, and becomes the rod-shaped bacterium when it multiplies. The vegetative rods
produce the spore usually at one end of the rod (Figure 1). The organisms are considered anaerobic.
Signs and Symptoms
Tetanus often begins with mild spasms in the jaw muscles (lockjaw). The spasms can also affect the
chest, neck, back, andabdominal muscles. Back muscle spasms often cause arching,
called opisthotonos.
Sometimes the spasms affect muscles that help with breathing, which can lead to breathing problems.
Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups. This is
called tetany. These episodes can cause fractures and muscle tears.
Other symptoms include:
Drooling
Excessive sweating
Fever
Hand or foot spasms
Irritability
Swallowing difficulty
Uncontrolled urination or defecation
Treatment may include:
Antibiotics, including penicillin, clindamycin, erythromycin, or metronidazole (metronidazole has
been most successful)
Bedrest with a nonstimulating environment (dim light, reduced noise, and stable temperature)
Medicine to reverse the poison (tetanus immune globulin)
Muscle relaxers such as diazepam
Sedatives
Surgery to clean the wound and remove the source of the poison (debridement)
Breathing support with oxygen, a breathing tube, and a breathing machine may be necessary.
Complications
Airway obstruction
Respiratory arrest
Heart failure
Pneumonia
Fractures
Brain damage due to lack of oxygen during spasms