Tetanus (Lockjaw): Causes, Symptoms, and Treatment

Tetanus is a severe, and often life-threatening illness that can quickly lead to death if not addressed. It is estimated that approximately two out of every ten persons diagnosed with tetanus will succumb to the illness if not given necessary treatment in a timely manner.

In particular, the infection affects the nervous system, causing muscles throughout the body to spasm and subsequently contract or tighten without relief. It is also known as lockjaw because of the fact that it can affect the muscles of the face and jaw, in some cases compressing the trachea and making it difficult to breathe.

In general, tetanus is considered much rarer than it was just over a century ago owing to the availability of vaccines that confer short-term immunity. Boosters need to be taken approximately every 10 years in order for you to experience long-term immunity.

Causes of Tetanus

The causative organism behind tetanus infections is a bacterial one that goes by the name clostridium tetani. However, infection doesn’t just occur via the normal means of bacterial replication and subsequent immune system response, but rather as a result of spores produced by these bacteria.

These spores are highly resistant to the environment, and are not affected by antibiotics that may kill the causative organism. This means that spores are the actual causative factor, producing a toxin known as tetanospasmin, which subsequently blocks signals from nerves that affect muscle contraction.

Tetanus is most likely to occur when blood is involved, such as the following:

  • Vehicular accidents or crush injuries
  • Burns, which expose large areas of the skin to pathogens
  • Puncture wounds, most commonly from stepping on nails that are rusty. Sharing syringes associated with the use of illicit intravenous drugs, or receiving a tattoo or piercing in unhygienic circumstances are other common causes of tetanus as a result of puncture wounds.
  • Bacterial contamination of everyday wounds, as simple as a minor cut that has been infected with dirt, feces or saliva that may have the causative organism.
  • Diabetics that experience chronic sores or conditions that lead to the accumulation of areas with dead tissue, as commonly seen in infections of the foot that cause ulceration.
  • Dental procedures or other minor surgical outpatient procedures that are done in less than sterile environments
  • Rarely, bites from insects or stray animals

Symptoms of Tetanus

The first manifestations of tetanus are very innocuous, and may not signal any real danger, especially owing to the fact that the incubation period of the bacteria ranges between 3 and 21 days, and may lead you to forget that you came into contact with possible harm.

If symptoms begin to manifest closer to the 3 day vicinity, this usually means that the infection is likely to be more severe, and less likely to have a positive prognosis.

Symptoms to look out for include:

Muscle Pain

A few days after initial contact you may start to experience transient neck or back pain, which appears a bit different from the typical pain experienced as a result of advancing age or an injury. This pain may take longer to resolve on a day-to-day basis, and usually transitions to the next symptom.

Cramps

Following a few days of experiencing the intractable pain, you may start to experience random spasms that last longer and longer until they can be classified as cramps. These cramps tend to affect muscles of the neck and back but also become troublesome and affect muscles of the abdomen, jaw and legs.

If interventional treatment is not sought at this time, symptoms usually worsen in rapid succession with new manifestations such as:

Difficulty Chewing Or Swallowing

This is due to tightening of the muscles around the jaw and neck, making it difficult for you to open your mouth, or even accommodate the swallowing of food with normal peristaltic movement. Regurgitation is common during this time as well.

Subsequently, other symptoms occur in rapid succession including:

Fever

Tachycardia

Hypertension

Significant Pain

As a result of very light touch, or even noise. This pain tends to worsen to further tetanus progresses.

Treatment of Tetanus

While recovery from tetanus is very reliable the sooner you start to address the symptoms, the best course of therapy undoubtedly remains vaccination. Vaccination confers very close to 100% immunity against tetanus, but needs to be repeated at regular intervals, most commonly once every 10 years. Persons with high risk jobs, such as in construction or solid waste management are advised to get booster shots every five years in order to maintain their immunity.

While recovery is also possible with more advanced infections, a number of challenges are also faced, owing to the fact that once tetanus spores binds to nerve endings, they do so permanently, rendering that nerve ending virtually useless. New nerve endings will be regenerated, but usually over the duration of several months.

Common approaches to treatment of tetanus include:

Antibiotics

If infection is suspected very early, such as following a visit your physician immediately after receiving a puncture wound, prescription of oral antibiotics may be sufficient to prevent symptoms altogether. Even though, as previously mentioned antibiotics are useless against the spores, since the bacteria will not have had sufficient time to replicate, the number of spores that have entered the body are usually very little.

Muscle Relaxants

These are used for symptomatic treatment of muscle spasms to mitigate discomfort and pain felt.

Maintaining Wound Hygiene

This means cleaning the infected area at regular intervals in order to prevent subsequent infection or to kill bacteria that may still be present at the location.

Immune Globulins

Tetanus immune globulin can help to neutralize the toxins which bacterial spores are known to produce. It is these toxins that effect the neuromuscular blockade characteristic of tetanus infection.

Tetanus Vaccine Boosters

Most effective when administered shortly after suspected infection.

Surgical Debridement

Debridement involves removal of dead tissue from the skin surface, most often times performed following burns. Debridement of diabetic foot ulcers are also common procedure.

Manual/Machine Ventilation

This is necessary if your tetanus infection has progressed to the point that breathing becomes difficult or labored. It involves the insertion of a breathing tube to facilitate respiration.

Increased Caloric Intake

A consideration many healthcare providers do not take into account is the necessity for increased caloric intake at this time. Owing to significant muscle activity, ATP is produced at a higher rate than normal. Thus, weakness from depletion of energy stores is common. Fortification with nutrition by whatever means deemed necessary (such as meal replacement shakes or intravenous nutrition) is a necessary approach as well.

Tetanus – Summary

The prognosis for tetanus is significantly better the sooner it is detected and addressed. The need for hospitalization is minimized by such an approach, and it is very likely that you will never observe any untoward effects.

Keeping up with vaccination schedules is without a doubt the best means of preventing a tetanus infection, followed by appropriate hygiene and sanitation practices.

References:

https://www.medicalnewstoday.com/articles/163063.php
https://www.mayoclinic.org/diseases-conditions/tetanus/symptoms-causes/syc-20351625
https://www.healthline.com/health/tetanus#treatment

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