Tetanus

Tetanus is a disease characterized by infection of the nervous system by a toxin called tetanospasmin. The main contagion route is deep wounds, which this bacterium enters when in contact with the ground, animals, or rusty objects.

Tetanus is a disease that people of all ages can get all over the world. However, it is much less frequent in developed countries thanks to the vaccination program; the rate is 0.1 cases per 100,000 inhabitants each year. Meanwhile, in developing countries, cases of tetanus are 20 per 100,000 inhabitants per year.

When a person is not vaccinated against tetanus, his life is in serious danger. The mortality in countries with good healthcare stands at 15%; meanwhile, in developing countries it shoots up to 50%, and can reach 75% in the poorest areas of the world.

What is it?

Tetanus is a serious bacterial disease that affects the nervous system . The main symptom is the contraction of different muscles of the body, which causes great pain in patients; In the vast majority of cases, it mainly affects the jaw and neck, thus causing difficulty in breathing. A life-threatening situation that requires immediate medical assistance.

Currently, thanks to the tetanus vaccine, the cases of this disease in developed countries are decreasing. However, this condition remains a serious threat in developing countries.

So far there is no cure for this disease. Thus, the treatment consists of treating the different complications that arise as a result of tetanus until the effects of the toxin disappear completely from the body.

Types of tetanus

There are four types of tetanus, which are classified according to the symptoms, as well as the patient himself.

• Generalized: it is the one that occurs most frequently and, as its name indicates, affects the entire organism in a generalized way. In the vast majority of cases, the first sign is the contraction of the jaw muscles, which is usually accompanied by insomnia and nervousness. As the disease progresses, muscles in other areas of the body and face contract, causing difficulty in swallowing and eating. The back muscles are the last to be affected.
• Localized: this type of tetanus is not very common, although it does occur in some cases. It consists of the contraction of the muscles of only one area of ​​the body; it generally affects that area where the wound that has given rise to the disease has occurred.
• Cephalic: it is a specific type of localized tetanus, which affects the head and neck. The contractions of the muscles in this area seriously endanger the life of the patient since they hinder, and even in some cases prevent, breathing.
• Neonatal: it is a type of tetanus that affects newborns. The most common cause is that mothers have not been vaccinated. The first signs begin a couple of weeks after tetanus and the development of the disease follows the same process as generalized tetanus.

Causes of tetanus

The spores of the bacterium Clostridium Tetani , responsible for tetanus, can be found on a large selection of surfaces, such as soil or dust; also in animal feces. When these spores enter a deep wound, they turn into bacteria that give rise to a very powerful toxin, tetanospasmin. It affects the nerves that control muscles , leading to various symptoms such as stiffness and spasms .

Symptoms of tetanus

Once the tetanus bacteria enter the body through a wound, the first symptoms can appear between a few days and a few weeks later; It basically depends on the patient’s own health status in relation to their immune system , as well as the virulence of the bacteria itself. The average incubation time oscillates between seven and ten days.

The main symptom of this disease, which occurs in practically 100% of patients, is stiffness in the jaw muscles ; generally, it is accompanied by spasms in this area. In addition, stiffness appears in the neck muscles and abdominal muscles. There is also difficulty swallowing and breathing.

As for the painful spasms , they last between two and four minutes; They arise from minor events, such as loud noise or simple sunlight.

Other symptoms typical of any bacterial disease may also occur: fever , excessive sweating, high blood pressure, and accelerated heart rate.

Risk factor’s

Regarding tetanus risk factors, the most important of all is not getting vaccinated or not following the established tetanus booster vaccination schedule . And it is precisely vaccination that is the most effective prevention method against the disease that currently exists.

Deep wounds are also considered risk factors , especially those made with objects such as splinters or nails; that is, puncture wounds. Similarly, burns and open fractures, as well as animal bites and insect stings, can be risk factors for tetanus.

Diagnosis of tetanus

At the first signs that lead to suspicion of this disease, it is essential to see a doctor since tetanus is a disorder that requires urgent assistance. In the first place, the patient’s medical history is taken, depending on his state of health and the symptoms he presents. It also assesses whether or not the patient is vaccinated against tetanus and if he has suffered an injury during the previous month.

Next, if the doctor believes that the patient may be infected with tetanus, the most common tests are blood tests and extraction of cerebrospinal fluid . So far there is no specific medical test to detect this disease, so the most common is to use these.

In the case of neonatal tetanus, it is essential to know in what hygiene conditions the delivery has taken place, as well as whether or not the mother was vaccinated.

Once the disease is diagnosed, the doctor must assess the severity of the disease and determine what the chances of survival are. For this, it is very important to know what the incubation period is; that is, the time that has elapsed between the infection and the beginning of the first signs.

• Mild tetanus : occurs when the incubation period takes more than ten days to appear.
• Moderate tetanus: in this case, the time that elapses between infection and the onset of symptoms is between seven and ten days.
• Severe tetanus: one whose incubation period appears in less than seven days is known as such.

Tetanus treatment

The early treatment of disease increases significantly the chances of survival of the patient; that is why it is so important to make an early diagnosis of it.

The first phase of treatment consists of preventing the production of the toxin that contaminates the body’s neurons . To do this, the wound is thoroughly cleaned with pressurized water and debrided; It consists of removing all the dead tissue and causing bleeding so that oxygen reaches the entire wound.

With the first phase of tetanus treatment, the source of the toxin is eliminated ; however, it is necessary to end the one that has already entered the bloodstream and has affected the body’s neurons. To neutralize it, the patient is injected with human tetanus immunoglobulin; an antibody that binds to the toxin and renders it useless. Injections are given to both men and buttocks.

The symptoms are then controlled to prevent muscle contractions and spasms typical of tetanus . For this, drugs such as diazepam are administered to the patient; the administration of specific muscle relaxants is also common.

It is important to turn out that tetanus is a life-threatening disease. Therefore, any person infected with this bacterium must be admitted to the Intensive Care Unit of a medical center for an exhaustive control of it.

Complications of tetanus

Tetanus is a serious disease that puts the life of those who suffer from it at serious risk; the survival rate is between 10 and 60 percent, depending on the type of tetanus involved, as well as the severity of the infection and symptoms. In the case of neonatal tetanus, the mortality rate is around 80%.

Complications from this condition are frequent, the most frequent being those related to the respiratory system.

Pulmonary embolism

A pulmonary embolism is a sudden blockage of a pulmonary artery . In the vast majority of cases, the cause of this disease is a clot in the leg that breaks off and travels to the lung through the bloodstream. The symptoms that recur in the vast majority of patients are choking, rapid breathing, and acute chest pain.

Pneumonia

An infection in one or both lungs is known as pneumonia ; it is usually caused by germs such as bacteria, fungi, and viruses. People with the highest risk of suffering from this disease are those over 65 years of age, as well as babies under 24 months. The most common symptoms are: high fever, chills, cough, shortness of breath, and chest pain when breathing or coughing.

Tetanus vaccine

As we have pointed out, tetanus is a serious disease. If to this we add the fact that there is no specific treatment to treat the infection, prevention is of great importance.

Currently, in developed countries, babies begin their vaccination program when they are two months old ; They are then given a booster dose at four, six, and eighteen months. Along with the tetanus vaccine they are given the diphtheria and pertussis vaccine . This is known as the DTP vaccine .

After the last dose is administered at eighteen months, it is advisable to administer a booster dose every ten years for life. Regarding this point there is a great debate in the medical field since there are experts who point out that it is not necessary at all.

Despite correct vaccination, every time a person suffers a serious injury, it is essential to assess their degree of protection against tetanus in order to know whether or not a booster dose is necessary. In general, the considerations are as follows.

• The wound is clean and the last dose has been given in the last ten years – a booster dose of tetanus vaccine is not necessary.
• The wound is clean and the dose has been administered for more than ten years: the booster dose is necessary.
• The wound is dirty and the dose has been given less than five years ago: no booster dose of the vaccine is necessary.
• The wound is dirty and the dose has been administered more than five years ago: the patient must receive a booster dose.