Medical Moment: Tetanus 101

26 Jul Medical Moment: Tetanus 101

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Paul Koelliker, MD, board certified in Emergence Medicine

Dr. Paul Koelliker answers this week’s questions about Tetanus

Tetanus is caused by an infection with the bacterium Clostridium tetani. This is an anaerobic bacterium which thrives in low oxygen environments like puncture wounds. It secretes a neurotoxin called tetanospasmin which causes a spastic paralysis. The incubation period can start as early as 4 days and be as long as several months, with an average of eight days. C. tetani is an organism found in soil throughout the world and is more concentrated in hot, wet climates and in soils near livestock.

You might be surprised to know: Rust does not contribute to the likelihood of bacterial contamination.

In 2010 tetanus caused approximately 60,000 deaths worldwide. This number is markedly down from 1990 where there were about 270,000 deaths. Most of these deaths occurred in developing nations and the downturn is attributed to increased vaccination efforts. Mortality rates vary with level of care available, but are eleven percent even with the best care. The young and old have the highest mortality rates. Tetanus is not spread from person to person, and infection results from contact with the environment.

There are four types of tetanus infections with generalized tetanus accounting for eighty percent (generalized, neonatal, local and cephalic types).

Symptoms of generalized tetanus start in the head and neck and proceed in a descending fashion. The first sign is commonly a spastic paralysis of the jaw muscle causing lockjaw. Severe facial spasms, stiffness of the neck, inability to swallow, and spasms of the muscles of the torso and extremities follow. The spasms are accompanied by fever, sweating, elevated blood pressure, and rapid heart rate. The spasms are extremely painful and forceful and can tear muscles and even fracture bones. The spasms frequently compromise breathing and cause loss of bowel and bladder control. The spasms can last for over a month and it can take a year to recover function after generalized tetanus.

The diagnosis of tetanus is made clinically. There are no available blood tests. The bacteria is only isolated from the wound of those with tetanus in a minority of cases (30%).

Treatment consists of a combination of eradication of the bacteria and supportive care. Tetanus immunoglobulin (antibodies against tetanus from plasma from a person(s) who has been immunized against tetanus) is given to provide some immediate immunity. If the infection is severe the immunoglobulin is infused into the spinal fluid as well as given intravenously or intramuscularly.

Tetanus immunoglobulin is expensive and carries the risk (although low) of blood borne infectious disease. Antibiotics are also given intravenously for weeks. The severe muscle spasms are treated with pain medication and sedatives. It is not uncommon that the spasms are so severe that the patient cannot breathe on their own and have to be pharmacologically paralyzed with a curare-like medication and placed on a respirator. Due to the prolonged period of the symptoms of tetanus, patients may need a tracheostomy (a surgical hole made into the windpipe) to assist breathing. Patients are unable to eat during this period and are provided nutrients through a tube that is surgically placed into their stomachs.

Tetanus is almost entirely preventable with proper vaccination. There are several options for vaccination and a booster is recommended by the CDC every ten years. To avoid potentially contracting this debilitating and sometimes fatal disease, stay up to date on your tetanus shots. Contact your primary care physician to learn more about tetanus, and check if you need re-immunization.

Editor’s note: The Telluride Medical Center is the only 24-hour emergency facility within 65 miles. You can choose your own medical provider visit with a specialist or take advantage of their Mountain Skin Care services. As a mountain town in a challenging, remote environment, a thriving medical center is vital to our community’s health.

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