Tetanus: A-to-Z Guide from Diagnosis to Treatment to Prevention

Introduction to tetanus:

Even though the bacteria that cause tetanus are common in the United States, the vaccine has made infections rare. Nevertheless, tetanus remains a major worldwide cause of illness and death.

Stepping on a rusty nail is one way to get Tetanus.

What is tetanus?

Tetanus, also called lockjaw, is caused by a toxin created by a bacterium found in the soil. When this germ gets into an open cut or wound, an unprotected person can contract tetanus, which creates serious muscle spasms that can be strong enough to snap the spine. Even with modern medical care, many people who get tetanus die from the disease.

The type of bacteria that causes tetanus is called Clostridium tetani. It is a relative of the bacteria that cause botulism and those that cause clostridium food poisoning.

It is widespread in dirt, especially when the dirt contains excrement.

Who gets it?

Tetanus can be found around the world, but it is most common in warmer climates and in warmer months. The wounds where it enters may be so minor as to be unnoticed, but deep puncture wounds are the most dangerous. People who are immunized are protected.

People can catch it even if the wound is not visibly contaminated. Obvious dirt, stool, or saliva in or on the wound greatly increases the risk.

Neonatal tetanus is another worldwide problem. Unless their mothers have been immunized, newborns can get infected if something dirty touches their umbilical stumps. More than ½ million babies around the world die each year from neonatal tetanus, although this is rare in the United States.

What are the symptoms?

Sometimes “lockjaw” is the first symptom – the involuntary clenching of the jaw muscles. Others begin with headache and irritability, followed by muscle stiffness and then muscle spasms. The muscles are described as rigid as a board. A high fever is common.

Involuntary contractions of the facial muscles create an eerie smile. Contractions of the trunk muscles can bend a person over backward, so that only the back of the head and the heels touch the floor.

Seizures are common, as well as loss of bowel and bladder control. Sadly, the person remains fully conscious, and in extreme pain throughout the illness.

Is it contagious?

Tetanus can be spread by dirty objects such as nails, splinters, or needles.

How long does it last?

Symptoms usually begin within two weeks of the infecting wound and then worsen over a week or so. The worst spasms last for about a week. Those who recover do so gradually over about a month.

How is tetanus diagnosed?

The rigid muscles, intense pain, and classic smile usually make tetanus easy to diagnose. Sometimes the bacteria that cause tetanus can be found in the infected wound, but most of the time lab tests are normal.

Either tetanus or rabies can follow an animal bite, and the initial symptoms may look similar, but the seizures look different in the two conditions. Also, people with rabies often have abnormal lab tests and a fear of water.

How is it treated?

To treat tetanus, people are often paralyzed and then put on a mechanical ventilator to keep them breathing. Muscle relaxants and anti-seizure medicines are important.

Treating tetanus also involves ridding the wound and the body of any remaining bacteria and ridding the body of the toxin. This usually means giving tetanus immune globulin (TIG), antibiotics, and then surgically removing an area of tissue around the wound.

How can it be prevented?

The tetanus vaccine is very effective at preventing tetanus. This is part of the regular childhood immunization series. The T in DTaP is a tetanus vaccine. Boosters are given after all wounds and animal bites if the person is not known to have at least 3 of these shots, and if the last proven shot has not been within 5 to 10 years (depending on the wound). Thorough wound cleaning is also important.

Newborn tetanus can be prevented by being sure that mothers have been properly immunized.

Some parents find it desirable for their children to have pierced ears as babies. But how early is too early? Even though tetanus is not very common (thanks to immunizations), the tetanus bacteria are everywhere. For this reason, it is best for a baby to have at least one (even better, three) tetanus shots behind her before her big day. Three shots would put the event at 6 months old for most kids.

Related concepts:

Lockjaw

Dr. Alan Greene

As a father of four himself, Dr. Greene has devoted himself to freely giving real answers to parents' real questions -- from questions about those all too common childhood conditions to those that address the most recent and rare pediatric illnesses. His answers combine cutting edge science, practical wisdom, warm empathy, and a deep respect for parents, children, and the environment. He is also an electrifying public speaker, and has personally touched many during his talks in North America, Europe, Asia, and the Middle East.

Dr. Greene is a graduate of Princeton University and the University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California he served as Chief Resident. He entered primary care pediatrics in January 1993.

Dr. Greene is the Past President of The Organic Center and on the Board of Directors of Healthy Child Healthy World. He is a founding partner of the Collaborative on Health and the Environment. He also consults for the Environmental Working Group.

In 1995, he launched DrGreene.com, cited by the AMA as “the pioneer physician Web site” on the Internet. His award-winning site has received over 80 million Unique Users from parents, concerned family members, students, and healthcare professionals. In addition to being the founder of DrGreene.com, he is the Medical Director for HealthTap.

In 2010 Dr. Greene founded the WhiteOut Movement to change how babies in the United States are fed. In 2012 he founded TICC TOCC - Transitioning Immediate Cord Clamping To Optimal Cord Clamping. He is also the founder of KidGlyphs, a free iPhone app that provides a tool for young children to express themselves beyond their verbal skills while teaching them important language skills.

Dr. Greene is the Founding President of the Society for Participatory Medicine and has served as both President and Board Chair of Hi-Ethics (Health Internet Ethics. He is on the Board of Directors for Healthy Child Healthy World, The Lunchbox Project, and The Society for Participatory Medicine. He has also served as an advisor to URAC for both their inaugural and their updated health web site accreditation program. He is a founding member of the e-Patient Scholars Working Group, and a founding board member of the Center for Information Therapy.

Dr. Greene is a regular columnist for Parenting Magazine. He is also the Pediatric Expert for The People’s Pharmacy (as heard on NPR) and Healing Quest (seen on PBS stations). He was the original Pediatric Expert for both Yahoo! and iVillage.

Dr. Greene is the author of Feeding Baby Green (Wiley, 2009), Raising Baby Green (Wiley, 2007), From First Kicks to First Steps (McGraw-Hill, 2004), The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997), and a co-author of The A.D.A.M. Illustrated Family Health Guide (A.D.A.M., Inc., 2004). He is the medical expert for three additional books, The Parent's Soup A-to-Z Guide to Your New Baby, (Contemporary Books, 1998) The Parent's Soup A-to-Z Guide to Your Toddler, (Contemporary Books, 1999), and The Mother of All Baby Books, (Hungry Minds, Inc., 2002).

Dr. Greene is a frequent keynote speaker at important events such as Health 2.0 2011 held in San Diego, CA, IFOAM 2008 (International Federation of Organic Agriculture Movements), held in Modena Italy, the first European Internet health conference, held in Maastricht, the first International eHealth Association Conference, held in Jeddah, and the largest e-Healthcare World Conference, held in Las Vegas, and the first Green Power Baby Shower, held in Hollywood. Dr. Greene also appears frequently on TV, radio, websites, and in newspapers and magazines around the world, including such venues as the TODAY Show, Good Morning America, Fox and Friends, The Dr. Oz Show, CNN, ABC, CBS, and NBC network news, NPR, The New York Times, The Wall Street Journal, USA Today, Time Magazine, Parade, Parenting, Child, Baby Talk, Working Mother, Better Home's & Gardens, and the Reader's Digest.

Dr. Greene loves to think about challenging ideas, he enjoys being where nothing manmade can be seen, and he wears green socks.

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