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Tetanus

(Lockjaw)

Definition

Tetanus is a bacterial infection. The infection affects the nervous system. It can lead to severe muscle spasms. Such spasms lead to lockjaw. This spasm makes it impossible to open or close the mouth. Tetanus can be fatal.
Nervous System
CNS and PNS
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Causes

Tetanus bacteria is found in soil, dust, or manure. It enters your body through a break in the skin.
Once in your body, the bacteria creates a toxin. This toxin causes tetanus.

Risk Factors

Factors that increase your risk of tetanus include:
  • Lack of tetanus vaccination (or not updating tetanus vaccination in timely manner)
  • IV drug use
  • Age: 50 or older
  • Skin sores or wounds
  • Burns
  • Exposure of open wounds to soil or animal feces

Symptoms

Symptoms of tetanus may include:
  • Headache
  • Stiff jaw muscles (lockjaw) or neck muscles
  • Drooling or trouble swallowing
  • Muscle spasticity or rigidity
  • Sweating
  • Fever
  • Irritability
  • Pain or tingling at the wound site
  • Seizures
  • Difficulty breathing
  • Heart beat that is irregular, too fast or too slow

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. The diagnosis is mainly based on the medical history.
Your doctor may test the wound. A culture will grow the bacteria causing the infection. Culture results are not always accurate for tetanus.

Treatment

Treatment may include:
  • Hospitalization—to manage complications of the infection
  • Opening and cleaning of the wound—entire wounded area may need to be surgically removed
  • Antibiotics
  • Tetanus immune globulin—antibodies against tetanus that help neutralize the tetanus toxin
  • A tetanus shot—if your tetanus vaccine is not up to date
  • Medication to treat symptoms—may include antiseizure medication or muscle relaxants
Tetanus can cause severe problems with breathing or swallowing. A breathing tube may be inserted in the throat. This will help keep the airway open until you heal. A surgical procedure called a tracheotomy may be done. This will provide an open airway if your upper airway can not be accessed.

Prevention

The best means of prevention is immunization. Immunization schedule for tetanus is as follows:
  • All children (with few exceptions) should receive the DTaP vaccine series. This protects against diphtheria , tetanus, and pertussis .
  • Children aged 11-12 years that have completed the DTaP series of shots will receive another vaccine called Tdap.
  • Adults should receive a booster dose of the tetanus and diphtheria vaccine (Td) every 10 years. They may also receive this vaccine after an exposure to tetanus. It is not harmful to receive a tetanus vaccination earlier than 10 years.
If you or your child has not been fully vaccinated, talk to the doctor. There are catch-up schedules available.
In addition to the vaccine, you can prevent tetanus by taking proper care of wounds:
  • Promptly clean all wounds.
  • See your doctor for medical care of wounds.

RESOURCES

National Foundation for Infectious Diseases http://www.nfid.org

National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov

CANADIAN RESOURCES

Canadian Family Physician http://www.cfpc.ca/

Caring for Kids http://www.caringforkids.cps.ca/

References

Harrison's Principles of Internal Medicine . 15th ed. McGraw-Hill Professional Publishing; 2001.

Pertussis, tetanus, and diphtheria. National Coalition for Adult Immunization website. Available at: http://www.nfid.org/idinfo/pertussis . Accessed November 12, 2012.

Recommended adult immunization schedule—United States, 2012. MMWR Morb Mortal Wkly Rep . 2012;6(4). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/recs/schedules/downloads/adult/mmwr-adult-schedule.pdf . Accessed November 12, 2012.

Recommended immunization schedule for persons aged 7 through 18 years—United States 2012. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/recs/schedules/downloads/child/7-18yrs-schedule-pr.pdf . Accessed November 12, 2012.

Tetanus (lockjaw) vaccination. Centers for Disease Control and Prevention (CDC) website. Available at: http://www.cdc.gov/vaccines/vpd-vac/tetanus/default.htm . Updated January 19, 2012. Accessed November 12, 2012.

1/31/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : : Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years—United States, 2008. MMWR. 2008;57;Q1-Q4. Centers for Disease Control and Prevention, MMWR website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm . Updated January 10, 2008. Accessed January 28, 2008.

1/24/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (tdap) vaccine from the advisory committee on immunization practices, 2010. MMWR Morb Mortal Wkly Rep. 2011;60(1):13-15.

11/4/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months—Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011;60:1424-1426.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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