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Childhood diseases - Tetanus

Useful information on the causes, symptoms, complications and treatment of tetanus, plus advice on the tetanus childhood vaccine and booster injections.
Tetanus (lockjaw) is a serious and often fatal disease, with spasms of muscle contraction through open wounds.


Bacilli of Clostridium tetani can be found in soil (especially agricultural soil), and the intestines and feces of horses, sheep, cattle, rats, dogs, cats, guinea pigs, and chickens. Spores are found in manure-treated soil, skin surfaces, and contaminated heroin.

There are three different clinical forms of tetanus: local (uncommon), cephalic (rare), and generalised (most common). Generalised tetanus accounts for 80% of tetanus cases.


The incubation period for tetanus is 3-21 days (with the average being about 8 days). Most of the time, the farther the wound is from the central nervous system, the longer the incubation period. Incubation period length and likelihood of death are inversely proportional. The first sign of tetanus is lockjaw (trismus), followed by stiffness of the neck and back, risus sardonicus, difficulty swallowing, and muscle rigidity in the abdomen. The stiffness and spasming of muscles expands throughout the body inferiorly.

Typical signs of tetanus include an increase in body temperature by 2-4 celsius, diaphoresis (excessive sweating), an elevated blood pressure, and an episodic rapid heart rate. Spasms and muscle contraction last for 3-4 weeks, and complete recovery may take months. About 30% of tetanus victims die, most of whom are elderly patients. In developing countries, the mortality rate may be as high as sixty percent.


Complications of the disease include spasms of the larynx (vocal cords), accessory muscles (chest muscles used to aid in breathing), and the diaphragm (the primary breathing muscle); fractures of long bones secondary to violent muscle spasms; and hyperactivity of the autonomic nervous system.


The wound must be cleaned. Penicillin and metronidazole will help decrease the amount of bacteria but it has no effect on the toxoid produced by the bacteria. Human anti-tetanospasmin immunoglobulin should be given. Diazepam and DTP vaccine booster are also given. Tetanus can be prevented by vaccination. A booster vaccine is recommended every ten years, and standard care in many places is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated.
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