Tetanus

Definition
Tetanus is a serious bacterial disease caused by a toxin that leads to stiffness of your jaw muscles and other muscles. Tetanus can cause severe muscle spasms, make breathing difficult and, ultimately, threaten your life. Spores of the tetanus bacteria, Clostridium tetani, usually are found in the soil, but can occur virtually anywhere. If deposited in a wound, the bacteria can produce a toxin that interferes with the nerves controlling your muscles. Treatment for tetanus is available, but the process is lengthy and not uniformly effective. Tetanus may be fatal despite treatment. The best defense against tetanus is preventing it by getting a tetanus shot and by properly caring for wounds.

Symptoms
Signs and symptoms of tetanus may appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The incubation period for the disease is usually between three days and three weeks, with an average of eight days. Signs and symptoms of tetanus may include:

Spasms of your jaw, neck and other muscles. As the toxin spreads to nerves, your face and jaw muscles may be affected by strong spasms. Spasms can also affect muscles in your chest, abdomen and back. Stiffness of your jaw, neck and other muscles. This is why tetanus is commonly referred to as lockjaw. Spasms and stiffness of your jaw and neck may lead to difficulty swallowing. Stiffness can also affect your chest, abdominal and back muscles. Difficulty breathing. Severe spasms can affect respiratory muscles and make it difficult to breathe.

Other signs and symptoms can include:
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Fever Muscular irritability

When to see a doctor See your doctor to obtain a tetanus booster shot if you have a deep or dirty wound and you haven't had a booster shot within the past five years or aren't sure of your vaccination status. Or see your doctor about a tetanus booster for any wound if you haven't had a booster shot within the past 10 years.

Causes
The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores of the bacteria may produce a powerful toxin, tetanospasmin, which acts on various areas of your nervous system. The effect of the toxin on your nerves can cause muscle stiffness and spasms — the major signs of tetanus.

Preparing for your appointment
If your symptoms are minimal, you're likely to start by seeing your family doctor. However, if they're severe or you're concerned about an infected wound, you're more likely to go to the emergency room. Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor. What you can do
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Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Write down key personal information, including when you were last vaccinated for tetanus and what type of vaccination you had, as well as any recent wound injuries. Make a list of all medications, as well as any vitamins or supplements, that you're taking. Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot. Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For tetanus, some basic questions to ask your doctor include:
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What is likely causing my symptoms or condition? Are there other possible causes for my symptoms or condition? What kinds of tests do I need? Is my condition likely temporary or chronic? What is the best course of action? What are the alternatives to the primary approach that you're suggesting? I have these other health conditions. How can I best manage them together? Are there any restrictions that I need to follow? Should I see a specialist? What will that cost, and will my insurance cover it?

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Is there a generic alternative to the medicine you're prescribing me? Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something. What to expect from your doctor Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend time on. Your doctor may ask:
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When did you first begin experiencing symptoms? Have your symptoms been continuous, or occasional? How severe are your symptoms? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? When were you last vaccinated for tetanus and what type of vaccine did you receive? Have you recently had a wound?

What you can do in the meantime If your symptoms are severe or you're concerned about an infected wound, seek immediate medical attention.

Tests and diagnosis
Doctors diagnose tetanus based on a physical exam and the signs and symptoms of muscle spasms, stiffness and pain. Laboratory tests generally aren't helpful for diagnosing tetanus.

Treatments and drugs
In most cases of tetanus, the illness is severe, and there's a risk of death despite treatment. Death may result from constriction of airways, pneumonia or instability in the autonomic nervous system. The autonomic nervous system is the part of your nervous system that controls your heart muscles, other involuntary muscles and glands. Treatment may consist of certain medications, as well as supportive care. Medications

Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus immune globulin (TIG). However, the antitoxin can neutralize only toxin that hasn't yet combined with nerve tissue. Antibiotics. Your doctor may also give you antibiotics, either orally or by injection, to fight tetanus bacteria.

Vaccine. You'll also need to receive a tetanus vaccine in order to prevent future tetanus infection.

Supportive therapies Tetanus infection often requires a long period of treatment in an intensive care setting. You may need drugs to sedate you and to paralyze your muscles, and that may result in shallow breathing that needs to be supported temporarily by a ventilator. People who've had tetanus often recover completely. However, some people have lasting effects, such as brain damage caused by a lack of oxygen when muscle spasms in the throat cut off the airway.

Prevention
You can easily prevent tetanus by being immunized against the toxin. Almost all cases of tetanus occur in people who've never been immunized or who haven't had a tetanus booster shot within the preceding 10 years. The vaccine The tetanus vaccine usually is given to children as part of the diphtheria and tetanus toxoids and pertussis (DTP) shot. This vaccination provides protection against three diseases: diphtheria (a throat and respiratory infection), pertussis (whooping cough) and tetanus. The latest version of this immunization is known as the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. The DTaP vaccine consists of a series of five shots, typically given in the arm or thigh to children at ages:
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2 months 4 months 6 months 15 to 18 months 4 to 6 years

The booster It's recommended that adolescents get a booster shot between the ages of 11 and 18, and that adults receive a tetanus booster shot every 10 years. If you're traveling internationally, it's a good idea to have up-to-date immunity because tetanus may be more common where you're visiting, especially if you're traveling to a developing country. If you receive a deep or dirty wound and it's been more than five years since your last booster shot, get another booster shot. A booster of the tetanus vaccine is typically given in combination with a booster of diphtheria vaccine. Recently, pertussis vaccine has been added to this routine combination immunization to ensure that adults and adolescents are fully protected against pertussis. This combination vaccine is referred to as Tdap, and it's approved for use in teens and adults under age 64. In order to stay up-to-date with all of your vaccinations, request that your doctor review your vaccination status on a regular basis.

Having had a tetanus infection doesn't provide immunity. Following recommendations for vaccinations is necessary to prevent recurrence of tetanus. If you were never vaccinated against tetanus as a child, see your doctor about getting the Tdap vaccine. You can't get a tetanus infection from the vaccine. Taking care of a wound If you have a wound, these steps will help prevent you from getting tetanus:

Keep the wound clean. Rinse thoroughly with clean water. Clean the wound and the area around it with soap and a washcloth. If debris is embedded in a wound, see your doctor. Consider the source. Puncture wounds or other deep cuts, animal bites or particularly dirty wounds may put you at increased risk of tetanus infection. Get medical attention if the wound is deep and dirty, and particularly if you're unsure of your immunization status. Your doctor may need to clean the wound, prescribe an antibiotic and give you a booster shot of the tetanus toxoid vaccine. If you've previously been immunized, your body should quickly make the needed antibodies to protect you against tetanus. Use an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment, such as the multi-ingredient antibiotics Neosporin and Polysporin. These antibiotics won't make the wound heal faster, but they can discourage bacterial growth and infection and may allow the wound to heal more efficiently. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment. Cover the wound. Exposure to the air may speed healing, but bandages can help keep the wound clean and keep harmful bacteria out. Blisters that are draining are vulnerable. Keep them covered until a scab forms. Change the dressing. Applying a new dressing at least once a day or whenever the dressing becomes wet or dirty may help prevent infection. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and paper tape.