TETANUS The smiling assasin

It is fine if you have never heard of tetanus. But, if you are a farmer, have family who farm, work with soil, and work as a builder perhaps, or involved in a road traffic accident, you should know about tetanus. Have you ever had a nail puncture your foot or cut your nails with a rusty blade? Regardless, you should know about tetanus. As my father would say, ‘No knowledge is lost’.

Tetanus

Tetanus, also known as lockjaw, is an infection characterized by muscle spasms. It pulls the lips and face back in spasm, exposing the teeth in a deathly smile. Tetanus is the smiling assassin.

Tetanus is caused by an infection with a germ, commonly found in soil, dust and manure. Tetanus occurs in all parts of the world in the soil and in animal and human intestines. It is most frequent in hot and wet climates where the soil contains a lot of organic matter. The germ, a bacterium called Clostridium tetani, generally enters through a break in the skin such as a scratch, cut or puncture wound. The tetanus bacteria often enter the body through wounds, which can be caused by nails, splinters, insect bites, burns, any skin break, and drug injection sites.

The tetanus germ multiplies in a contaminated wound especially inside deep wounds or those with dead tissue. Puncture wounds are therefore favorite locations of entry for the bacteria. The commonest story is that someone steps on a rusty nail and it leads to infection with this horrible germ. Tetanus can also be a hazard to both the mother and newborn child (by means of the uterus after delivery and through the umbilical cord stump). It is important to cut the umbilical cord with clean and uncontaminated instrument.

The poison

The germ when in the body then produces toxins. The potent toxin that is produced when the tetanus bacteria multiply is the major cause of harm from tetanus. The particular toxins are essentially poisons that interfere with muscle contractions, resulting in the symptoms.

Typically, the infection starts a few days to about 3 weeks after the injury. In many situations, the original wound may have even healed and be forgotten about. Diagnosis is based on the presenting signs and symptoms.

The symptoms of tetanus begin with spasms in the jaw and then progress to the rest of the body. These spasms usually last a few minutes each time and occur frequently for three to four weeks. Spasms may be so severe that the body is bent into awkward positions and bones snap. Other symptoms may include fever, sweating, headache, trouble swallowing, high blood pressure, and a fast heart rate.

Smiling to death

Tetanus can make you pretty sick and render you at high risk of death. The spasms affect the muscles for swallowing and breathing requiring intensive care in some situations. In fact, without the appropriate treatment and supportive care, people die. Generally, about 10% of those infected die. For those who survive, it may take months to recover from the disease and be back to normal or near normal. It is important to know that the disease does not spread between people and you cannot catch it from someone else.

Prevention

Infection can be prevented by proper immunization with the tetanus vaccine. The vaccine is highly effective, widely available and everyone should be vaccinated against tetanus. Three doses of the vaccine are required to provide adequate and long lasting protection. People with a significant wound and especially following a road traffic accident should be given the vaccine.

Treatment

General measures to treat the sources of the bacterial infection with antibiotics and drainage of pus in the wound are carried out in the hospital. The wound should be cleaned and any dead tissue removed. Patients are also routinely treated with specific antibiotics to kill the germs and prevent them from multiplying and hence developing the toxin.

Other treatment is directed toward stopping toxin production, neutralizing its effects, and controlling muscle spasms. Sedation is often given for muscle spasm, which can lead to life-threatening breathing difficulty. The patient is monitored for any signs of compromised breathing muscles. Management in intensive care to help the patient breath may be necessary and life saving. Mechanical ventilation may be required if a person's breathing is affected. In more severe cases, breathing assistance with an artificial respirator machine may be needed.

In those who have a significant wound and less than three doses of the vaccine both immunization and tetanus immune globulin are recommended. In those who are infected tetanus immune globulin or if not available intravenous immunoglobulin (IVIG) is used. Muscle relaxants can be used to control spasms.

The toxin already circulating in the body is neutralized with antitoxin drugs. The tetanus toxin causes no permanent damage to the nervous system after the patient recovers. After recovery, patients still require active immunization because having the tetanus disease does not provide natural immunization against a repeat episode.

Now, you know! So, go and get vaccinated.

NB: The Annual General Meeting of the Association of Private General Practitioners of Nigeria will hold in Abuja in April 2016. We are talking about ‘Communicable Disease’ such as Malaria, HIV and Tuberculosis. Other important topics are cancer screening and medical missions. If this is your forte, then please be part of the process. Call or email me.