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Tetanus: Diagnostics and Treatment
Introduction
Tetanus is a rare but fatal disease that affects the central nervous system (CNS). It is common among neonates and children in nations without immunization programs and in tropical regions, particularly among men (Centers for Disease Control and Prevention Control [CDC], 2023). Research shows that out of the 73,000 tetanus cases recorded in 2019, over 27,000 infections were among neonates (CDC, 2023). In addition, a report indicates that tetanus is prevalent in Sub-Saharan Africa and South Asia, which account for approximately 82% of all cases globally (Khan et al., 2022). Although the disease has no cure, the use of vaccines such as diphtheria, tetanus, and pertussis (DTaP), and tetanus and diphtheria (TD) has significantly helped in controlling the ailment (Domachowske, 2019). Since 2000, there has been a 88% reduction in tetanus-related fatalities (Brook, 2021). Tetanus causes muscle rigidity, spasms, difficulties in breathing and swallowing, seizures, and irregular blood pressure, though it may result in fatalities in rare cases.
Causes of Tetanus
Tetanus, also called lockjaw, is a severe condition resulting from a bacterial infection. It is caused by the Clostridium tetani bacterium, whose spores, including dust, manure, and soil, are common in the environment (World Health Organization, 2023). The spores develop into bacteria upon entering the human body. Clostridium tetani bacteria are likely to infect body areas with skin breaks such as lacerations, burns, or wounds caused by objects like needles (CDC, 2022a). In addition, the bacterium can also invade the body through various means, including insect bites, intramuscular injections, surgical procedures, and dental infections (CDC, 2022a). Individuals who are predisposed to this infection include unvaccinated people, those with weak immune systems, and intravenous drug users (CDC, 2022a). The incubation period of this illness varies from 3 to 21 days, with some cases taking several months (CDC, 2022a). Nevertheless, this may depend on the intensity of the infection.
Forms of Tetanus
Different types of tetanus affect individuals, each with its own characteristics. They include cerebral, generalized, neonatal, and localized cases (Domachowske, 2019). The cerebral or cephalic is a rare form of tetanus that affects the heads muscles and nerves and occurs due to head trauma or laceration, eye injury, otitis media, or dental procedures (Domachowske, 2019). Alternatively, generalized tetanus is the most prevalent type, characterized by a stiff neck, risus sardonicus, and muscle spasms (Domachowske, 2019). On the other hand, neonatal tetanus is a generalized type of tetanus common among newborns of unvaccinated mothers or those infected through contaminated equipment used to cut the umbilical cord (Domachowske, 2019). Lastly, localized tetanus causes incessant contractions of muscles around the site of infection, which lasts for weeks.
The Influences, Effects, and Outcomes of Tetanus
Once the tetanus bacteria enters the body, it affects different nerves and muscles. Clostridium tetani secrete the tetanolysin and tetanospasmin toxins into the bloodstream (Megighian et al., 2021). In this case, tetanolysin causes severe destruction to the body tissues. Alternatively, tetanospasmin moves into the motor neurons presynaptic terminals, damaging a vesicular synaptic membrane protein and leading to the inactivation of inhibitory neurotransmission that suppresses the motor neuron, paralyzing muscle activity (Megighian et al., 2021). Subsequently, tetanospasmin travels to the neurons in the CNS, hindering the release of inhibitory neurotransmitters, such as gamma-aminobutyric acid (GABA) and glycine (Megighian et al., 2021). Under normal circumstances, these inhibitory neurotransmitters reduce excessive activities in motor neurons and prevent the muscles from contracting too powerfully. Nevertheless, tetanospasmin blocks the inhibitory neurotransmitters, causing uncontrolled activation of the motor neurons, resulting in a tetanic spasm (Megighian et al., 2021). This can result in uncontrollable muscle contraction and activity to the extent that muscle tears and bone fractures may occur.
Tetanus poses several adverse effects on different parts of the body. One of the major impacts of tetanus is muscle stiffness and spasms (Almas et al., 2021). Tetanospasmin impairs the functioning of the inhibitory neurotransmitters resulting in intense muscle activity, which may cause the rigidity of the jaw and neck muscles and extend to other body parts. This rigidity can progress to the extent that an individual may experience difficulties opening their mouth (trismus) or swallowing (CDC, 2022b). Tetanus also causes muscle spasms, particularly around the wound area, which can last several minutes, making them extremely agonizing (Almas et al., 2021). The cramps may be prompted by sensory stimuli such as touch or noise. In some cases, the spasms are acute and may result in drooling uncontrolled urination, or the body arching backward, a disorder called opisthotonos (Almas et al., 2021). Similarly, since tetanus affects the neck muscles, individuals with this condition may have trouble breathing. In extreme cases, this can result in dyspnea, hypoxia, or respiratory failure (Khan et al., 2022). Therefore, tetanus causes intense pain to individuals due to muscle stiffness, spasms, and difficulties in breathing.
Lockjaw may severely impair the autonomic nervous system, posing a threat to critical body processes. Tetanospasmin may affect this system which regulates crucial body functions such as blood pressure, sweating, and heart rate. This may result in bradyarrhythmias, irregular heartbeats, labile blood pressure, and cardiac arrest, which may be fatal (Domachowske, 2019). Equally, tetanus can cause fever and sweating, especially when an individual is experiencing a muscle spasm. Furthermore, in acute cases, the disorder triggers seizures or convulsions, which are life-threatening because they may result in the loss of consciousness (Almas et al., 2021). Not to mention, tetanus also causes risus sardonicus due to the continuous contraction of the facial muscles (Almas et al., 2021). The condition can trigger constant headaches due to muscle rigidity. Thus, the impact of tetanus on the autonomic nervous system interferes with essential body functions, predisposing individuals to severe ill health.
The severity of tetanus can trigger several other health complications. The disorder may cause aspiration pneumonia if generalized spasms make an individual accidentally inhale secretions from the stomach or foreign objects into the lungs (Almas et al., 2021). Additionally, tetanus might trigger vocal cord paralysis (Laryngospasm), resulting in suffocation in acute cases. Not to mention, laryngospasm combined with the stiffness and spasms of the diaphragm, chest wall, and abdominal wall muscles may cause asphyxiation, leading to respiratory failure (Domachowske, 2019). In addition, tetanus can result in fractures due to continuous muscle spasms and pressure sores due to increased immobility. Similarly, in rare cases, the illness could trigger urine retention because of sphincter spasms (Almas et al., 2021). Equally, acute muscle spasms may damage the skeletal muscle, resulting in acute renal failure (Domachowske, 2019). Hence, individuals suffering from tetanus are at a higher risk of developing more problems, further exacerbating their health outcomes.
Neonatal tetanus has devastating impacts on infants, particularly those born to nonimmunized mothers. Among neonates, tetanus causes rigidity and spasms in facial muscles, limbs, and the entire body (Brook, 2021). This stiffness can become so acute that the infants may have problems breathing or feeding, resulting in dehydration and malnutrition. In addition, neonatal tetanus leads to irritability and restlessness among infants due to the agony and discomfort associated with muscle stiffness and spasms (Brook, 2021). The long-term effects of this disorder on newborns may include neurodevelopmental impairments, deficiencies in speech, gross motor skills and language development, and behavioral issues (Brook, 2021). Thus, neonatal tetanus greatly distresses infants, adversely affecting their growth.
In rare but severe cases, tetanus may result in fatalities. Research indicates that 2 in every 10 individuals affected by tetanus are likely to die (U.S. Department of Health & Human Services, 2021). The mortality rate for generalized tetanus is higher among older adults and those who are unvaccinated. Nevertheless, neonatal tetanus has the highest mortality incidence, with a 80%-100% case fatality rate (CDC, 2023). Therefore, though uncommon, the condition can lead to death if not promptly and effectively treated.
Conclusion
Tetanus is a disease mainly affecting the CNS, which is prevalent in tropical regions. It is caused by the Clostridium tetani bacterium and exists in different forms, including localized, neonatal, cerebral, and generalized cases. Generalized tetanus is the most common case, with many adverse effects on individuals, such as muscle rigidity, spasms, and breathing problems. It also impairs the autonomic system, causing changes in blood pressure and heartbeat. In addition, the severity of tetanus can trigger severe health complications such as aspiration pneumonia, respiratory failure, and fractures. Neonatal tetanus may cause deficits in gross motor skills and language development as well as neurodevelopmental impairments. If left untreated, tetanus can result in fatalities, with the highest mortality rate being recorded among neonates.
References
Almas, T., Niaz, M. A., Zaidi, S. M., Haroon, M., Khedro, T., Alsufyani, R., Al-Awaid, A. H., Tran, E., Khan, A. W., Alaeddin, H., Rifai, A., Manamperi, K. T., Khan, A., & Haadi, A. (2021). The spectrum of clinical characteristics and complications of tetanus: A retrospective cross-sectional study from a developing nation. Cureus, 13(6), 1-7. Web.
Brook, I. (2021). Neonatal tetanus. Pediatric Emergency Medicine Journal, 8(1), 17. Web.
Centers for Disease Prevention and Control. (2022a). Causes and how it spreads. Web.
Centers for Disease Prevention and Control. (2022b). Symptoms and complications. Web.
Centers for Disease Prevention and Control. (2023). Why CDC is working to prevent global tetanus. Web.
Domachowske, J. (2019). Introduction to clinical infectious Diseases. Springer.
Khan, M. A., Hasan, M. J., Rashid, M. U., Kha Sagar, S., Khan, S., Zaman, S., Sumon, S. M., Basher, A., Hawlader, M. D., Nabi, M. H., & Kakoly, N. S. (2022). Factors associated with in-hospital mortality of adult tetanus patientsA multicenter study from Bangladesh. PLOS Neglected Tropical Diseases, 16(3), 1-16. Web.
Megighian, A., Pirazzini, M., Fabris, F., Rossetto, O., & Montecucco, C. (2021). Tetanus and tetanus neurotoxin: From peripheral uptake to central nervous tissue targets. Journal of Neurochemistry, 158, 12441253. Web.
U.S. Department of Health & Human Services. (2021). Tetanus. Web.
World Health Organization. (2023). Tetanus. Web.
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