We should always take care of ourselves. It is important that we look after our mental and physical health. From burnout, lung, and heart diseases to simple wounds, we should be able to address them accordingly. Neglecting simple symptoms might lead to serious complications that might be irreversible or fatal. So we must always listen to what our body is telling us. 

There is an acute and fatal disease that can start just from a simple wound. Tetanus is a disease of the nervous system caused by the bacteria called Clostridium tetani. Tetanus is usually acquired through infection of a wound or cut. 

Tetanus in Ancient Times

Tetanus has plagued the human population since ancient times. It is a well-known disease for thousands of years. Documents on Egypt describing the symptoms of the disease as early as 3000 BC. 

People in Ancient history pretty much understand that something is infecting the wound that causes tetanus. But their ideas of treating the disease were far from what the current treatment is. Around 300 BC, Chinese physicians were thought to be treating the disease by needling patients above the ears. Hippocrates in Ancient Greece was telling tetanus patients to perspire by drinking strong wine while being wrapped in oil-soaked clothes. In the Renaissance period, patients with tetanus were covered with manure. 

Discovering Tetanus and Vaccine

Research on tetanus bore fruit in 1884 when the disease was replicated in animals by Giorgio Rattone and Antonio Carle. They were able to reproduce it by injecting infected human pus. In the same year, Arthur Nicolaier was able to associate bacteria on the soil to tetanus. He injected animals with soil samples to reproduce tetanus. 

In 1897, Edmond No card demonstrated the protective effect of passive transfer of antitoxin or passive immunization. Passive immunization occurs when an individual receives specific antibodies from donors. 

In 1889, Japanese Bacteriologist Shibasaburo Kitasato was able to isolate the bacteria responsible for tetanus from an infected person. In his study, he injected the isolated bacteria in the animals and they exhibited tetanus afterward. He also reported that the toxin could be neutralized by specific antibodies. Passive immunization with prophylaxis was used for treatment during World War I. 

In 1923, French veterinarian Gaston Ramon was able to inactivate the tetanus toxin using formaldehyde, resulting in a toxoid that can be used as a vaccine. In 1924, Descombey, who was a student of Gaston Ramon, developed the toxoid that was given to U.S. soldiers fighting in World War II. 

Clostridium tetani in Action

Clostridium tetani is a motile rod microorganism. It is an obligate anaerobic bacteria. Meaning it is sensitive to heat and cannot survive in the presence of oxygen. However, it can produce spores that are resistant to heat and other chemical agents. 

The spores are widely distributed in soil and in the intestines and feces of sheep, cattle, horses, chickens, and other animals. Manure treated soils may contain a large number of C. tetani spores. If not exposed to sunlight, the spores can stay in the soil for months and years. 

Clostridium tetani bacteria usually enter through a wound. When inside the body with the presence of low oxygen or anaerobic condition, the spores germinate and turn into active bacteria. 

The bacteria produce two exotoxins, tetanolysin, and tetanospasmin. Tetanospasmin is a neurotoxin that causes the clinical manifestation of the disease tetanus. On the basis of weight, It is one of the most potent toxins known.  

The toxins produced are disseminated via blood and lymphatics. It will then act on the central nervous system much like pesticides. It will block the release of inhibitory transmitters. This leads to unopposed muscle contractions, seizures, and spasm. 

Symptoms of Tetanus 

The disease is particularly common and serious in newborn babies and pregnant women who are not sufficiently immunized with tetanus toxoid vaccines. Tetanus during pregnancy or within 6 weeks of the end of pregnancy is called maternal tetanus while tetanus within the first 28 days of the newborn is called neonatal tetanus. 

The incubation period of tetanus varies between 3 to 21 days after infection. Most cases occur within 14 days. In general, the further the injury site or wound is from the central nervous system, the longer is the incubation period. 

Three different types of tetanus were described. Local tetanus is an uncommon form of tetanus in which patients exhibit persistent contraction of muscles in the same area of the injury or wound. Next is the rare form, cephalic tetanus. C. tetanus is present in the middle of the ear or following injuries to the head. 

The most commonly reported type is generalized tetanus which is about 80% of all the reported cases. The first sign is lockjaw followed by the stiffness of the neck, difficulty in swallowing. There will be muscle spasms in the back, abdomen, and extremities. Symptoms also include headache, fever, sweating, and changes in blood pressure. 

Spasms of the vocal cords or the muscles for respiration can cause severe breathing problems. Frequent muscle spasms and convulsions can result in broken bones. 

Treatment and Prevention

At the moment, there are no specific diagnostic tests used to check tetanus. Diagnosis is made on clinical signs and symptoms and not on the confirmation of Clostridium tetani. Tetanus is a medical emergency requiring aggressive wound care, drugs to control muscle spasms, antibiotics, immediate treatment with a medicine called tetanus immune globulin (TIG). Complete recovery may take months. 

Prevention of tetanus can be done through immunization with tetanus-toxoid-containing vaccines (TTCV). To be protected throughout their lifetime, the World Health Organization (WHO) recommends that people must receive 6 doses, 3 primary and 3 booster doses, of TTCV. 

Neonatal tetanus can be prevented by vaccination of women with TTCV either during or outside pregnancy. 

The very low tetanus cases among individuals immunized up to 10 years prior to infection suggest an efficacy rate of nearly 100% for TTCV. 

Tetanus is a preventable disease and we should take advantage of this. It is better to get vaccinated and complete the required doses. 

Cite this article as:
Editorial Staff, "Disease Review: Tetanus," in Medicalopedia, June 18, 2020, [Permalink: https://www.medicalopedia.org/8986/disease-review-tetanus/].