Tetanus

Tetanus is known as lockjaw. If the pathogen multiplies in a contaminated wound, the person affected can experience muscle spasms throughout their whole body after 4 to 30 days. People with tetanus frequently die of breathing problems and cardiovascular failure.

Tetanus has a very high mortality rate, but it decreases to 10 to 20 percent with good intensive care. People can protect themselves from the disease with preventive vaccination. This is why tetanus has become very rare in Germany.

All it takes is for a wound or injury where tetanus pathogens are multiplying for the condition to develop. Tetanus is also called “lockjaw” because different muscle groups tense up and become stiff.

Typical signs are:

• at first, muscle spasms near the wound, later sudden twitching of large muscle groups
• the appearance of a grin caused by tension in the facial muscles (Risus sardonicus or rictus grin)
• lockjaw: the mouth cannot be opened (trismus)
• hyperflexion of the back and neck muscles (opisthotonus)
• difficulty swallowing
• no or low fever
• maintained consciousness

The tetanus pathogen is the bacterium Colstridium tetani. These bacteria are found practically everywhere, especially in soil and in horse manure. Tetanus pathogens can form a particularly resistant form: the spores. Bacterial spores are resistant to environmental influences such as heat or disinfectant. This means that pathogens can survive in the ground for years.

If the living conditions for the bacteria get better again, they change back into forms that can multiply. Clostridia multiply particularly well at body temperature and under low oxygen conditions, i.e. in the absence of air. Only then do they form disease-causing toxins.

These toxins migrate along the nerves to the spinal cord, where usually inhibitory nerves reduce muscle excitation. But the toxins switch off this inhibition so that the muscles are over-activated, resulting in the muscles tensing up even at the slightest stimulus.

People who are poorly vaccinated or not vaccinated at all are at the highest risk of getting tetanus. A precondition for an infection is always an open injury, i.e. a wound. Infection from person to person is not possible.

In Germany, there have been fewer than 15 cases of the disease per year in the last few years. These occurred mainly with the elderly who had no vaccine protection.

However, it looks different in a global perspective: in 2017, over 30,000 new-born babies worldwide were still dying from tetanus. These infections mainly occur in warm, humid countries with a low vaccination rate and inadequate medical care.

The course of the disease is different for non-vaccinated people than for those who have been partially vaccinated. New-born babies have a special form of the disease.

Course of the generalized form

The generalized form of lockjaw is the most common in Germany and affects non-vaccinated patients. This form shows the typical symptoms. If the spasms are very severe and affect flexors and extensors of the spine at the same time, spinal fractures can occur.

In the further course of the disease, the toxins of the tetanus bacteria also attack the nerves supplying the respiratory organs and blood vessels. The patients then have difficulty breathing, fluctuations in blood pressure and sweating. If there is a lack of good intensive care, they will die from lung and cardiovascular failure.

Course of the newborn form

The newborn form mainly occurs when the mother is not vaccinated and the infant’s umbilical stump is not kept hygienically clean. In infants, the tetanus pathogens enter the body through the umbilical stump. They show symptoms such as muscle stiffness, spasms and sucking weakness within the first two weeks of life. Most cases of death from tetanus worldwide are due to the newborn form.

Course of the localized form

Sometimes the localized form occurs in patients who are only partially vaccinated. The symptoms are then limited to the muscles in the immediate vicinity of the wound. This form is usually harmless, but can transition to the generalized form.

People can protect themselves from tetanus by getting vaccinated. The Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends the following vaccination measures for children and adults:

Babies should be vaccinated three times at monthly intervals from the second month of life and then once at 11 to 14 months. This completes the primary immunization. The first booster is administered at the ages of 5 to 6, the second at the ages of 9 to 16.

Adults can catch up on their primary vaccination according to the regimen used for children. They should then have a booster every ten years.

The usual vaccine is a combination vaccine that also provides protection against diphtheria, or diphtheria and whooping cough.

The Robert Koch Institute website provides answers to frequently asked questions about the tetanus vaccination.

Doctors can reach a definite diagnosis of the disease on the basis of typical symptoms such as lockjaw and spasms of the muscles in the face and back. To confirm the diagnosis, the toxins formed by the pathogens can be proven in an animal experiment. But this is only needed in exceptional cases.

Doctors treat tetanus at different levels. On the one hand, they fight the pathogens and their toxins, on the other hand they administer medication that alleviates the symptoms.

Active and passive immunization

If there is an injury, patients who are not vaccinated or whose vaccination status is not known, receive injections of tetanus immunoglobulins. These are antibodies that render the tetanus toxins harmless (passive immunization). At the same time, the normal vaccine is given to additionally encourage the body to produce its own antibodies (active immunization).

Patients who are fully vaccinated and whose last vaccination is not too long ago get neither immunoglobulins nor additional vaccination.

Wound care

All patients with deep or contaminated wounds and major tissue damage must have a surgeon debride and carefully clean the wound area. This prevents the pathogens from multiplying and toxins being produced.

Antibiotics

Although antibiotics cannot fight against pathogenic toxins, they can prevent toxin-producing bacteria from multiplying further. This is why doctors also prescribe an antibiotic such as metronidazole.

Intensive care

If patients already have symptoms of tetanus, doctors monitor vital functions such as breathing and circulation in an intensive care unit. In order to avoid spasms, they are placed in an environment with as little irritation as possible and are given muscle-relaxing medication.