By Dr. Goke Akinrogunde
Tetanus is one deadly but easily preventable disease condition – done via vaccination. But for those not vaccinated, it comes not just as a potential killer but also comes embarrassing with its various manifestations of locked jaw, spasm, uncontrollable body stiffness, funny facial expression, body posture etc.
The salient point to note here is that tetanus is dangerous; it kills so easily and cheaply too. I have had cause in the past to narrate cases of close relative and friends who fell to tetanus, like play, like play.
As old as time
Tetanus was well known to ancient people who recognised the relationship between wounds and fatal muscle spasms. The word “tetanus” is derived from the Greek word tetanos meaning “taut”, and teinein to “stretch”.
Tetanus is an infectious disease caused by contamination of wounds from bacteria that live in the soil. The causative bacterium Clostridium tetani is an organism capable of living many years in the soil in a form called a spore.
According to historical documentation, the bacterium was first isolated in 1899 by Japanese physician, ShibasaburoKitasato, while he was working in Germany. Kitasato also found the toxin responsible for tetanus and developed the first protective vaccine against the disease.
Mode of transmission
Tetanus occurs when a wound becomes contaminated with tetanus bacteria spores. Infection follows when spores become activated and develop into bacteria that multiply and produce a very powerful toxin (poison) that affects the muscles. Tetanus spores are found throughout the environment, usually in soil, dust, and animal waste. The usual locations for the bacteria to enter the body are puncture wounds, such as those caused by rusty nails, splinters, or insect bites. In a similar manner, burns and any break in the skin are also potential entryways for the bacteria.
It is important to note however that tetanus is acquired through contact with environment; it is not transmitted from person to person.
The disease results in severe, uncontrollable muscle spasms.
The earliest sign is “locked jaw” muscle spasms of the face, causing the disease to sometimes be called “lockjaw disease.” In severe cases, the muscles used to breathe can develop spasm, causing a lack of oxygen to the brain and other organs that can potentially lead to death.
The disease pattern
The tetanus bacteria produce the toxin (poison) tetanospasmin, which is responsible for causing tetanus. Tetanospasmin binds to motor nerves that control muscles, enters filaments that extend from nerve cells to the muscle fibers, and travels in the along the nerve fiber until it reaches the body of the motor nerve in the spinal cord or brainstem. Then the toxin migrates into the synapse (small space between nerve cells critical for transmission of signals among nerve cells) where it binds to presynaptic nerve terminals and inhibits or stops the release of certain inhibitory neurotransmitters. Because the motor nerve has no inhibitory signals from other nerves, the chemical signal to the motor nerve of the muscle intensifies, causing the muscle to tighten up in a huge continuous contraction or spasm. If tetanospasmin reaches the bloodstream from the wound site, it can be deposited in many different presynaptic terminals resulting in the same effect on other muscles.
Immunisation altered tetanus spread
In developed countries, because of widespread immunisation and careful wound care, the total annual number of cases has come so low, averaging about 40 cases per year in USA for example.
However, the case in underdeveloped countries of Africa, Asia, and South America is different, here, tetanus is far more common. The annual worldwide incidence is between 500,000-1 million cases. The majority of new cases, however on worldwide basis, are in the newborn in their first month of life i.e. neonates.
The disease can come in four different patterns:
Generalised tetanus can affect all skeletal muscles. It is the most common as well as the most severe form of the four types.
Local tetanus manifests with muscle spasms at or near the wound that has been infected with the bacteria.
Cephalic tetanus primarily affects one or several muscles in the face rapidly (in one to two days) after a head injury or ear infection. Trismus (“lockjaw”) may occur. The disease can easily progress to generalized tetanus.
Neonatal tetanus is similar to generalized tetanus except that it affects a baby that is less than 1 month old. This condition is rare in developed countries.
Tetanus may develop in people who are not immunized against it, especially in the older generation born before the 1960s when tetanus vaccine was yet to be incorporated as routine vaccination in infants and young children, or in people who have failed to maintain adequate immunity with active booster doses of vaccine.
The main feature of tetanus is muscle rigidity and spasms.
In generalized tetanus, the initial complaints may include any of the following:
Irritability, muscle cramps, sore muscles, weakness, or difficulty swallowing are commonly seen.
Facial muscles are often affected first. Trismus or lockjaw is most common. This condition results from spasms of the jaw muscles that are responsible for chewing. A sardonic smile (devilish-looking) — medically termed risussardonicus — is a characteristic feature that results from facial muscle spasms.
Muscle spasms are progressive and may include a characteristic arching of the back known as opisthotonus. Muscle spasms may be intense enough to cause bones to break and joints to dislocate.
Severe cases can involve spasms of the vocal cords or muscles involved in breathing. If this happens, death is likely, unless medical help (mechanical ventilation with a respirator) is readily available.
Any wound is a serious case
The point to note here is that if one has a wound, one should seek medical attention immediately. It is particularly important in those not immunized or have not had the booster dose in the last 5-10 years, any open wound is at risk of developing tetanus. It is especially important to visit a hospital if the wound is large, crushed, or heavily contaminated, any victim of such must go to the nearest hospital for evaluation. Occasionally, both a tetanus booster (toxoid) and tetanus antibodies are required if the wound that is assessed to be tetanus-prone. Tetanus antibodies are reserved for people with incomplete immunizations with a tetanus-prone wound.
And in cases where a wound cannot be recalled to have occurred but nevertheless one experiences trouble swallowing or have muscle spasms in the facial muscles, such a case must see a doctor immediately because one can never tell, it could be an incipient tetanus showing the earliest signs. Anyhow one looks at it, for tetanus, it will always be correct knowing that “prevention is many times better and cheaper than attempted cure”.
Tetanus-related death is avoidable. Get immunized / immune-boosted today – it is free.