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Is Your JAWLOCKED...speaking of... TETANUS !

Have you ever wondered what Tetanus is, and why you received a vaccine? Actually, You probably never even gave it a second thought. You, more likely received the Tetanus vaccine as part of your immunizations as a child, or even received a “Tetanus booster”, after some type of injury.

Now, in regards to vaccines, you have probably heard of Tetanus, but described in combination with the Pertussis, and Diphtheria vaccines, but in the abbreviated form of DTaP, or Tdap, or DT.

These are a combination of vaccines against these particular infectious diseases.

Did… you… ALSO know, you probably have heard of Tetanus before, but by its more common “other name”, which is “LOCKJAW”!

Historically, Hippocrates (the Father of modern medicine), first described Tetanus in as early as the 5th century BC. In 1884 Antonio Carle and Giorgio Rattone from the University of Turin, in Italy, discovered the cause of Tetanus to be from the Clostridium tetani bacteria, but it wasn’t until 1924 that an actual vaccine was developed.

What is Tetanus?

Tetanus is a Bacterial Infection caused by the bacterium Clostridium tetani, but known more commonly as Lockjaw. The reason it is called Lockjaw is due to how the effects of the bacteria cause muscle spasms, usually beginning in the jaw with progression to the rest of the body.

How do you “get” Tetanus?

Tetanus is interesting in the sense that it is one type of bacteria that is not transmitted from person to person as many other bacteria, such as through coughing and sneezing.

But unfortunately though, the bacterium Clostridium tetani, is a common bacteria, that is found in dirt, soil, dust, saliva, and feces. The bacteria then enters a person’s body through contaminated objects via a puncture wound, or cuts in the skin, from a nail or knife/blade, or through an open wound.

The bacteria then produces spores that in turn produce a toxin called Tetanospasmin. This toxin affects a person’s neuromuscular system, specifically skeletal muscle, resulting in the spasms, kind of like a stun gun or an electric eel, except this is through and from the inside of you.

In our bodies, we have 3 muscle types: The first type…Skeletal muscle which we consciously control, its attached to our bones and allows for us to move; The second type…Smooth muscle which we do not control, focuses on internal structures such as in the lungs, and stomach, intestines, and blood vessels; and the third type…Cardiac muscle, which we also do not control, and is specific to the heart.

As mentioned, the Tetanus toxin affects a person’s skeletal muscle, resulting in intense muscle spasms; You don’t want to imagine if Tetanus affected cardiac muscle, like the heart, cause if your heart spasmed like skeletal muscle, we would be dead.

Tetanus usually develops between 3 days to 3 weeks, after exposure, but it can take up to several months for symptoms to actually begin, with months to recover after treatment, and with as high as 10% of exposures leading to death. In 2015, there were almost 60,000 deaths worldwide due to Tetanus.

What are signs and Symptoms of Tetanus?

Signs and Symptoms Include fever, sweating, headache, cramping of the Jaw, trouble swallowing, high blood pressure, and tachycardia (or fast heart rate), muscle spasms, Seizure-like Jerking or absent-like (staring) seizures, All over body Pain and muscle stiffness.

Types of Tetanus

There are 4 type of Tetanus:

These are Generalized tetanus, Neonatal tetanus, Local tetanus, and Cephalic tetanus.

The most common type of tetanus which accounts for about 80% of cases, is Generalized tetanus

This type starts at the head and makes its way down the body.

It starts with Trismus, which means “gnashing,” also another name for “LOCKJAW”, which involves the muscles of chewing.

Then Risus sardonicus can occur, which means a scornful laugh, and is a spasm of the facial muscles, and neck muscles causing stiffness.

This evolves to opisthotonos which is a spasming of body muscles causing the legs and arms to become rigid, the arms are pulled up to the body, fists are clenched, a backward-arching of the head, neck, and spine occur.

These Muscle spasms and stiffness of the neck, abdomen, and chest may cause difficulty breathing. This can continue intermittently for up to a month.

The second type of tetanus is Neonatal tetanus. If the mother has NOT been vaccinated against tetanus this can lead to GENERALIZED type of tetanus (that I just discussed) in newborns, usually from infection when the umbilical cord is cut with a non-sterile instrument.

Neonatal tetanus IS COMMON in under- developed countries for this reason.

However, If the mother has been vaccinated against tetanus, the baby is protected through passive immunity (from the antibodies acquired from the mother that are passed through to the baby).

Just another reason to be vaccinated against Tetanus, cause who wants their baby to go through that. Due to vaccinations, Neonatal tetanus is NOT common in developed countries, where mothers have been vaccinated.

A least common form of tetanus is Local tetanus, now this can lead to General Tetanus, But Local Tetanus is where people have spasms, or contractions in the area where the injury occurred, for example the foot. Although rare, it does account for approximately 1% of deaths associated with Tetanus, but usually when treatment is not sought.

The most rare type of tetanus is Cephalic tetanus. Although extremely uncommon, don’t lets its rareness fool you, as it has a fatality rate, or death rate of about 25%.

Why?........... well this is due to its complicating presentation, and differential diagnosis. This type usually occurs due to an injury to the head area. Whether it be a penetrating injury or a cut, and it can lead to trismus or Lock jaw (as I mentioned above). It can also lead to a facial palsy or eye droop, mimicking a stroke; thus physicians may not suspect this type of tetanus, or Tetanus in general.

What are the Complications of Tetanus?

Complications of tetanus may include:

Fractures of bones, due to the powerful muscle spasms; and Death due to spasms of the muscles that control the airway, and or the tetanus toxins affecting the nerves of breathing, heart function, and the brain.

How do you prevent Tetanus?

Tetanus is prevented through vaccination with the tetanus vaccine. In the United States, Tetanus is rare due to its immunization program, and even then, most of all the cases of Tetanus result from lack of vaccination. Remember, the tetanus vaccine is included in the Tdap, DPT , and DT immunization combination, with the “T” for TETANUS.

Prevention is the most important aspect in managing Tetanus, because there is NO CURE FOR TETANUS, and therefore complications of tetanus can be life-threatening. Overall treatment focuses on symptom management, until the effects of the tetanus toxin resolve.

And with all that said, the reason that Tetanus is rare in developed countries like the United States “IS BECAUSE“ we ARE vaccinated against it.

So remember that when you hear about D P “T”, or

TdaP…thats “T”—D—a--P with the “T” being for TETANUS, you now know what it means and what it is, and what it can do, and WHY you need it!

According to the CDC, tetanus vaccines are recommended for people of all ages, with booster shots throughout life, every 10 years.

For nursing students or nurses..

If you were to encounter a patient with Tetanus, how would you care for them?

Nursing Interventions would include:

Obtaining and monitoring of vital signs every 2 hours. Assessing and auscultation of breath sounds

Maintaining a patent airway through positioning of the head, Removing excessive secretions via suctioning

Providing for safety

administering antipyretics and antibiotics as ordered, and encouraging fluids and nutrition.

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