Tetanus, also called lockjaw, is a serious illness caused by tetanospasmin, a powerful nerve toxin produced by Clostridium tetani. The bacterium Clostridium tetani is an organism capable of living many years in the soil as a spore. Tetanus occurs when a wound becomes contaminated with bacterial spores. Infection follows when spores become active, multiply, and produce a very powerful poison that affects the muscles. Tetanus spores are found throughout the environment, usually in soil, dust, and animal waste (such as manure). Clostridium may enter the body through a deep cut, such as cuts acquired when stepping on a nail, from splinters, insect bites, burns, injection-drug sites, or puncturing the skin with a sharp object. Deep wounds or those with devitalized (dead) tissue are particularly prone to tetanus infection.
Tetanus is not transmitted from person to person. An individual usually becomes infected with tetanus when dirt enters a wound or cut.
The infection causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw, which makes it impossible to open the mouth or swallow. If this occurs, the individual may suffocate. Due to symptoms, tetanus is frequently a fatal infectious disease.
If an individual gets tetanus, there is usually a long course of treatment. Drugs that increase immunity to fight infection, and decrease muscle spasms are used. Tetanus is curable, but depending on the severity and number of symptoms up to 50% of individuals with tetanus may die. The tetanus vaccine is effective, but its protection does not last forever. Adults should get a tetanus shot, or booster, every 10 years.
There are four types of tetanus: generalized, local, cephalic, and neonatal. In generalized tetanus, all skeletal muscles can be affected. Generalized tetanus is the most common, as well as the most severe form of tetanus. Death is usually due to respiratory failure or disturbance of heart rhythm. Local tetanus causes muscle spasms at or near the wound that has been infected with the bacteria. Cephalic tetanus primarily affects one or more muscles in the face. No muscles elsewhere are involved, unless the disease progresses to generalized tetanus. Neonatal tetanus is a common and serious tetanus infection found in newborn babies. Most infants who get the disease die. Neonatal tetanus is particularly common in rural areas where most deliveries are at home without adequate sterile procedures. In 2000, WHO estimates that neonatal tetanus killed about 200,000 infants.
Before World War II, when the vaccine came into widespread use, about 600 cases of tetanus and 180 deaths were reported annually in the United States. Now there are about 70 cases per year and 15 deaths, most of them in elderly adults. Overall, the mortality rate is approximately 45%.
Worldwide, tetanus is predominantly a disease of underdeveloped countries located in warm, damp climates. In developing countries of Africa, Asia, and South America, tetanus is far more common. The annual worldwide incidence is between 300,000-500,000 cases.
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