Also referred to as lockjaw, tetanus is an acute exowxin-mediated infection caused by the anaerobic, spore-forming, gram-positive bacillus Clostridium cetani. The infection usually is systemic, but it may be localized.
Tetanus is entirely preventable by immunization but continues to be common in areas where soil is cultivated, in rural areas, in warm climates, during summer months, and among males. Neonates and me elderly are prominently involved. Because reporting is incomplete, the burden of illness is greater than statistics indicate. In the United States most cases follow injury, such as a puncture wound, laceration, or abrasion, and are often acquired outdoors.
Tetanus occurs worldwide, but it's more prevalent in agricultural regions and developing countries that lack mass immunization programs. It's one of the most common causes of neonatal deaths in developing countries.When C. tetani enters the body, it causes local infection and tissue necrosis. It also produces toxins mat enter the bloodstream and lymphatics and eventually spread to central nervous system tissue.
Transmission occurs through a puncture wound that is contaminated by soil, dust, or animal excreta containing C. tetani or by way of burns or minor wounds.
Signs and symptoms
Tetanus often begins with muscle spasms in the jaw and face, together with difficulty swallowing and stiffness or pain in muscles in the neck, shoulder, or back. The muscle spasms can be severe and can quickly spread to muscles of the abdomen, upper arms, and thighs.
The symptoms of tetanus usually appear anywhere from 3 to 14 days after the person has become infected.
Blood cultures and tetanus antibody tests commonly are negative; only one-third of patients have a positive wound culture. Cerebrospinal fluid pressure may increase above normal.
Treatment for tetanus may include:
The patient with tetanus also requires high-dose antibiotics - preferably penicillin administered I V. if he isn't allergic to it. If he is allergic to penicillin, tetracycline can be substituted.
Tetanus can be prevented with a vaccine. Children who are less than 7 years of age can receive DTaP vaccine - a combined vaccine against diphtheria, tetanus and pertussis (whooping cough). Teenagers and adults should receive booster doses of Td vaccine, a combined vaccine against tetanus and diphtheria every 10 years.
You can also help prevent tetanus by protecting the bottoms of your feet against deep or dirty wounds (such as being punctured by a rusty nail). You can do this by wearing thick-soled shoes or sandals instead of going barefoot, especially when outdoors.
Neonatal tetanus can be prevented by making sure that all pregnant women have proper immunization before delivery and by delivering their babies in sanitary conditions.
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