Tetanus (tetanus)

Tetanus is an acute infectious disease with a severe course, which is triggered by the bacterium (Clostridium tetani).

The name tetanus is derived from the characteristic symptom, namely a cramp-like rigidity of the muscles. The muscle rigidity is initially localized only to the face before spreading to the whole body in later stages and can lead to death if left untreated.

Since most of the population is vaccinated against tetanus, this disease occurs very rarely nowadays. Even if a non-vaccinated person falls ill, the outbreak of the disease can be well prevented with a combination vaccination.

While tetanus has been almost completely eradicated in Europe and North America thanks to the mandatory vaccination, the WHO estimates that around one million people die every year worldwide.

A tetanus infection can occur as a result of an injury to the skin. Through the wound, the tetanus pathogens, which are found especially in the soil and in the feces of some animals, can penetrate the body and produce their toxin, which ultimately triggers the infection.

The danger of becoming infected with the bacteria exists above all with small foreign bodies, such as wood splinters, which remain in the tissue, or with large heavily soiled wound surfaces, torn wound edges and poorly supplied with blood tissue areas.

The typical muscle spasms are triggered by the tetanus toxin (tetanospamine) penetrating along the nerves to the brain or entering the brain via the bloodstream, where it inhibits certain areas of the brain.

The incubation period varies greatly and is usually between three days and 3 weeks. If the incubation period shortens, the prognosis usually worsens as well.

One of the typical symptoms of tetanus is the so-called lockjaw, in which the tongue and jaw muscles tense. As a result, the face is distorted into a grimace, which is expressed by constant smiling and raised eyebrows.

Other complaints include:

• Sore throat
• difficulty swallowing
• Restlessness, irritability
• Stiff neck and cramped arms or legs
• headache, fever, chills, and cramps
• rapid heartbeat (tachycardia), increase in blood pressure, increased sweating
• The cramps can be triggered by touch or visual and touch stimuli

In the course of the disease, further cramps occur in the area of the back and abdominal muscles. If spasms of the bladder and intestinal muscles occur, there is constipation or urinary retention. Later, there is an inability to speak or cry.

Death occurs when there is spasm of the respiratory muscles. However, if intensive medical measures are taken in time, the mortality rate of tetanus is 10-20%, while it is much higher if untreated.

The diagnosis is made on the basis of the typical clinical findings. Thus, it can be assumed that muscle stiffness or cramps as a result of a wound injury are strongly suggestive of a diagnosis of tetanus.

Another diagnostic option is a test that detects the toxin of the tetanus bacteria in wound material or blood serum. However, this test is not always conclusive.

If a complete basic immunisation and a booster vaccination are available, a tetanus disease is very unlikely. However, there is still a slight risk with increasing age, as the number of antibodies directed against the tetanus toxin decreases.

For the proper treatment of tetanus are 3 rules:

• The site of entry must be identified and the wound edges must be excised.
• Neutralize the tetanus toxin and immunize the patient.
• The existing symptoms must be treated

Cutting out the wound is essential, especially in the case of deep injuries, as dirt and dead tissue promote the multiplication of tetanus bacteria. Some antibiotics can be used to help, but they are no substitute for cutting out the wound.

As the tetanus toxin circulates in the body after infection, antibodies (immunoglobulins) directed against the tetanus toxin must be injected into the buttock muscles and the wound edges.

Furthermore, it is important to keep the airways open and to treat the muscle spasms with medication, since the spasm of the facial and laryngeal muscles can lead to impaired ventilation. Artificial respiration may be necessary. Since the disease does not produce immunity, a complete tetanus immunization (=vaccination) is particularly important.

Thanks to vaccination and modern intensive medical treatment, the tetanus mortality rate is 10 to 20%. Death usually occurs as a result of respiratory problems caused by tetanus.

In Germany, only 15 cases of tetanus have been recorded in recent years, the majority of which were elderly people. Before 1970, there were far more than 100 cases per year.

To exclude a tetanus disease, one should be vaccinated in any case. Infants and toddlers are usually given the basic immunization as a combination vaccination against other diseases. After the basic immunization, a booster must be given every 10 years. If you have forgotten the date of the last tetanus vaccination, your doctor can perform a tetanus vaccination titer test to determine whether there are enough antibodies circulating in your blood.

For people over 60 years of age, it is particularly important to keep up with the vaccination, because with increasing age, antibodies are increasingly broken down, which increases the likelihood of a tetanus disease.