Stelkramp

Stelkramp, the Dutch term for tetanus, is a potentially life‑threatening infectious disease caused by the neurotoxin tetanospasmin produced by the bacterium Clostridium tetani. The disease is characterized by generalized muscle stiffness and painful spasms, often beginning with involuntary jaw clenching and neck stiffness, and can progress to widespread rigidity and respiratory compromise.

The spores of C. tetani are common in soil, dust, and animal feces. Infection occurs when spores enter the body through a wound and the local environment becomes anaerobic, allowing toxin production. The illness is not contagious from person to person.

Tetanospasmin disrupts inhibitory neurotransmission in the central nervous system, leading to unregulated motor activity and sustained muscle contraction. Clinical features typically include trismus (lockjaw), stiffness of the neck and abdomen, and painful muscular spasms that can be triggered by minor stimuli. Severe cases may involve opisthotonos, autonomic instability, and respiratory failure.

Diagnosis is primarily clinical, based on history of wound exposure and characteristic signs. Laboratory tests are not diagnostic but can assist in ruling out other conditions. Prompt recognition is important to initiate treatment and prevent complications.

Prevention centers on vaccination with tetanus toxoid, usually given in childhood vaccines with boosters every 10 years. In the event of dirty or uncertain wounds, non‑immune individuals may require tetanus immunoglobulin and a booster dose.

Treatment involves wound debridement when needed, antibiotics such as metronidazole or penicillin G, and supportive care. Spasms are controlled with sedatives or benzodiazepines; airway management may be necessary. After recovery, patients should complete vaccination to restore protection. Global tetanus remains rare in high‑income regions but persists in areas with limited vaccination coverage.