Stivkrampe

Stivkrampe, also known as tetanus, is an acute, toxin-mediated disease caused by the neurotoxin tetanospasmin produced by the bacterium Clostridium tetani. The toxin disrupts inhibitory neurotransmission in the central nervous system, leading to unopposed motor neuron activity, muscle rigidity, and painful spasms.

Transmission occurs when C. tetani spores enter a wound, particularly deep or contaminated wounds. Spores are common in soil, dust, and animal feces. The disease is not contagious from person to person.

Clinical features typically begin with stiffness of the jaw and neck (lockjaw), progressing to generalized muscle rigidity, painful spasms, and back arching. Autonomic disturbances such as fluctuations in blood pressure and heart rate may occur. Severe cases can compromise respiration and require intensive supportive care.

Diagnosis is primarily clinical, based on history of wound exposure and characteristic symptoms. Laboratory tests support the diagnosis but are not definitive.

Treatment aims to remove the source of toxin, neutralize circulating toxin, control spasms, and provide supportive care. This includes wound debridement, antibiotics such as metronidazole, administration of tetanus immune globulin to neutralize unbound toxin, and vaccination if the immunization status is incomplete. Sedation and muscle relaxation (often with benzodiazepines) and respiratory support may be necessary in severe cases.

Prevention relies on vaccination with tetanus toxoid as part of routine immunization (DTaP for children, Tdap for older individuals) and regular boosters every 10 years. Proper wound cleaning and assessment of vaccination status are essential, especially for high-risk injuries. Neonatal tetanus remains a significant concern in settings with limited vaccination coverage.