Tetanus

Tetanus is a rare, acute infectious disease caused by the toxin-producing bacterium Clostridium tetani. The organism is common in soil and animal feces and can enter the body through contaminated wounds. The illness is not spread from person to person.

Tetanospasmin, the toxin produced by C. tetani, blocks inhibitory neurotransmitters in the spinal cord and brainstem, leading to unregulated motor neuron activity and muscle stiffness and spasms.

Clinical features include trismus (lockjaw), jaw and neck stiffness, painful muscle contractions, risus sardonicus, abdominal rigidity, and generalized painful spasms that can be triggered by minor stimuli. Autonomic instability may occur.

Diagnosis is clinical; laboratory tests support but are not definitive.

Treatment involves immediate wound cleaning and debridement; antibiotics such as metronidazole; tetanus immune globulin to neutralize unbound toxin; vaccination status considered; supportive care in an intensive care unit; muscle relaxants; sedation; and management of autonomic dysfunction as needed.

Prevention rests on vaccination with tetanus toxoid-containing vaccines (DTaP, Tdap, Td). A primary series is given in childhood, with booster doses typically every 10 years or after a potentially dirty wound. Vaccination of pregnant women helps prevent neonatal tetanus, and proper wound care is essential for all individuals.

Epidemiology shows a substantial decline in high-income countries, but tetanus remains a concern in resource-limited settings. Neonatal tetanus has been largely eliminated in many regions through maternal vaccination and improved hygiene.

Prognosis varies with age, wound severity, and access to care; prompt treatment improves outcomes, but tetanus can be life-threatening, especially in severe cases.