Cost of tetanus in the United States.

A 6 year old boy in Oregon was hospitalized with tetanus. It took 57 days and over $800,000 for him to regain his health and go home!

This blog post will discuss who is at risk of this painful disease; what tetanus is; how to prevent it; how someone gets it; and how it is treated.

What is tetanus?

  • Tetanus is also known as lockjaw.
    • Often, the patient first shows spasms of the jaw muscles.
      • The jaw cramps up, or locks in place…
        • hence the name lockjaw.
    • Soon, the patient is unable to even open his mouth and
      • has trouble swallowing and breathing.

Additional symptoms of tetanus include

  • sudden muscle spasms in the stomach
    • board-like rigid abdomen
  • painful tightening of muscles all over the body
    • these spasms may be triggered by
      • loud noises, light, or physical contact
  • seizures
  • involuntary jerking (i.e. you have no control over it)
  • headache
  • fever
  • sweating
  • changes in blood pressure and heart rate 

Having difficulty breathing can even cause death.

Tetanus is a vaccine-preventable disease.

What causes tetanus?

  • Infection from a bacterium called Clostridium tetani causes tetanus.
    • These bacteria typically hang out in our environment.
      • When the environment gets harsh,
        • these bacteria change into tough, hardy forms
          • that can resist harshness,
            • such as lack of nutrients, dryness etc.
        • These hardy forms are called spores.

When these spores get inside damaged human tissue,

  • the spores change back into their original form
    • a form that allows the bacteria to produce the tetanus toxin (poison),
      • which causes the damage seen in tetanus.

How do these spores enter the body and cause tetanus?

Spores enter via skin broken by

  • nails
  • thorns
  • wood splinters
  • metal splinters
  • i.v. drug use
  • chronic skin ulcers and wounds
  • surgery
  • dental infections
  • burns
  • accidents
  • insect bites
  • fractures (that exposes the bone)

Other risk factors include

  • diabetes, and
  • history of immunosuppression

Diagnosis is based on clinical symptoms.

Symptoms overlap with those of strychnine poisoning (caused by ingestion of rat poison).

  • Therefore, lab tests have to rule out strychnine poisoning.

How do you treat tetanus?

  • Patients are admitted to the ICU.
    • immediately treated with human tetanus immune globulin (HTIG)
      • shortens the course of tetanus and
        • may also reduce severity of illness
    • HTIG is important in
      • immediately preventing tetanus toxin (a poison created by Clostridium tetani bacteria)
        • from binding irreversibly to tissues.
    • patients are also given metronidazole (brand name Flagyl)
      • now considered the antibiotic of choice for tetanus
  • supportive therapy aka symptom based treatment, is important in tetanus patients
    • controls symptoms
  • If patient has a wound that got infected with spores of Clostridium tetani, or
    • if patients falls into
      • a certain risk category
        • Look at section above on ‘How do these spores enter the body and cause tetanus?’
      • DEBRIDE (clean) the wound to REMOVE ALL SPORES and DEAD TISSUE 
      • if tetanus vaccine status on a patient with a certain type of wound (Look at section above on ‘How do these spores enter the body and cause tetanus?’) is UNKNOWN and 
        • patient hasn’t developed tetanus yet,
          • give the tetanus vaccine as a preventive measure
        • IF the patient’s records show less than 3 tetanus vaccine doses given,
          • give the tetanus vaccine as a preventive measure

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