Tetanus

Tetanus is caused by Clostridium tetani infection from spores found in the soil that penetrate in the organism through an open wound. Once in the organism, the spores produce the tetanus toxin that joins the neuromuscular junctions through the nerve axons and provokes spasms and contractions of the skeletal muscles.

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The differential diagnosis includes meningitis, encephalitis and rabies (see these terms), as well as peritonsillar abscess, medication (phenothiazine, metoclopramid)-induced dystonic reactions, subarachnoid hemorrhage, hypocalcemic tetany and acute strychnine poisoning.

Treatment is symptomatic and aims to control contractions with high doses of myorelaxant drugs or even prolonged curarization until elimination of the toxin. The only effective treatment is systematic vaccination. This vaccination is 100% effective and there are almost no counter indications. In practice, a vaccinated subject (three injections and one booster shot after one year, followed by booster shots at 10-year intervals) will never get tetanus. For wounded individuals with an uncertain vaccination status, systematic administration of specific gamma globulins prevents the disease. The risk of wound infection is constant.

Diagnosis is based on clinical signs.

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Annual incidence in developed countries is inferior to 1 per million inhabitants. The annual incidence is 200 times higher in the poorest countries and, according to estimates from the WHO in 2000, neonatal tetanus is the third most common cause of death in this age group (with more than 150,000 deaths worldwide in 2007). The number of adult cases of tetanus in these countries remains unknown.

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