tetanus

and Christiane Fux, medical editor

Marian Grosser studied human medicine in Munich. In addition, the doctor, who was interested in many things, dared to make some exciting detours: studying philosophy and art history, working on the radio and, finally, also for a Netdoctor.

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Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Tetanus is a dangerous bacterial infectious disease. Infection occurs through contaminated wounds. Even the smallest injuries can be enough. The poison of the bacteria causes excruciating and long-lasting muscle spasms. If left untreated, tetanus is fatal. Many patients die even under intensive care. That is why vaccination is important for everyone. Read here how to contract tetanus, what symptoms it causes and what to do.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. A34A33Z27A35

Brief overview

Description: bacterial infection, bacterial toxins cause severe muscle cramps, if left untreated, fatal outcome due to respiratory paralysis
Symptoms: blocked mouth, "devil grin", swallowing disorders, larynx paralysis, irritability, restlessness, extreme cramping of the trunk muscles, overstretched back up to vertebral fracture, respiratory paralysis
Causes: Infection with Clostridium tetani even over the smallest wounds, spores in the soil or animal droppings, increases in places where there is a lack of oxygen (therefore superficial wounds are less dangerous than deeper ones)
Diagnostics: typical symptoms after injury, evidence of the bacterium in the serum
Treatment: cutting out the edges of the wound, administering antibodies, intensive medical treatment with oxygen supply, ventilation if necessary
Prognosis: if left untreated, it is almost always fatal, with intensive care treatment a death rate of up to 20 percent

Tetanus: description

Tetanus is caused by infection with the bacterium Clostridium tetani. The spores of the bacterium are found in the feces of animals, especially horses, and mainly in the soil. The spores are very resistant and can survive for a long time without a host. They only multiply in an anaerobic environment, i.e. in the absence of oxygen.

They get into the human body through minor injuries. Their poison then also travels to the brain and spinal cord. Often a small cut or splinter in the skin is enough for the infection. The transmission from person to person is not possible in tetanus, so sick people are not contagious.

This is how you get infected with tetanus

Tetanus is caused by bacteria that can survive in the earth for a long time. The bacteria enter the body through the smallest of wounds and multiply there.

Tetanus: This happens in the body

The bacteria produce two toxins:

One, tetanolysin, destroys red blood cells and may also damage the heart.

The second toxin that the bacteria produce is tetanospasmin. It travels along the nerves and eventually reaches the central nervous system. The poison inhibits nerve impulses that normally prevent excessive muscle contractions. If this inhibiting control instance fails, the nerves are severely overexcitable. The result is strong, long-lasting, excruciating muscle cramps that are typical of tetanus.

Tetanus: incubation period

The time span between infection and the appearance of the first symptoms (incubation period) is very different in tetanus. In the case of rapid courses, the first signs of the disease appear after a few days, in other cases it takes up to three weeks. Even cases in which symptoms took months to develop have been described. If the incubation period is very short, many pathogens may have entered the body at the same time. The disease is then particularly difficult.

Tetanus: symptoms

Tetanus manifests itself primarily in strong, persistent muscle cramps. In principle, these can affect any part of the muscle. It is typical that acoustic and visual stimuli as well as touch stimuli can trigger the cramps.

Mouth gag and devil grin

A typical symptom of generalized tetanus is blocked mouth. The tongue and jaw muscles cramp, which leads to a grimace: constant "smile" and raised eyebrows, one also speaks of the "devil's grin". In addition, patients cannot open their mouths wide.

Swallowing disorders and paralyzed larynx

If the muscles in the throat and larynx are affected, the patient has difficulty swallowing. In extreme cases, patients can neither speak nor scream.

Arched back

In addition, strong cramps develop in the back and abdominal muscles. Those affected extend their backs arched. In extreme cases such forces arise that even vertebral bodies break.

Other signs of tetanus include:

Pain and muscle stiffness, especially in the neck and face
Increase in blood pressure
sweat
Restlessness, irritability
Racing heart (tachycardia)
Cramps in the limbs
Breathing problems
Infants who suffer from neonatal tetanus also show pronounced drinking weakness.
General symptoms of illness such as headache, fever, shivering.These can occur in the run-up to the cramps, but they often do not occur.

If left untreated, tetanus is dramatic. The patients ultimately die from paralysis of the respiratory muscles. They remain fully conscious until they die, which makes the suffering particularly excruciating.

Different forms of tetanus

Doctors distinguish four forms of tetanus:

The generalized form: This leads to the classic appearance of the disease with strong cramps all over the body.
The local form: Here the symptoms (such as muscle stiffness) are mostly limited to the limb where the pathogen's entry point is located. This is more often the case if there is still some residual vaccination protection.
The cephalic tetanus: In this special form, the infected wound is on the head. Since the nerve paths to the brain are short here, the incubation time is also short.
Neonatal tetanus: Neonatal tetanus only affects newborns. Infants from unvaccinated mothers become ill. The infection often occurs due to poor hygiene during or after the birth, with the pathogens usually entering via the navel. This form of tetanus is the most common worldwide and occurs primarily in countries with poor hygiene standards and poor medical care.

Tetanus: causes and risk factors

The bacterium Clostridium tetani only reproduces under anaerobic conditions, i.e. only where no oxygen can reach.

A superficial wound with a slightly larger area is better ventilated than a deep cut or stab with a pointed object. Such a wound is therefore less dangerous. A seemingly harmless injury while working in the garden, on the other hand, such as a sting on a thorn, can be an ideal entry point for the tetanus pathogen.

In addition, the pathogen feels very comfortable in tissue that has already died, because here, too, there is an anaerobic environment. Such dead (necrotic) tissue is more common in larger wounds, especially if they are not adequately treated with surgery.

Risk factor skin diseases

In addition, diseases of the skin surface, such as overt eczema, can also promote tetanus infection.

Age as a risk factor

Older people are more likely to develop tetanus. In them, the antibodies that their body has formed after a vaccination often break down faster than in younger people. You will therefore need booster vaccinations at shorter intervals. If this does not happen, they are less well protected.

Older people often have poor blood circulation, for example due to vascular diseases or diabetes. In the event of an injury, the wound is also less well supplied with blood and therefore less well supplied with oxygen. As a result, it is easier for the anaerobic bacteria to multiply.

Tetanus: examinations and diagnosis

The doctor makes the diagnosis of tetanus based on the typical clinical findings: If muscle stiffness or spasms occur as a result of a wound injury, the diagnosis of tetanus is usually clear. For further diagnostics, tests are available with which the poison of the tetanus bacteria can be detected in the wound material or in the blood serum (neutralization test). However, these are not always meaningful.

Tetanus: treatment

There are three basic rules for treating tetanus:

Identification of the entry portal and cutting out the wound edges (wound debridement)
Neutralization of the tetanus poison and immunization
Supportive measures against the symptoms

The wound is carefully cut out immediately. This is especially important with deep wounds. Some antibiotics, especially metronidazole, are effective against the tetanus pathogen, but are not a substitute for thorough wound cleaning. In addition, they cannot reduce the toxins already produced. The toxins act in the body for up to twelve weeks. That is how long it takes for the symptoms to go away for good. An improvement usually occurs after four to eight weeks.

Inject antibodies:

To neutralize the circulating tetanus venom, antibodies (immunoglobulins) that are directed against the tetanus venom are instead injected into the gluteal muscles and the edges of the wound.

Keep airways open

Since the facial and larynx muscles cramp in tetanus, the airways must be kept open in a targeted manner. The sick person receives oxygen through a nasogastric tube. Artificial ventilation on a ventilator is also often required. The muscle spasms are treated with special drugs called muscle relaxants.

Dark and calm

Sometimes it helps to move the patient to a darkened and noiseless room. So he is sealed off from external stimuli that could trigger further convulsions.

Tetanus vaccination

The Standing Vaccination Commission (STIKO) recommends tetanus vaccination for people of all ages. Primary vaccination already takes place in infants and should be completed before the first birthday. This is followed by refresher courses at ages 5-6 and 9-16. Refreshing every ten years from the last immunization is recommended.

The vaccination is not directed against the bacteria themselves, but against the toxins that they produce. With a weakened dose of poison, the immune system is set on the toxins. It then produces antibodies against them.

The number of antibodies that are formed is decisive for the effectiveness of the vaccination. This can be measured using the so-called titer.

Thanks to extensive vaccinations, only around 15 tetanus cases are now recorded in Germany each year. Most of them meet adults over the age of 60.

You can find out what to look out for when getting a vaccination against tetanus in the article Tetanus vaccination.

Tetanus: disease course and prognosis

Tetanus should not be underestimated. The tetanus symptoms are not only associated with considerable pain for those affected, but also lead to death if left untreated.

However, since intensive medical therapy is usually started in good time, this can usually be prevented. After about four weeks the symptoms will gradually go away, and after another four weeks they will go away completely. Occasionally, consequential damage remains that require further treatment.

Tetanus does not induce immunity, which means that the person can get the same infection again. A complete immunization (= vaccination) and regular booster vaccinations against tetanus are therefore important.