Tetanus is a vaccine preventable infection that is caused by the Clostridium tetani bacteria.
Unlike most other infections though, tetanus isn't contagious. Instead, spores of Clostridium tetani get into dirty wounds and then begin to grow into active bacteria.
The now "awake" Clostridium tetani bacteria then begin producing exotoxins that cause the symptoms of a tetanus infection.
Symptoms of Tetanus
Unvaccinated children can develop symptoms of tetanus two days to two months (average is two weeks) after getting a wound that is contaminated by tetanus bacteria. The most characteristic symptoms are painful muscle spasms that gradually get worse over a week, including:
- spasms of the muscles around their mouth, giving the typical "lockjaw" appearance of tetanus
- spasms of the muscles around the throat, which can make it hard to swallow
- spasms of the chest muscles, making it difficult to breath
- spasms of the muscles in the neck, back, arms, legs, and abdomen
Other associated symptoms can include fever, headache, irritability, tachycardia (high heart rate), urinary retention (secondary to bladder muscle spasm), low blood pressure or high blood pressure.
Diagnosis of Tetanus
Tetanus is usually diagnosed in someone with painful muscle spasms and history of a dirty wound.
It is important to keep in mind that your child is not only at risk for tetanus following the classic case of stepping on a rusty nail. Tetanus spores live in the soil and so almost any dirty wound can lead to tetanus infections. Although puncture wounds are the most common that lead to tetanus, scrapes, burns, dog bites, and even spider bites can also cause tetanus if the wounds becomes contaminated with dirt or feces.
Testing for the Clostridium tetani in the original wound is sometimes possible, but is not necessary for a diagnosis of tetanus, since it is technically difficult to too.
Treatments for Tetanus
The treatments for tetanus can include sedation and mechanical ventilation and:
- human tetanus immunoglobulin (TIG) to try and neutralize the tetanus toxin
- antibiotics, such as penicillin G, metronidazole, erythromycin, or tetracycline
- muscle relaxants, such as diazepam, magnesium sulfate, midazolam, and baclofen
- neuromuscular blocking agents, such as vecuronium and pancuronium, which cause paralysis
Tetanus Shot
Most importantly, like other vaccine preventable infections, keeping up-to-date on your child's immunizations will help to prevent your child from getting tetanus.
One thing that complicates tetanus is that your child may still need a tetanus shot even if he is up to date on his immunizations if it has been five or more years since his last tetanus shot and he has:
- a wound that is contaminated with dirt, feces, or saliva
- a puncture wound
- an avulsion wound, in which part of the wound is pulled away from the other part
- a wound caused by crush injury, burn, or frostbite
So if your child had a tetanus shot at age four (the DTaP vaccine kids get before starting kindergarten), then he may need a tetanus shot if he gets a dirty wound before he gets a tetanus booster when he is 11 or 12 years old (the Tdap vaccine).
What You Need To Know
- Tetanus is rare in the United States, but likely because so many kids get immunized with the DTaP and Tdap vaccines, which provide protection against the tetanus bacteria.
- Neonatal tetanus can occur in newborns if their mother isn't immunized against tetanus and their umbilical cord stump gets contaminated.
- See your pediatrician as soon as possible if your child needs a tetanus shot after getting a dirty wound.
Sources:
Tetanus. Weisberg SS - Dis Mon - October 2007; 53(10); 519-521
Long: Principles and Practice of Pediatric Infectious Diseases, 2nd ed.
Kliegman: Nelson Textbook of Pediatrics, 18th ed.
Gershon: Krugman's Infectious Diseases of Children, 11th ed.
