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Tetanus is a serious and often fatal disease caused by the neurotoxin tetanospasmin which is produced by the Gram-positive, obligate anaerobic bacterium Clostridium tetani. Tetanus also refers to a state of muscle tension. more...

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It was first documented by Hippocrates, and records dating back to the 5th century BCE provide countless clinical observations of the disease. However, the etiology of the disease was not discovered until 1884 by Carle and Rattone. Passive tetanus immunization was first implemented during World War I.

Bacilli of C. tetani can be found in soil (especially agricultural soil), and the intestines and feces of horses, sheep, cattle, rats, dogs, cats, guinea pigs, and chickens. Spores are found in manure-treated soil, skin surfaces (of both animals and humans), under nail-beds, and in contaminated heroin.


There are four different clinical forms of tetanus: local (uncommon), cephalic (rare), generalized (most common), and neonatal (a common cause of infant mortality in underdeveloped countries). Generalized tetanus accounts for 80% of tetanus cases.


The incubation period for tetanus is 3 days to as long as 15 weeks (with the average being about 8 days) . For neonates, the incubation period is 4 to 14 days, with 7 days being the average. Most of the time, the further the wound is from the central nervous system, the longer the incubation period. Incubation period length and likelihood of death are inversely proportional; a deep, contaminated wound that allows the bacteria to flourish and causes a quick, aggressive infection is much more life-threatening than a shallower, less-contaminated wound that causes milder symptoms to appear days or weeks later.

The first sign of tetanus is a mild jaw muscle spasm called lockjaw (trismus), followed by stiffness of the neck and back, risus sardonicus, difficulty swallowing, and muscle rigidity in the abdomen. The stiffness and spasming of muscles expands throughout the body inferiorly, and can be so powerful that they cause muscle tears and even fractures. Typical signs of tetanus include an increase in body temperature by 2 to 4°C, diaphoresis (excessive sweating), an elevated blood pressure, and an episodic rapid heart rate. Spasms and muscle contraction last for 3 to 4 weeks, and complete recovery may take months. About 30% of tetanus victims die, most of whom are elderly patients. In developing countries, the mortality rate may be as high as sixty percent.

Complications of the disease include spasms of the larynx (vocal cords), accessory muscles (chest muscles used to aid in breathing), and the diaphragm (the primary breathing muscle); fractures of long bones secondary to violent muscle spasms; and hyperactivity of the autonomic nervous system.


The wound must be cleaned. Penicillin and metronidazole will help decrease the amount of bacteria but they have no effect on the toxin produced by the bacteria. Human anti-tetanospasmin immunoglobulin should be given. Diazepam and DTaP vaccine booster are also given.


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From Gale Encyclopedia of Medicine, 4/6/01 by Lori De Milto


Tetanus is a rare but often fatal disease that affects the central nervous system by causing painful muscular contractions. It begins when tetanus bacteria enter the body, usually through wounds or cuts exposed to contaminated soil. Tetanus is easily preventable through vaccination.


Tetanus is rare in the United States, with nearly all cases occurring in adults who were not vaccinated as children. About 100 cases are reported each year; 70% of these occur in people over the age of 50. Most of the people who die of tetanus infections (75%) are at least 60 years old.

Tetanus causes convulsive muscle spasms and rigidity that can lead to respiratory paralysis and death. It is sometimes called "lockjaw" because one of the most common symptoms is a stiff jaw, unable to be opened. Sometimes, tetanus affects only the part of the body where the infection began, but in almost all of reported cases, it spreads to the entire body. The incubation period from the time of the injury until the first symptoms appear ranges from 2-50 days. Symptoms usually occur within 5-10 days. When symptoms occur early, the chance of death is increased. Tetanus is not contagious.

Causes & symptoms

Tetanus is caused by a bacteria called Clostridium tetani where spores (the dormant form) are found in soil, street dust, and animal feces. Tetanus spores germinate in the body producing a highly poisonous toxin in the blood, spreading to the nervous system. The infection is usually transmitted through deep puncture wounds or cuts or scratches that are not cleaned well. Many people associate tetanus with rusty nails and other dirty objects, but any wound can be a source. Less common ways of getting tetanus are animal scratches and bites, surgical wounds, dental work, and theraputic abortion. Cases have also been reported in people with no known wound or medical condition.

The first symptom of tetanus is often a stiff or "locked" jaw which prevents the patient from opening his/her mouth or swallowing. This is also called trismus and results in a facial expression called a sardonic smile. Stiffness of the neck and other muscles throughout the body and uncontrollable spasms often follow. Sometimes these convulsions are severe enough to cause broken bones. The bacterial toxin (tetanospasmin) affects the nerve endings, causing a continous stimulation of muscles. Other symptoms include irritability, restlessness, loss of appetite, and drooling. People with tetanus that is localized experience pain and tingling only at the wound site and spasms in nearby muscles.

In the underdeveloped world, neonatal tetanus accounts for about one half of tetanus deaths and is related to infection of the umbilical stump in a baby born of an unimmunized mother.


Tetanus is diagnosed by the clinical symptoms and a medical history that shows no tetanus immunization. Early diagnosis and treatment is crucial to recovery from tetanus.


Tetanus is a life-threatening disease that requires immediate hospitalization, usually in an intensive care ward. Treatment can take several weeks and includes antibiotics to kill the bacteria and shots of antitoxin to neutralize the toxin. It also includes antianxiety drugs to control muscle spasms or barbiturates for sedation. In severe cases, patients are placed on an artificial respirator. Recovery can take six weeks or more. After recovery, since the levels of circulating toxin are quite low, the patient must still be adequately immunized against this disease.


Up to 30% of tetanus victims in the United States die. Early diagnosis and treatment improves the prognosis. Neonatal tetanus has a mortality rate of more than 90%.


Tetanus is easily preventable through vaccination. All children should have a series of five doses of DTaP, a combined vaccine which offers protection against diphtheria, tetanus, and pertussis, before the age of seven, according to the Centers for Disease Control and Prevention's national immunization guidelines, the Advisory Committee on Immunization Practices, the Committee on Infectious Diseases of the American Academy of Pediatrics, and the American Academy of Family Physicians. Children will not be admitted to school without proof of this and other immunizations.

The DTaP (Diptheria, Tetanus, accellular Pertussis) vaccine should be given at ages 2 months, 4 months, 6 months, 15-18 months, and 4-6 years. DTaP is the preferred vaccine for children up to the age of seven in the United States; it has fewer side effects than DTP and can be used to complete a vaccination schedule begun with DTP. DTaP was first approved by the Food and Drug Administration in September 1996. In December 1996, it was approved for use in infants. Between the ages of 11-13, children should have a booster for diphtheria and tetanus, called Td.

Adults should have a Td booster every 10 years. Statistics from the Centers for Disease Control and Prevention show that fewer than half of Americans 60 years of age and older have antibodies against tetanus. The Centers for Disease Control and Prevention suggests adults may be re-vaccinated at mid-decade birthdays (for example, 45, 55). Adults who have never been vaccinated against tetanus should get a series of three injections of Td over 6-12 months and then follow the 10-year booster shot schedule.

Side effects of the tetanus vaccine are minor: soreness, redness, or swelling at the site of the injection that appear anytime from a few hours to two days after the vaccination and go away in a day or two. Rare but serious side effects that require immediate treatment by a doctor are serious allergic reactions or deep, aching pain and muscle wasting in the upper arms. These symptoms could start from two days to four weeks after the shot and could continue for months.

Keeping wounds and scratches clean is important in preventing infection. Since this organism grows only in the absence of oxygen, the wounds must be adequately cleaned of dead tissue and foreign substances. Run cool water over the wound and wash it with a mild soap. Dry it with a clean cloth or sterile gauze. To help prevent infection, apply an antibiotic cream or ointment and cover the wound with a band-aid. The longer a wound takes to heal, the greater the chance of infection. If the wound doesn't heal or it is red, warm, drains, or swells, consult a doctor.

Following a wound, to produce rapid levels of circulating antibody, a doctor may administer a specific antitoxin (human tetanus immune globulin, TIG) if the individual does not have an adequate history of immunization. The antitoxin is given at the same sitting as a dose of vaccine but at separate sites. Some individuals will report a history of significant allergy to "tetanus shots." In most cases, this occurred in the remote past and was porbably due to the previous use of antitoxin devised from horse serum.

Key Terms

A genus of deadly bacteria that are responsible for tetanus and other serious diseases, including botulism and gangrene from war wounds. It thrives without oxygen.
Diphtheria and tetanus toxoids and accellular pertussis combination vaccine.
Diphtheria, tetanus, and whole-cell pertussis vaccine.
Tetanus and diptheria vaccine.
A poisonous substance that flows through the body.
Any injury that breaks the skin, including cuts, scratches, and puncture wounds.

Further Reading

For Your Information


  • "Have You Had Your Shots Yet?" Tufts University Health & Nutrition Newsletter (August 1997): 4.
  • Zamalu, Evelyn. "Adults Need Tetanus Shots, Too." FDA Consumer (July/August 1996): 14-18.


  • "Childhood Infections: Tetanus. "The Nemours Foundation of the duPont Hospital for Children and the Nemours Children's Clinic. (10 Dec 1997).
  • "Shots for Safety." National Institute on Aging Age Page. (7 December 1997).
  • "Taking Care of Cuts, Scrapes, and Minor Wounds: What Mom May Not Have Told You." Mayo Health O@sis @ (9 December 1997).
  • "Tetanus & Diphtheria (Td) Vaccine."Centers for Disease Control and Prevention. (10 December 1997).

Gale Encyclopedia of Medicine. Gale Research, 1999.

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