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Tetanus

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.

Types

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.

Symptoms

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.

Treatment

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.

Read more at Wikipedia.org


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Summer is approaching—have you had a tetanus shot?
From AORN Journal, 5/1/04

In preparing for gardening and Lawn-mowing season, have you gotten a tetanus shot? According to a March 26, 2004, news release from the National Foundation for Infectious Diseases, many people are unaware of the risk of contracting tetanus through dirt, potting soil and manure. A consumer survey conducted by the National Gardening Association shows that 40% of respondents did not have current tetanus vaccinations.

The childhood vaccine series for tetanus and diphtheria does not protect people throughout their Lives. One series does protect against both diseases, but a booster is required every 10 years. Tetanus can enter the body through any simple wound, and although it is rare in the United States, people can be exposed.

Of those surveyed, 57% did not know where tetanus comes from. Only 35% understood that tetanus can be contracted though animal and insect bites. Although 80% reported sustaining some type of injury that could result in tetanus while working around the home, 40% reported they did not have an up-to-date vaccination. Compared to children, older adults are at increased risk of contracting tetanus, a fact realized by only 14% of respondents. Survey respondents who Like to garden had higher immunization rates (ie, 60%) than the general population.

Tetanus can be difficult to diagnose, is complicated to treat, and can be fatal. Contracting the disease once does not render a person immune to future infections, which is why getting routine boosters is so important.

Many Unprotected Against Tetanus Risks From Home, Garden, and Yard Activities (news release, Washington, DC: National Foundation for Infectious Diseases, March 26, 2004) http://www.prnewswire.com (accessed 29 March 2004).

COPYRIGHT 2004 Association of Operating Room Nurses, Inc.
COPYRIGHT 2004 Gale Group

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