Warning Signs Of Tetanus

Tetanus or more commonly known as lockjaw is a non-communicable disease caused by a bacteria called Clostridium tetani. This bacteria is commonly found in soil but it is also found in sawdust, saliva and animal feces.

Before we get into the signs of tetanus, we first need to know the risk factor of the conditions:

  • Failure to get vaccination:
    • Affected individuals failed to get treatment immediately after having massive open wound injury
    • Failure or refusal of vaccination in babies (DTaP vaccination) and in pregnant mothers (anti-tetanus toxoid)
  • Foreign body enters through the skin and later cause bacteria to enter the bloodstream such as splinters or ingrown nails

Once the bacteria enters the bloodstream, it will multiply first before symptoms and signs manifest. This process is known as the incubation period and takes about seven to ten days. Symptoms commonly appear within the first 14 days of initial infection. The earlier onset of the symptoms usually means the infection is more severe and has poor prognosis. The bacteria then produce a toxin which will affect the brain and nervous system. Once the toxin affects the nervous system, it can cause symptoms. Diagnosis of tetanus is clinical, which means it is based on detailed history and physical examination findings. So far there is no laboratory test that can confirm tetanus infection. Therefore, diagnosing tetanus needs to have a high index of suspicion.

Symptoms and signs of tetanus include:

  • Fever and sweating
  • Headache**
  • Sensitive to lights (photosensitive)**
  • Difficulty in swallowing and breathing; this can be seen when patient gasping for air and increase in salivation**
  • Seizure and possibly coma**
  • Painful muscle stiffness**
  • Stiffness of joints**; notable sites are jaw (lockjaw) and neck

** refers to the warning signs of tetanus and indicates the toxin is already present inside the nervous system. Failure to recognize these signs may lead to death and other possible complications.

Complications of tetanus can occur if the symptoms and signs are unable to be recognized early and this can cause:

  • Shock and possibility of multiorgan dysfunction syndrome (MODS)
  • Bone fractures due to severe muscle spasm
  • Respiratory failure due to spasm of the airway
  • Lung infection
  • Hospital acquired infection due to prolonged hospital stay
  • Death

Treatment of tetanus is directed at eliminating the bacteria and relieving the symptoms. Depending on the symptoms, the treatment may vary. In general, these are some of the treatment given in a patient with tetanus:

  • Antibiotics to eliminate the bacteria
  • Human tetanus immunoglobulin to eliminate the toxin produced by tetani
  • Immediate wound care and administration of anti-tetanus toxoid to provide immunity against tetani before it can multiply and produce toxin
  • Muscle relaxants to relieve muscle spasms

Other than that, tetanus is preventable. Here are some common practice and care that can be done to prevent tetanus:

  • Vaccine:
    • Pregnant mother and trauma patients: Anti-tetanus toxoid
    • Babies: Diphtheria-Tetanus-Pertussis (DTaP) vaccine
  • Wound care:
    • Always take care of the wound, clean it and do not leave it exposed
  • Hygiene:
    • Practice the correct steps of hand washing and always take care of the hand hygiene

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