Locking in on tetanus

Posted on 4 July 2017

Tetanus is an infection caused by the Clostridium tetani bacteria, which are found in soil, dust, manure and saliva. The bacteria can enter the body through a puncture wound to the skin, such as a deep cut or bite.

Once in the system, the poisonous bacteria multiply and produce a neurotoxin that causes irritation of the nerves, leading to progressive and unrelenting spasms, cramps and muscle seizures. As the condition progresses, the muscles become unable to relax. Spasms in the jaw muscles produce lockjaw – called klem-in-die-kaak in Afrikaans. Progressively, patients become unable to eat, swallow and, eventually, breathe. Without proper treatment, sufferers can die of suffocation.

Tetanus, while rare, is a medical emergency, and sufferers need urgent treatment in a hospital.

Contrary to popular belief, stepping on a rusty nail will not cause tetanus – except if the nail is dirty and has the tetanus bacteria on it. It is the dirt on the nail, not the rust, that carries the risk of tetanus.

Prevention

Tetanus infection is preventable by vaccination, and is usually part of routine childhood immunisation. Anyone who has not been vaccinated against tetanus is vulnerable to contracting the disease – from the newborn to the elderly.

Dr Chris de Muelenaere, a specialist in family medicine at Mediclinic Muelmed, says all newborns should be immunised, usually as part of the newborn immunisation schedule. He also recommends that people be vaccinated against tetanus every 10 years, particularly if they are outdoors a great deal.

‘Anyone uncertain of their vaccination status should get a booster vaccination dose after an injury contracted out in the open, like on a road, in the garden, on a farm, or from a dog bite. If the person knows they’ve had a booster shot within the previous five years, it is not necessary,’ says Dr de Muelenaere.

In South Africa, booster shots are available at any clinic that provides vaccinations to babies, at all emergency rooms, and at most medical practices. Many pharmacies also stock the vaccine. If not immediately available, having the shot the following day will still be an effective preventative measure.

Importantly, says Dr de Muelenaere, the vaccine must be stored under refrigerated conditions at all times.

Treatment

Tetanus is treatable, but only in a hospital that has ventilator facilities. Symptoms start between three to 21 days after being infected with the bacteria.

‘There might be fever, and sepsis in the wound, but that is not how it kills someone. The patient will feel progressively unwell, experience stiffness, muscle spasms, rigidity, difficulty swallowing, eating and drinking, and with time, experience an inability to breathe,’ Dr de Muelenaere explains.

Don’t confuse rabies with tetanus

While one of the ways of contracting tetanus is from bites or scratches by animals, rabies can only be caused that way. Rabies is a virus (as opposed to an infection caused by a bacteria, as with tetanus) transmitted from a contaminated animal. Rabies spreads to the brain and causes progressive brain damage and destruction, leading to severely erratic behaviour. It is unrelenting and, unlike tetanus, is usually fatal, even when treated in intensive care.