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Tetanus is a potentially fatal condition characterized by muscle spasms and other effects. It is commonly associated with infected cuts or puncture wounds caused by a tainted substance, but it may be detected, avoided, and handled to decrease its occurrence.
Tetanus, also known as lockjaw, is a very dangerous infection that was identified in 1889 by Kitasato, a Japanese researcher. Tetanus is caused by the bacterium Clostridium tetani, which damages the Central Nervous System (CNS). Infection of wounds and injections are the most likely routes of transmission to humans. The cuts or wounds become infected by the bacteria thus causing the disease. Clostridium tetani is found all over the globe in things like manure, soil, dust and the human intestines. The primary animals involved include herbivores, but every animal can be a carrier. The disease is mostly prevalent in warm climates as well as rural areas that are highly cultivated. It is worth noting that the causative organism can get in the body through even a very tiny scratch. However, puncture wounds and cuts that are deep such as those from knives or nails are the most vulnerable to tetanus infections. The infection causes muscle spasms that are very severe, thereby locking the jaws, and this is what makes the disease to be referred to as lockjaw. As a result, the patient becomes unable to open his or her mouth or swallow, and in some cases the disease may lead to death due to suffocation.
Signs and Symptoms of Tetanus Disease
The disease usually begins with insignificant spasms in the muscle of the jaws, which may also affect the muscle of the face to result in a risus sardonicus appearance. In addition, other muscles that might be affected include those of the buttocks, abdomen, back, neck and chest. Spasms in the back muscle cause opisthotonos. When the spasms affect the muscles associated with respiratory, the patient experiences problems in breathing (CDC, 2017). Tetany, a sudden, powerful as well as painful contraction of groups of muscle may result from prolonged muscular action, thereby causing muscle tears and fractures. In addition, there may be other symptoms associated with tetanus infection that include fever, excessive sweating, drooling foot spasm, suffocation, irregular heartbeat and defecation as well as urination that are uncontrolled (CDC, 2017).
Period of Incubation
The disease may incubate up to a period of many months. However, the usual incubation is ten days. The most important thing to note is that the close the site of injury is from the CNS, the shorter is the period of incubation of the disease. In turn, the severity of the symptoms increases in shorter incubation periods. It takes around 4 to 14 days following birth for symptoms to appear in neonates. Based on the clinical findings, four categories of tetanus have been identified, including generalized tetanus, neonatal tetanus, local tetanus and cephalic tetanus (CDC, 2017).
Causes of Tetanus Disease
The disease is caused by bacteria called Clostridium tetani, which is usually associated with objects that accumulate rust in outdoor places harboring bacteria that are anaerobic. It is important to note that the rough rusty surfaces of a metal offers a prime habitat for the endospores of the bacteria to live in because of its increased surface area, while an object like a nail provides a means to deliver the endospores within the body by puncturing the skin (Edmonds, 2014). Upon getting in an appropriate environment, the endospore starts to metabolize and causes the disease. If an individual steps on a nail, the tetanus infection may result because an anaerobic environment is made available by the oxidation of the object, thereby delivering endospores to grow in a suitable environment.
The disease affects the skeletal muscle that is utilized in voluntary movement but cannot affect the cardiac muscle due to its intrinsic electrical aspect. The toxins produced binds to the nerve terminals t the periphery and are transported to the CNS through the axon where it is then fixed to gangliosides before being taken up through endocytosis into the axons. The toxins blocks gamma-aminobutyric acid and glycine making it impossible to check the nerve impulses, thereby resulting to the muscular spasms.
Diagnosis of the Tetanus Disease
Clostridium tetani has only been demonstrated through the generation of tetanospasmin in mice, but presently, there is no diagnosis of the disease through blood tests in humans. However, Spatula test has been done where the posterior pharyngeal wall is touched to observe the effect. A test through spatula test is positive if there is involuntary jaw contraction characterized by biting the spatula (Apte & Karnad, 1995).
Prevention and Treatment
The prevention of tetanus disease is through tetanus toxoid vaccination (Centers for Disease Control and Prevention, 1991). All patients with a puncture and does not know about his or her vaccination status should be given a booster vaccine. Adults are usually advised to get a booster vaccine after every 10 years, while children below seven years get the tetanus vaccine as a combined vaccine together with diphtheria and pertussis. Treatments for mild tetanus include diazepam, metronidazole and tetanus immunoglobulin. Intensive care admissions are required for severe tetanus to allow for human tetanus immunoglobulin to be intrathecally administered (World Health Organization, 2010).
Tetanus disease is among the fatal infections that poses a public health concern. The disease is caused by Closridium tetani, which is an anaerobic bacterium that is found in various places, especially in rusty metals like nails. People should therefore, be knowledgeable about the diseases pathophysiology as well as the preventive measures and treatments to be at a position to manage the tetanus infections.
Apte, N. M., & Karnad, D. R. (1995). Short report: the spatula test: a simple bedside test to diagnose tetanus. The American journal of tropical medicine and hygiene, 53(4), 386-387.
CDC. (2017). Tetanus. Retrieved online on 29th April, 2017 from https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf
Centers for Disease Control and Prevention. (1991). Diphtheria, tetanus and pertussis: recommendations for vaccine use and other preventative measures. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR, 40, 1-28.
Edmonds, M. (2014). If You Step On A Rusty Nail, Will You Really Get Tetanus? Retrieved online on 29th April, 2017 from Http://Science.Howstuffworks.Com/Science-Vs-Myth/Everyday-Myths/Rusty-Nail-Tetanus1.Htm
World Health Organization. (2010). Current recommendations for treatment of tetanus during humanitarian emergencies. Current recommendations for treatment of tetanus during humanitarian emergencies.
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