Tetanus is a very rare disease in the developed countries. However, in the 20th century it used to be a common infection that could easily kill any infected person. Even may grand-grandfather died because of tetanus in the 1950s.


The cause of tetanus is a bacterium known as Clostridium tetani. This bacterium is quite widespread. It lives in soil and it is also present in intestines of many animals. Therefore, the highest risk of infection is in people working in agriculture, gardening, etc. The bacteria enter our organism usually with minor skin injuries. Once they enter our body, they begin to produce a toxin, which is responsible for the tetanus symptoms. The toxin gets into the bloodstream and spreads throughout the body. When the toxin reaches the neurons, it irritates them and causes excessive activation of striated muscles including the breathing muscles.


The disease manifests with gradually worsening muscle contractions that are sometimes very painful. The first signs include the spasm and contraction of the jaw muscles, which is referred to as trismus, and contraction of mimic muscles giving a characteristic facial expression (risus sardonicus – sardonic smile). The muscle spasms spread to the majority of muscles and may completely immobilize the patient. The most feared is the spasm of breathing muscles, which causes suffocation with a fully preserved consciousness. The most severe stages include the so-called opisthotonus when the patient is spastically bent as a bow and touching the pad only with the toes and with the head.


The diagnosis can be stated from the symptoms. Any fresh skin wound underlines the suspicion. The clostridia can be found by microbiological examination of a swab from the wound and the toxin in blood may be confirmed as well.


The disease is extremely rare in countries with effective vaccination program. Interestingly, the common vaccines do not target the bacteria, but the toxin. The principle is easy – we use harmless modified toxin in inactive form (so-called toxoid), which allows our immune system to produce efficient antibodies. When we later face the real toxin, it is quickly destroyed before causing any harm.


The vaccination must be regularly repeated, in adults approximately once in ten years. When a person is wounded and does not know the date of the last vaccination, it is advisable to perform revaccination.


When the disease develops, it must be handled as a life-threatening situation. The patient may be treated by administration of produced antibodies against the toxin. This is a very expensive solution, but the patient’s life may depend on it. If there is any wound that allowed the bacterium to enter the body, it must be cleaned and antibiotics should be used as well. Severe cases require stabilization of the patient, sedation and artificial lung ventilation.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources