Summary
Tetanus is an infectious disease due the anaerobic bacterium Clostridium Tetani and characterized by spasms and contractions of the skeletal muscles. Annual incidence in developed countries is inferior to 1 per million inhabitants. The annual incidence is 200 times higher in the poorest countries and, according to estimates of the WHO in 2.000, neonatal tetanus would be the third cause of deaths of this age (e.g. more than 150,000 in the world in 2007). The number of adult cases of tetanus in these countries remains unspecified. Symptoms appear 4 to 20 days after wound contamination with a trismus and a risus sardonicus. Depending on the severity of the disease, these painful contractions can, in a few days or even hours, spread to the whole body. Death can follow due to respiratory failure. Tetanus is due to Clostridium Tetani spores found in the soil and able to penetrate in the organism through an open wound. Once in the organism, the spores produce the tetanus toxin that joins the neuromuscular junctions through the nerve axons and provokes spasms and contractions of the skeletal muscles. Diagnosis is based on clinical signs. The differential diagnosis include meningitis, encephalitis, peritonsillar abscess, rabies, medication (phenothiazin, metoclopramid)-induced dystonic reactions (see these terms), subarachnoidal hemorrhage, hypocalcemic tetany and acute strychnine poisoning. Treatment is symptomatic and aims to control contractions with high doses of myorelaxant drugs or even prolonged curarization until elimination of the toxin. The only effective treatment is correct vaccination of all humans. This vaccination is 100% efficient; there is almost no counter indication. In practice, a vaccinated subject (3 injections and one booster shot after one year followed by 10-year interval booster shots) will never get tetanus. For a wounded person with an uncertain vaccination status, systematic administration of specific gamma globulins allows to prevent the disease. The risk of infection of a wound, even slight, is constant. Prognosis is variable. The disease lasts 2 to 4 weeks, with a mortality varying between 20 and 80% depending on the gravity, age, and the local possibilities of reanimation. *Author: Dr F. Trémolières (August 2009)*.
