Tetanus is a serious bacterial infection that affects the body’s nervous system. It is primarily characterized by painful muscle spasms, especially in the neck and jaw area. It is a life-threatening health condition considering that it affects an individual’s ability to breath. However, the invention of the tetanus vaccine has meant that cases of tetanus have reduced not only in the United States but also the rest of the world. However, for those who have not been vaccinated, the disease remains a threat for them. The causative agent for tetanus includes a host of neurotoxins produced by Clostridium tetani. The term “lockjaw” is commonly associated with tetanus to denote the cardinal features associated with the disease, including painful spasms affecting the masseter muscles.
The disease is spread uniformly across the globe. The mortality rates are high in Africa, Asia, and South America as observed in the 2001 pandemic that led to the death of 282.000 people in these areas (Kyu et al., 2017). Neonatal tetanus remains a significant cause of death, especially in Asia and Africa. The increased universal vaccination of children especially in the resource-rich countries means that the prevalence of the infection has dramatically reduced since 1940. The Center for Disease Control and Prevention (CDC) between 2001 and 2008 reported a total of 233 incidences of tetanus in the United States. Although the annual incidence was at 0.10 cases per a million people, individuals of 65 years and above had an increased rate of 0.23 cases per a million people (Centers for Disease Control and Prevention). Tetanus is a potentially fatal bacterial infection associated with inadequate immunization and results in symptoms of pain in the muscles, especially in the head and neck region.
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Etiology and Risk Factors
The primary bacterium responsible for tetanus is known as Clostridium tetani. The bacteria can be found in manure, soil, and dust, among other areas. The pathogen infects humans by accessing the body through punctured wounds and cuts. The bacterium leads to the production of the tetanus toxins which affect the nervous system. Other conditions that could lead to infection with the bacteria include burn, animal bites, and non-sterile injections.
Risk factors associated with the disease include lack of immunization, presence of a punctured wound, burns, and an untreated necrotic tissue. According to the Center for Disease Control and Prevention, the risk of acquiring tetanus is higher in adults above the age of 65 years (Kyu et al., 2017). The disease can also be caused thanks to an incomplete tetanus immunization regime. Aseptic obstetric behaviors, especially in the care facilities, could also result in the disease. Cases of tetanus have also been reported in individuals with drug injecting habits. Any form of invasive injury is enough risk factor the disease.
Pathophysiology
Clostridium tetani is an active anaerobic bacterium. The bacterium releases tetanus toxins which enter the nervous system of the body through the lower motor neurons. The toxins travel upwards via the spinal cord to the brain stem. The symptoms that ensue are as a result of the toxins present in the nervous system. The toxins also interfere with the neurotransmitters, therefore, affecting the contracting of the body muscles. The effects of the tetanus toxins are described as structural and biochemical. The structural changes occur due to its impact on the striated muscle cells, which are responsible for voluntary movement. Biochemically, it affects the release of essential chemicals such as gamma-aminobutyric acid (GABA) and glycine (Hassel, 2013).
The bacteria move through a mechanism known as the retrograde axonal transport system where it accesses the spinal cord and the brainstem. The tetanus toxins enter adjacent inhibitory interneurons. At this level, the bacterial blocks the process of neurotransmission by interfering with the membrane proteins that facilitate the neuroexocytosis. Neurotransmission is thus inhibited especially that which controls muscle contraction and the anterior horn cells (Hassel, 2013). The disinhibition of the autonomic neurons and anterior horn cells lead to painful spasms, muscle tone, and autonomic instability.
Clinical Manifestations and Complications
The symptoms for tetanus affect the whole body. Common manifestations include nervous system dysfunction, increased blood pressure, and muscle spasms. Stiff muscles, especially at the facial and neck region, is a common happening. The person can also experience difficulty swallowing, neck stiffness, and drooling, among others. The complications associated with tetanus include breaking of bones, pulmonary embolism, and death (Hassel, 2013).
As regards the breakage of bone, the severity associated with the contraction of the muscles could result in stress leading to bone breaking. The muscles spasms could also cause the traveling of a blood clot from another region of the body, thereby blocking the main artery to the lung resulting in pulmonary embolism. Breathing difficulties associated with the tetanic spasms could lead to death. The lack of oxygen leads to incidents of cardiac arrest and death.
Diagnostics
Laboratory testing is not recommended for the diagnosis of tetanus. Doctors primarily rely on the physical examination of the patient. The main signs that the doctor will show interest in include painful spasms and muscle stiffness (Hassel, 2013). In some instances, laboratory tests might be required to rule out other health conditions associated with the muscles. Examples of these infections include meningitis and rabies. The immunization history of the patient will also help in the process of diagnosis. A lack of immunization means that the patient was at an increased risk of acquiring tetanus infection.
Other investigations to consider for tetanus include serum toxin and the actual detection of Clostridium tetani in the wound tissue. Once the bacteria are in the body, antitoxin bodies are released. As such, this provides another fundamental biological marker that could be exploited in the laboratory. The presence of these antibodies in the blood could point out to possible infection with the bacteria responsible for causing tetanus.
Conclusion
Tetanus is a potentially life-threatening disease that has serious public health implications. From the risk factors associated with it, each person has a responsibility of acquiring a complete tetanus vaccine. Caution should also be taken to avoid an unhealthy lifestyle such as injection under aseptic conditions. Treatment mainly relies on physical examination, but laboratory diagnoses are also acceptable especially in differentiating tetanus from other diseases with similar manifestations.
References
Centers for Disease Control and Prevention (CDC). Tetanus surveillance --- United States, 2001-2008. MMWR Morb Mortal Wkly Rep 2011; 60:365.
Hassel, B. (2013). Tetanus: pathophysiology, treatment, and the possibility of using botulinum toxin against tetanus-induced rigidity and spasms. Toxins, 5(1), 73-83.
Kyu, H. H., Mumford, J. E., Stanaway, J. D., Barber, R. M., Hancock, J. R., Vos, T., ... & Naghavi, M. (2017). Mortality from tetanus between 1990 and 2015: findings from the global burden of disease study 2015. BMC Public Health, 17(1), 179.
