Tetanus

What Causes Tetanus?

A tetanus infection occurs when Clostridium tetani spores, often found in soil or animal feces, enter the body, usually through a wound, and develop into bacteria. Once a tetanus infection is established, the bacteria secrete a toxin that interferes with the transmission of nerve signals and the brain, resulting in painful muscle contractions and the inability to move certain muscles.

Tetanus bacteria can grow and reproduce more effectively when they get into the body through specific pathways, such as:

• Wounds that are contaminated with dirt, saliva, or feces
• Deep puncture wounds
• Burns
• Compound bone fractures

Although contaminated wounds are a common source of tetanus infection, the bacteria can enter the body in other ways, such as during surgical procedures or using hypodermic needles.

Is Tetanus Hereditary?

External environmental sources cause tetanus, and family history plays no part in developing an infection.

How Is Tetanus Detected?

Early detection of tetanus is essential because the infection may be fatal if treatment is delayed until symptoms are advanced. Symptoms usually begin about two weeks after exposure to the bacteria, although the incubation period can be between 3 and 21 days (or even longer).

Early symptoms of tetanus may include:

• Muscle spasms near the wound
• Painful spasms and stiffness in the jaw (“lockjaw”)
• Spasms and stiffness in the neck
• Problems swallowing
• Rigid abdominal muscles
• Fever
• Rapid heart rate

How Is Tetanus Diagnosed?

When your doctor suspects tetanus may be present, they may follow a diagnostic procedure that includes:

• Medical history questions. Your doctor will look for signs that you may be at increased risk for a tetanus infection, including possible sources of exposure.
• Physical exam. This exam will look for the characteristic muscular symptoms of a tetanus infection.

How Is Tetanus Treated?

No treatment will cure tetanus. Treatment of the infection involves drugs to prevent the spread of bacteria and toxins, control symptoms, and prevent complications. Emergency care is essential, and the patient will often be treated in a hospital’s intensive care unit.

The treatment procedure for tetanus commonly includes:

• The wound will be cleaned to remove bacteria, contaminants, and dead tissue.
• An antitoxin called human tetanus immunoglobulin (HTIG) will be administered. This treatment will neutralize toxins released by the bacteria that have not yet affected the nervous system. Toxins that have already bound to nerve cells won’t be affected by HTIG.
• Antibiotics such as metronidazole may be used to slow the progression of the infection.
• Sedatives such as diazepam may be used to control muscle spasms.
• Other drugs may be used to prevent respiratory and heart-related complications.
• Respiratory assistance (mechanical ventilation) may be required in some cases.

Most people who get prompt treatment survive, but recovery typically takes months. In some cases, certain symptoms (such as poor muscle tone) may linger for years.

How Does Tetanus Progress?

The time from exposure to the tetanus bacteria to the beginning of symptoms, the incubation period, typically ranges from 3-21 days but is usually about two weeks. In some cases, the bacteria may not cause a symptomatic infection for more than a month.

Muscular symptoms are the first to appear, followed by symptoms that affect the body’s autonomic (involuntary) functions, usually in the second week after symptoms begin. These autonomic symptoms may include:

• High or low blood pressure
• Rapid heart rate
• Fever
• Sweating

As the infection progresses, symptoms and complications may become severe and life-threatening. Complications can include:

• Respiratory difficulties caused by tightening vocal cords
• Pneumonia
• Broken bones and joint dislocations caused by muscle contractions
• Blood clots in the lungs
• Respiratory failure or heart failure
• Secondary infections

How Is Tetanus Prevented?

The most effective way to prevent a tetanus infection is to vaccinate against the bacteria and maintain an up-to-date vaccination status. That usually means getting a booster shot every ten years.

Regardless of your vaccination status, be sure to thoroughly clean all wounds, even minor ones, immediately. If you incur a wound contaminated with dirt or animal feces and you are unvaccinated, more than five years since your last booster, or can’t remember your last vaccination, consult your doctor.

If you experience any of the symptoms of tetanus, seek emergency medical care immediately.

Tetanus Caregiver Tips

If you are a caregiver for a loved one with tetanus, keep these tips in mind:

• Attend doctor appointments with your loved one so you can understand the diagnosis, the treatment plan, and the expectations for recovery.
• During recovery, provide a comfortable space for the sufferer free from noise, excessive stimulation, and stress.
• After treatment, work with your loved one’s medical providers to learn how you can best support them as they recuperate. Understand the goals of any long-term therapies, and be realistic about expectations.
• Call upon family and community to help out whenever possible. Don’t try to take sole responsibility for caregiving.

Tetanus Brain Science

When Clostridium tetani spores enter the body, they come to life (germinate) in areas with low oxygen content (such as in dead tissue in deep wounds). As the bacteria grows and reproduces, it releases a toxin called tetanospasmin into the bloodstream. Over the course of the infection, tetanospasmin has progressively more severe effects on the nervous system.

• The toxin enters the connection between muscles and the nerve cells, called motor neurons, that control muscle movements. The toxin interferes with the neurochemical process that usually inhibits muscle contractions, causing the muscles to contract and become rigid.
• Over time, the toxin travels through nerve cells to the central nervous system (the brain and spinal cord). There the toxin interferes with the release of specific chemicals called neurotransmitters. These chemicals, glycine and GABA, inhibit unwanted nerve signals between the brain and the body’s muscles. As the toxin limits the action of glycine and GABA, uncontrolled signals pass from the central nervous system to the muscles, resulting in spasms and contractions.
• By the second week after symptoms begin, the toxin has usually traveled to the brain stem, the part of the brain that controls involuntary functions such as heartbeat and blood pressure.

Tetanus Research

Title: Enhancing Anti–Tetanus Vaccine Response After Autologous Stem Cell Transplantation

Stage: Recruiting

Principal Investigator: Muhamed Baljevic, MD

University of Nebraska Medical Center

Omaha, NB

This pilot randomized Phase II trial (10 subjects per arm) will compare immune reconstitution following transplantation of an autologous mobilized graft product to reconstitution following transplantation of a mobilized graft product followed by an autologous lymphocyte infusion collected prior to G-CSF mobilization. All subjects will receive tetanus vaccines pre and post-transplant. The primary endpoint will be tetanus vaccine immune responses post-transplant.

Title: Comparing the Incidence of Preeclampsia Between Pregnant Women Receiving Tdap Vaccinations at Week 28 or Week 36

Stage: Not Yet Recruiting

Principal Investigator: Craig D. Scoville, MD, PhD

Institute of Arthritis Research

Idaho Falls, ID  

Preeclampsia is a significant medical condition occurring in 3-8% of pregnancies and impacts both maternal and fetal health deleteriously. Dr. Craig D. Scoville has made an important discovery, showing that early Tdap vaccinations in pregnancy can reduce the incidence of preeclampsia by more than 50%. A prospective clinical research trial is proposed and urgently needed to validate this finding and thereby significantly contribute to reducing the incidence of this common and severe pregnancy complication.

A double-blinded, randomized prospective clinical research study is proposed to validate the hypothesis that Tdap vaccinations at week 28 in pregnancy can reduce the incidence of preeclampsia by more than 50%. This project will recruit 1600 pregnant women with appropriate informed consent in the first trimester of pregnancy, obtain detailed obstetric and health history, and then randomize these subjects so 800 women receive Tdap at week 28 and 800 women receive Tdap at week 36. All women will be followed during their pregnancies using a standard of care with special attention to preeclampsia and fetal outcomes. Blood samples will be obtained at weeks 12, 20, and 36 to test the anti-tetanus toxoid antibody levels, anti-diptheria antibody levels, anti-pertussis antibody levels, and also maternal cytokines (IL-2, IL-4, IL-6, IL-10, TNFa, IL-17, and IFNg), and placental biomarkers (sFlt-1, sEng, and PIGF) for preeclampsia on those patients who develop preeclampsia and compare to those who didn’t and thereby better understand the biomarkers of preeclampsia and devise a better formula for positive prediction for preeclampsia. To make this change in clinical practice and save lives, this study is asking for funding from NICHD PA-18-480.

Title: A Phase II Randomized, Blinded, and Placebo-controlled Trial of CMV RNA-Pulsed Dendritic Cells With Tetanus-Diphtheria Toxoid Vaccine in Patients With Newly-Diagnosed Glioblastoma

Stage: Recruiting

Principal Investigator: Maryam Rahman, MD

University of Florida

Gainesville, FL

Dendritic cells (DC) are involved in activating, or turning on, your body’s immune system. Your immune system helps guard your body against germs, viruses, and other threats. Although dendritic cells are very strong, their number in the body is not high enough to cause a robust immune response; therefore, more DC are made in a laboratory with cells collected from an individual’s blood.

In this study, we will make a vaccine that we hope will educate immune cells to target the pp65 antigen, a type of immune marker in GBM, thus resulting in what we call the pp65 DC vaccine. The use of a vaccine that activates your immune system is a type of immunotherapy. It is hoped that by giving the pp65 DC vaccine as a shot under the skin, the immune system will be activated to attack tumor cells in the brain while leaving normal cells alone.

To see if the pp65 DC vaccine is effective for treating GBM, subjects will be assigned to different treatment groups. Two subject groups will receive the pp65 DC vaccine, and one group will receive a placebo.