October 25, 2024, 12:04 pm | Read time: 6 minutes

Tetanus is a life-threatening infectious disease. It is caused by certain bacteria that can enter the body through even minor injuries. As a result, severe cramps occur, which can also affect a person’s breathing and swallowing muscles. In the worst case, this can be fatal.

What is tetanus?

Tetanus (also known as lockjaw) is caused by an infection with the so-called “Clostridium tetani.” These bacteria are predominantly found in horse manure, as well as in soil and road dust. The bacteria are able to form spores, which makes them resistant to unfavorable conditions. “Clostridium tetani” is anaerobic, which means that it can only multiply without oxygen. The fact that the bacterium’s spores have the ability to survive for a long time makes the pathogen particularly dangerous.²

How do you get infected?

Superficial cuts, splinters, or other minor injuries can allow the spores to enter a person’s body. As soon as this happens, the bacteria release toxins, which can then spread to the spinal cord and brain. However, tetanus is not contagious and cannot be transmitted from person to person.³ It is also possible for the bacteria to be transmitted to humans through feces from other animals and animal bites.

Occurrence of the disease

Despite the availability of vaccines, tetanus remains a significant health problem in many parts of the world. This is particularly the case in low-income areas or regions with poor birth hygiene or low vaccination rates. For example, newborns can contract tetanus if the umbilical cord is cut at birth with non-sterile instruments. The World Health Organization (WHO) estimates that around 25,000 newborns died from tetanus worldwide in 2018.⁴

How widespread is tetanus in Germany?

Due to better living conditions and vaccinations, the disease rarely occurs in Germany. In 2019 and 2020, three people died from tetanus in Germany.⁵

What are the causes of tetanus?

The disease is not caused directly by the bacteria but only indirectly by the release of dangerous toxins. If the tetanus spores penetrate the wound, the bacteria multiply and produce toxins. These then enter the surrounding tissue.

The bacteria produce two main toxins:

• Tetano-lysine: It destroys red blood cells and can damage the heart.
• Tetano-spasmin: It can enter the central nervous system and inhibit nerve impulses, which are generally responsible for preventing excessive muscle contractions.

The inhibition of nerve impulses leads to prolonged and severe muscle spasms, a hallmark and dangerous feature of the disease. The cramps can be triggered by visual, acoustic, or tactile stimuli.

Incubation period

According to the Robert Koch Institute, the average incubation period (between the injury and the onset of symptoms) is usually three days to three weeks. However, it can also range from one day to several months.⁶

These symptoms are typical of tetanus

A typical symptom of tetanus is muscle rigidity with severe cramps. It is often the case that the entire musculature of the person is affected. Cramps can also occur in the affected person’s facial and chewing muscles. Possible consequences include difficulty swallowing and difficulty speaking.

Lockjaw and “devil’s grin”

This results in cramping of the tongue and jaw muscles. This causes those affected to appear as if they are grimacing by constantly smiling or raising their eyebrows. In this context, the term “devil’s grin” or “risus sardonicus°” is used. Additionally, individuals affected are unable to open their mouths, a condition known as trismus.

Hyperextension of the back

Besides facial cramps, individuals may also experience cramps in the back and abdominal muscles. In this case, those affected arch their backs, which can even lead to vertebral fractures.⁷

Other symptoms include

• Problems with breathing
• Irritability, restlessness
• Cramps in the limbs
• Increase in blood pressure
• Muscle stiffness and pain (in the neck and face)
• Palpitations
• Difficulty drinking in infants
• General symptoms of illness such as fever, headache, and chills

Course of the disease

If left untreated, tetanus is invariably fatal, as it leads to paralysis of the respiratory muscles and subsequent death. The first symptoms of the infectious disease usually appear three days to three weeks after infection. Additional signs of the disease may include numbness and tingling around the wound site. Restlessness, tiredness, and headaches can also be signs of tetanus.

As the disease progresses, severe and painful cramps occur in the affected person’s muscles and jaw area. In addition, cramps occur in the chest muscles and larynx, which are so severe that they can lead to death by suffocation.

Diagnosis of the disease

Tetanus is diagnosed on the basis of the symptoms. Muscle cramps or stiffening of the muscles after a wound injury are among the decisive signs. In rare cases, toxin detection is also used to confirm the diagnosis.⁸

Treatment of tetanus

As a rule, patients suffering from a tetanus infection are treated in the intensive care unit. The aim of tetanus treatment is to ensure the survival of those affected. This is achieved with the help of intensive care measures and by preventing the bacteria from multiplying. This can also stop the spread of toxins in the patient’s body.

Disinfection and treatment of the wound

In addition, the infected wound must be surgically treated quickly, and contaminated or even inflamed tissue must be removed. The affected person is then given medication (e.g., metronidazole) to combat the tetanus bacteria. However, it does not ensure that the toxins produced by the bacteria can be neutralized.

Antibodies

In order to eliminate the toxins that have not yet bound themselves to nerves, certain antibodies against the tetanus toxin (also known as tetanus immunoglobulin) are used and injected into the affected person’s muscle. However, if the toxin is already bound to the nerves, there is no way of removing it from the body.

Medication to relax the muscles

Instead, those affected are given medication to relax the muscles. The cardiovascular system and breathing must also be monitored. If the patient develops breathing problems, artificial respiration must be used. Even with intensive medical care, ten to twenty percent of those affected still die from a tetanus infection – mainly from heart and respiratory failure.⁹

Who is particularly at risk?

People who have burns, surgical wounds, or a history of intravenous drug use are particularly at risk of contracting tetanus. It is also possible that an infection can occur after birth – for example, in the mother in utero. Or in the newborn if unhygienic conditions prevail. People who have a weakened immune system or diabetes are also at greater risk of contracting tetanus.¹⁰

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Prevention of tetanus

Minimizing the risk of injury alone is not a reliable preventive measure. Vaccination, on the other hand, provides effective protection. It is administered in combination with other vaccines (e.g., against diphtheria or whooping cough). Vaccination is recommended at the age of two, four, and twelve months. After the basic immunization of the child, a booster every ten years is sufficient. It is also wise to regularly review the vaccination record to ensure that booster shots are not overlooked.¹¹