Republic of the Philippines Founded 1907 RA 9299

NEGROS ORIENTAL STATE UNIVERSITY

Dumaguete, Bais, Guihulngan, Mabinay, Pamplona, Siaton and Bayawan-Sta. Catalina
COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

INTRODUCTION

Tetanus comes from the Greek word “tetanus” meaning taut and “teiteim” which means to stretch. It is also called lockjaw. It is a serious infectious disease of the nervous
system in which toxin causes severe muscle spasm. It is a medical condition characterized by a prolonged contraction of skeletal muscle fibers.

It is caused by a bacterium Clostridium tetani. Infection generally occurs through wound contamination and often involves a cut or deep punctured wound. Tetanus is often
associated with rust, but this concept is somewhat misleading. The C.Tetani is an Anaerobic bacteria which survives in an environment that lacks oxygen, thus with or without rust
a person may have a tetanus once C. Tetani enters the wound. Contaminated wounds are the site where tetanus bacteria multiply. Deep wounds or those with distallized tissue are
particularly prone to tetanus infection. The tetanus toxin affects the site of interaction between the nerve and the muscle that it stimulates, this region is called the neuromuscular
junction. The tetanus toxin amplifies the chemical signals from the nerve to the muscles to tighten up in a continuous contraction or spasm. This results in either localized or
generalized muscle spasm.

The incubation period ranges from 3 to 21 days, usually about 8 days. In general, the further the injury site is from the central nervous system, the longer the incubation period.
The shorter the incubation period, the higher the chance of death. In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days.

Tetanus may be categorized into the following 4 clinical types:

 Generalized tetanus
 Localized tetanus
 Cephalic tetanus
 Neonatal tetanus
 Republic of the Philippines Founded 1907 RA 9299

NEGROS ORIENTAL STATE UNIVERSITY

Dumaguete, Bais, Guihulngan, Mabinay, Pamplona, Siaton and Bayawan-Sta. Catalina
COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

Approximately 50-75% of patients with generalized tetanus present with trismus (“lockjaw”), which is the inability to open the mouth secondary to masseter muscle spasm.
Nuchal rigidity and dysphagia are also early complaints that cause risus sardonicus, the scornful smile of tetanus, resulting from facial muscle involvement.

As the disease progresses, patients have generalized muscle rigidity with intermittent reflex spasms in response to stimuli (eg, noise, touch). Tonic contractions cause
opisthotonos (ie, flexion and adduction of the arms, clenching of the fists, and extension of the lower extremities). During these episodes, patients have an intact sensorium and feel
severe pain. The spasms can cause fractures, tendon ruptures, and acute respiratory failure.

Patients with localized tetanus present with persistent rigidity in the muscle group close to the injury site. The muscular rigidity is caused by a dysfunction in the interneurons
that inhibit the alpha motor neurons of the affected muscles. No further central nervous system (CNS) involvement occurs in this form, and mortality is very low.

Cephalic tetanus is uncommon and usually occurs after head trauma or otitis media. Patients with this form present with cranial nerve (CN) palsies. The infection may be
localized or may become generalized.

Neonatal tetanus (tetanus neonatorum) is a major cause of infant mortality in underdeveloped countries but is rare in the United States. Infection results from umbilical cord
contamination during unsanitary delivery, coupled with a lack of maternal immunization. At the end of the first week of life, infected infants become irritable, feed poorly, and
develop rigidity with spasms. Neonatal tetanus has a very poor prognosis.

Although at present, tetanus is rare, it has not been eradicated, and early diagnosis and intervention are lifesaving. Prevention is the ultimate management strategy for tetanus.
It can be prevented by vaccination of tetanus toxoid. A booster is needed every 10 years after primary immunization.

In the Philippines, the incidence rate of tetanus is 12 out of 86, 241, 627.