Tetanus: What you need to know.

Clinton was an 8-year-old boy, very intelligent with the rest of his life in front of him. Like any other child his age, he was very playful. One day while playing, Clinton stepped on a nail hanging out of a piece of wood in the yard, injuring his left foot. Unbeknownst to his parents, this nail had also injured one of the bones in the foot. Thinking it was ‘just a wound’, his parents took him to a traditional healer who applied some herbal potions on the wound and used others to massage the injured foot every couple of days. The wound initially looked to be healing but, after one week, Clinton’s foot began to swell and he had difficulty walking. Later, the wound started discharging pus, yet the parents kept on taking him the traditional healer.

Two weeks later, his parents noticed he could not open his mouth. He had difficulty feeding and swallowing. His body would also become stiff especially when there was much noise. At this time, the colour of his foot had changed; it looked dark and smelly. What was going on with their son?

His parents had had enough. They decided to seek medical advice. However, with the recent socio-political upheavals, they had to wait a few more days to have a safe means of transport. On arrival at the hospital, Clinton was in respiratory distress. His muscles were so stiff he could barely breathe. The wound on his foot was discharging pus. The foot itself looked necrotic. He was diagnosed with tetanus (and a septic fracture of his foot). Despite the treatment at the emergency room, Clinton unfortunately passed away a couple of hours later.

What is Tetanus?

Tetanus is an infectious, yet non-communicable, disease acquired through exposure of a wound or cut to the spores of the bacterium, Clostridium difficile. These spores are found in the environment worldwide, especially in the soil, animal intestinal tracts and on surfaces of rusty tools like nails and needles. These spores are very resistant to heat and can survive in harsh environments for long.

Once the spores enter the body, they release a toxin which travels through the nerves until it reaches the brain where it causes continuous stimulation of the nerve cells.

Over the last few decades, the incidence has significantly reduced, but tetanus remains an important public health problem in many parts of the world especially in low-income countries. Tetanus is estimated to cause about 200,000 deaths worldwide, mostly in new-born babies and young children.

Who is affected?

Tetanus can affect people of all ages but new-born babies and pregnant women who have not been vaccinated are at greatest risk.

How does tetanus present?

On average it takes 7 – 21 days for symptoms to appear once the spores enter the wound. It can be as short as 2 days and as long as 50 days depending on the distance of the wound from the brain. Often there’s history of injury with a rusted instrument or application of cow dung on the umbilicus of a new-born baby. Some of the most common symptoms include

• Lockjaw (inability to open the mouth)
• Muscle spasms often in the back, abdomen and extremities; often triggered by noise, light or touch
• Difficulty swallowing
• Headache
• Difficulty breathing

How is tetanus treated?

Treatment involves supportive care (especially respiratory support), cleaning of the wound, tetanus antitoxin, antibiotics and drugs to control the spasms.

Even with adequate treatment, mortality can be as high as 60% depending on the severity of the disease.

How can tetanus be prevented?

Tetanus can be prevented through immunization with tetanus-toxoid containing vaccines. To be protected throughout life, the World Health Organization (WHO) recommends that an individual receives 6 doses of vaccine as follows:

• 3-dose primary series with tetanus-diphtheria containing vaccines: From as early as 6 weeks of age, and given every 4 months
• 3 booster doses: Given in the second year of life (12-23 months), at 4-7 years and at 9-15 years of age.

Maternal and neonatal tetanus be prevented by immunizing (5-dose series) women of childbearing age either during pregnancy or outside of pregnancy. Additionally, healthy practices to emphasize are clean practices when a woman is delivering, care of the umbilical cord, and proper wound care for surgical and dental procedures.

Any questions or comments? Drop them in the comments section below.

Author: Oryn Yong, MD

Clinton était un garçon assez intelligent. Du haut de ses 8 ans, il aimait bien courir les pieds nus. Un jour alors qu’il était dans les bois, il marcha sur un vieux clou. La blessure qui en résulta avait l’air si banale que ses parents l’emmenèrent chez un tradipraticien qui appliqua des potions. Une semaine plus tard, le pied de Clinton enflait, et une substance semblable à du pus s’écoulait de sa plaie. Le tradipraticien continua cependant d’utiliser ses potions. L’état de Clinton ne s’améliorait pas. Il n’arrivait plus à ouvrir la bouche, ni à s’alimenter. Son corps raidissait, surtout lorsqu’il y’avait du bruit, et son pied noircissait de plus en plus. L’odeur était insoutenable. Qu’arrivait-il à Clinton ?

Face à cette image des plus insupportables de leur fils, les parents décidèrent finalement de le conduire à l’hôpital, chose qu’ils ne purent faire que quelques jours plus tard. A son arrivée, Clinton avait extrêmement du mal à respirer, ceci dû à la raideur des muscles de sa poitrine. L’écoulement de pus persistait, et son pied avait l’air d’être dépourvu de vie. Le diagnostic de tétanos fut posé, associé à une fracture septique des os du pied. Les médecins firent tout ce qui était en leur pouvoir, mais Clinton ne survécut pas.

Qu’est-ce que le tétanos ?

Le tétanos est une maladie infectieuse, mais non contagieuse, contractée par le contact d’une plaie ou d’une coupure avec les spores de la bactérie Clostridium difficile. Ces spores sont présentes dans l’environnement, en particulier dans le sol, les matières fécales des animaux, et sur des outils rouillés.

Le tétanos reste un problème de santé publique important, en particulier dans les pays sous- développés. Il est responsable d’environ 200,000 décès dans le monde, principalement chez les nouveau-nés et les enfants.

Qui peut être infecté ?

Le tétanos peut toucher des personnes de tout âge, mais les nouveau-nés et les femmes enceintes non vaccinées sont les plus exposés.

Comment se présente le tétanos ?

Les symptômes les plus courants incluent

-trismus (incapacité à ouvrir la bouche)

-Spasmes musculaires souvent déclenchés par le bruit, la lumière ou le toucher.

-Difficulté à avaler

-Maux de tête

-Difficulté à respirer

Comment traite-on le tétanos ?

Le traitement comprend une prise en charge des symptômes (en particulier respiratoires), des soins de la plaie, l’immunoglobuline antitétanique, des antibiotiques et des médicaments pour contrôler les spasmes.

Même avec un traitement adéquat, la mortalité peut atteindre jusqu’à 60% selon la gravité de la maladie.

Comment prévenir le tétanos ?

Le tétanos peut être prévenu par la vaccination.  L’organisation mondiale de la santé (l’OMS) recommande 6 doses de vaccin, comme suit :

– Une première série de 3 doses données aux bébés respectivement à 6, 10 et 14 semaines

-3 doses de rappel : à 2ans (12-23 mois), entre 4 à 7 ans et entre 9 à 15 ans.

Le tétanos maternel et néonatal peut être prévenu en vaccinant les femmes en âge de procréer (5 doses) pendant ou en dehors de la grossesse.

Translation : Ines Kwawa, MD