Tetanus

A toxin-mediated infection due to the anaerobic bacteria Clostridium tetani and characterized by spasms and contractions of the skeletal muscles, the disease is often lethal.

Epidemiology

Tetanus has almost disappeared from countries where a vaccination policy is ensured and implemented. Annual incidence in developed countries is less than 1 / 1,000,000 inhabitants, and mainly affects patients over 70 years of age. The annual incidence is 100 to 200 times higher in the poorest countries. There are no international statistics on the number of adult cases. In 2015, the number of newborn deaths recorded was 34,000. In 2018 neonatal and maternal tetanus was eliminated in 14 of the 57 countries deemed to be at high risk.

Clinical description

Tetanus can occur at all ages. The first symptoms appear 4 to 20 days after a wound contamination and begin by a trismus. In a few hours or a few days (depending on the severity), these painful contractures will spread to the whole body; they can be accompanied by dysautonomics disorders. Death can occur from respiratory blockade.

Etiology

Tetanus caused by Clostridium Tetani, a bacterium found in almost all soils and animal droppings and present as spores. It enters the body through a contaminated wound, and produces a neurotropic toxin which gains, following the nervous axes, the neuromuscular junctions where it attaches, causing spasms and contractures of the striated muscles.

Diagnostic methods

Diagnosis is exclusively based on clinical signs.

Differential diagnosis

Differential diagnosis includes local causes of trismus, muscular dystonia induced by certain drugs, and much more rarely, meningitis or certain forms of hysteria.

Management and treatment

Treatment is symptomatic and aims to control contractures with large doses of muscle relaxant drugs or even prolonged curarization, until the toxin is removed, which often requires respiratory resuscitation. The only effective treatment is vaccination. It is 100% effective and there are almost no contraindications. In practice, a vaccine recipient (three injections and a booster after one year, followed by the scheduled booster) will never get tetanus. For injured individuals whose vaccination status is uncertain, the risk of tetanus is constant, and the systematic administration of specific gamma globulin necessary.

Prognosis

The prognosis is variable. The disease lasts from 2 to 4 weeks, the mortality varying between 20 and 80% depending on the severity of the disease, the age of the patient and the local possibilities of resuscitation.