TETANUS - THE DISEASE

TETANUS - THE DISEASE

1. Information on Tetanus
   1. World Health Organization (simple) http://www.who.int/topics/tetanus/en/ 
   2. eMedicine Infectious Disease (detailed)http://emedicine.medscape.com/article/229594-overview 
   3. eMedicine Emergency Medicine (detailed)http://emedicine.medscape.com/article/786414-overview  
   4. Mayo Clinic (basic) http://www.mayoclinic.com/health/tetanus/DS00227 
   5. US Centers for Disease Controlhttp://www.cdc.gov/ncidod/diseases/submenus/sub_tetanus.htm 
2. What is tetanus (aka Lockjaw)? Tetanus is caused by the bacterium Clostridium tetani, the spores of which are widespread in the environment. The disease is caused by the action of a neurotoxin, produced by the bacteria when they grow in the absence of oxygen, e.g. in dirty wounds or in the umbilical cord if it is cut with a non-sterile instrument. The 4 clinical types of tetanus are generalized, local, cephalic, and neonatal.
3. How is it transmitted? How can it be prevented (without vaccination if possible)? The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores of the bacteria may produce a powerful toxin, tetanospasmin, which actively impairs your motor neurons, nerves that control your muscles. The source of infection usually is a wound (~65%), which often is minor (eg, wood or metal splinters, thorns). Chronic skin ulcers are the source in approximately 5% of cases, and in the remainder of cases, no obvious source is identified. (Note: Remember that tetanus only survives in an anaerobic environment so only a true puncture would that doesn’t bleed red is your most likely way to contract tetanus - not a bite wound from a dog’s well-oxygenated mouth or bleeding gash that is well cleaned). 
4. What are its symptoms? Tetanus is characterized by muscle spasms, initially in the jaw muscles. As the disease progresses, mild stimuli may trigger generalized tetanic seizure-like activity, which contributes to serious complications and eventually death unless supportive treatment is given. Symptoms usually begin 8 days after the infection, but onset may range from 3 days to 3 weeks.
5. How can it be treated? When must treatment start? Passive immunization with human tetanus immune globulin (TIG) shortens the course of tetanus and may lessen its severity. A dose of 500 U may be as effective as larger doses. Therapeutic TIG (3,000-6,000 units as 1 dose) has also been recommended for generalized tetanus. (Note: If you are concerned about contracting tetanus from a wound, TIG should be administered. Administration of the vaccine at the time of injury will not prevent tetanus should that injury cause it).
6. Is it a chronic or acute condition? How successful is treatment?