Tetanus: A Nasty, Fascinating Bug, by Dr. Bob

Nearly everyone has heard of the famous “lockjaw”, but not everyone knows that the cause is tetanus infection.  Even fewer people have actually seen a case of tetanus, even in the medical circles it is a rare event in the U.S.  There are only 233 cases reported from 2001 to 2008–or 1/10,000,000.  Deaths are even more rare here in the States, and of those 233, 31 were fatalities.  Most deaths were people over 65, presumed to be less than optimally immunized.  

There has only been one reported infant case in the U.S. in that time period, and that was with a mom that was not immunized.  You may be getting the message here, but let me spell it out for you:  GET YOUR TETANUS SHOT!  All arguments against a tetanus vaccination are just noise. Keep it up to date and keep it current.  You need a shot every 10 years, and once it gets beyond six years if you a nervous prepper you should probably get it updated. So, let’s get into the details and weird, fun stuff about tetanus.  Tetanus infection is caused by Clostridium tetani bacteria, which lives in spore form in soil, dust, and animal feces.  The spores sit dormant in our environment waiting and hoping with their little spore minds for a dirty wound to get into.  They then transform (robot transformer noise inserted here) into the bacterium and start to grow.  The incubation period for tetanus spores can be from a single day to months later.  As they grow, they make this nasty tetanus toxin called tetanospasmin which messes with your motor neurons which control your muscles.  It is released when the bacterium are actually killed by time or your own immune system.  They actually get you when you kill them, how cool is that?  Very.  Anyway, the toxin then affects your nervous system and causes muscle spasms that look like this: , sweats, fever, rapid heart beat, high blood pressure, trouble swallowing and breathing due to the spasms it causes.  The most common and famous symptom is of course the painful spasm of your masseter muscles in your jaw, sometimes strong enough to bust your molars in half!  Ouch.

The good news is that tetanus will not grow in healthy tissue, it needs wounds, skin infections, dead tissue, or foreign bodies to invade.  Most often the types of things people get that can allow a tetanus infection to start are splinters, gun shot wounds, puncture wounds, crush injuries, open fractures, burns, animal bites, non-sterile injections, umbilical stump infections (infants), dental infections and even ear infections.  90% of tetanus infections can easily be traced to a wound or infection source, but 10% or so are more devious and are likely to start with a simple scratch or small crack in the skin.  Most tetanus infections tend to strike the elderly, diabetics, or IV drug addicts. WTSHTF one of these will be missing very quickly due to getting shot a lot or being cured by lack of supply. Diabetics will have an obvious change to their diets and lifestyles, and will need to be vigilant against wound infections.  Elderly folks can prevent being victims of tetanus by keeping their vaccinations up to date.

There are four types of tetanus infection to review.  The first is neonatal tetanus infection.  Babies don’t like dirt, at least at first.  They should be delivered in as clean an environment as possible and special care needs to be taken of their little umbilical stumps after the cord is cut.  Basically, an umbilical stump is an open wound, and it should be treated as such.  Non-immunized moms have given their babies risk of tetanus infections.  Don’t be one of those moms.  There are certain cultures that also do stupid things to the umbilical stump which increases the risk of tetanus infection.  Don’t rub weird stuff on an umbilical stump!  Your weird cultural practices of rubbing ghee, oil, juice, or whatever on the kids new shriveling cord needs to stop.  End of that story.  The bad thing is that babies tend to die more than adults from tetanus infection, usually from 10-60% of the neonatal infections are fatal.  Final messages about neonatal tetanus: Keep deliveries clean, umbilical stumps clean, and moms vaccinated.

Next types of tetanus infection are cephalic and local.  Usually caused by a head or neck wound, cephalic tetanus will usually progress to generalized tetanus like the local infection does.  Cephalic tetanus causes more of an immediate and local spasm due to the location of the wound.  The cranial nerves are usually affected; and besides the almost immediate lockjaw that occurs, there are lots of facial muscle spasms, neck muscle spasms, and swallowing troubles right off the bat with this type of tetanus.  Cephalic tetanus is really a local tetanus, which is the next type of tetanus to discuss.  Local tetanus, as already mentioned, usually progresses to the generalized type just like cephalic tetanus.  It can cause local symptoms of spasm at the site of the infection, and rarely the infection will stay localized to that area close to the wound.  Sometimes local tetanus will affect the abdominal muscles and confuse people.  It will not always be next to or close to the wound causing it, making it seem like the person may have appendicitis or another surgical problem in the abdomen instead of a tetanus infection.  This gets tricky to figure out, so for our discussion, let’s keep it simple and categorize this type as near the wound causing it.  Both these types of tetanus can, and usually do, progress to the generalized type of tetanus infection.

Generalized tetanus gives the symptoms that we have already reviewed.  Half of people get lockjaw, but the stiff neck, spasms, risus sardonicus (sardonic smile, think of The Joker in Dark Knight), rigid abdomen, apnea (irregular breathing) due to spasm of neck or chest muscles, and trouble swallowing.  Usually symptoms will last 4-6 weeks from their onset, due to the ongoing effect of the toxins released even after the bacteria are dead.  Treatment of generalized tetanus is best done in an ICU with anesthesia and IV medications. (Not likely in TEOTWAWKI.) 

Antibiotics are recommended for the treatment of tetanus, and there are lots of antibiotics that are helpful in killing the bacteria.  The best is metronizadole, which is recommended as the first-line treatment.  After that, Penicillin, Cephalexin and other Cephalosporins, Doxycyline and other Tetracyclins, Azithromycin and other Erythromycins, Vancomycin, and Chloramphenacol are all effective against tetanus.  One that is not is sulfamethoxazole (Bactrim), which is used in the treatment of MRSA and many wounds.  The best treatment choice available is having a treatment choice.  The wound also needs to be cleaned and dead tissue removed (debrided).  As you can start to recognize, tetanus treatment is a lot easier with vaccination to prevent the disease than it is after getting it.

So, in TEOTWAWKI, what do you really do with a person that is suspected to have a tetanus infection?  Well, with the fatality rate in adults ranging from 8-50%, prayer never hurts.  The interesting thing about tetanus symptoms:  they are triggered by loud noise, bright lights, and touch.  How spooky is that?  Placing a tetanus victim in a cool, dark, quiet place will help their symptoms and may help improve their survival.  While the fatality rate is high for non-immunized people and nearly zero for those immunized, even after our ten years runs out and there was no tetanus vaccine around, the immunity would continue to help survival and has shown to be a predictor in survival even after vaccination is older than ten years.  The other way to confirm the diagnosis is also pretty cool:  a spatula test.  Touch the back of their throat with a tongue depressor or Q-tip and usually you will trigger a gag reflex.  With a tetanus infection, touching the throat will cause the jaw to clamp down on the instrument and spasm.  So don’t use your finger!  The test is only really necessary when trying to decide between a tetanus infection you suspect or a possible dental infection causing a tight jaw.  As already mentioned, usually the wound plus symptoms equals tetanus.

Besides antibiotics, medications like diazepam (Valium), Baclofen, and Magnesium can help with the spasms if you have it.  Most likely you will not, so it’s back to the treating the person like and mushroom and then praying for them.  Don’t go the way of blues musician Joe Hill Louis, Henry David Thoreau’s brother, and Robert E. Lee’s favorite horse Traveller–all dying of tetanus.  Keep up with your vaccinations and get your kids vaccinated too against tetanus.  Kids start at two months of age getting a Tdap shot, don’t miss this chance to protect your child.

Stay strong and stay vaccinated against tetanus.

JWR Adds: Dr. Bob is is one of the few consulting physicians in the U.S. who dispenses antibiotics for disaster preparedness as part of his normal scope of practice. His web site is: SurvivingHealthy.com.