The bacteria lives in soil, dust, manure, and saliva, and typically enters the body through a cut or puncture by a contaminated object or an animal bite. Stepping on a rusty nail is a common means of contracting tetanus, though it is not the rust that causes infection. The tetanus bacteria is also common in contaminated heroin and is a danger to intravenous drug users.
Tetanus is called lockjaw due to the muscle spasms which typically begin in the jaw.
The incubation period can be up to several months, depending on how far the injury site is from the central nervous system.
Onset symptoms are lockjaw (trismus) and facial spasms called risus sardonicus (facial grin), followed by stiffness of the neck, difficulty swallowing, and rigidity of pectoral and calf muscles. Other symptoms include fever, sweating, headache, restlessness, irritability, breathing problems, burning sensation during urination, loss of bowel control, high blood pressure, and increased heart rate. The spasms continue for three or four weeks, and the individual spasms can last for several minutes. They can be severe enough to cause muscle tears and bone fractures. A common spasm is called opisthotonus (Greek for “tension behind”), “in which an individual’s head, neck and spinal column enter into a complete ‘bridging' or ‘arching.’” The painful contractions are called “tetany.” The spasms can also attack breathing muscles.
The tetanus infection is fatal in about 10% of cases.
The antitoxin serum for tetanus was developed by Emil von Behring and Shibasaburo Kitasato in 1890-92. A vaccine was developed in 1924 by P. Descombey. It was widely used in World War II to prevent tetanus induced by battle wounds.
Tetanus is still a killer among those who aren’t vaccinated and aren’t properly treated. In 2015, there were about 209,000 infections and 59,000 deaths globally, which was down from 356,000 in 1990 (“Global, regional, and national life expectancy,” 1980-2015, Lancet, Oct. 2016).
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