Tag: wounds

Tetanus and Tetanus Shots

Tetanus is a vaccine-preventable disease that is caused by the Clostridium tetani bacteria.

Can an unvaccinated child really get tetanus after a toe nail injury?
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)

Unlike most other infections though, tetanus isn’t contagious. Instead, spores of Clostridium tetani get into dirty wounds and then begin to grow into active bacteria.

The now “awake” Clostridium tetani bacteria then begin producing exotoxins that cause the symptoms of a tetanus infection.

In the pre-vaccine era, there were about 500 to 600 cases of tetanus in the US each year and about 165 deaths.

Fortunately, tetanus is rare now, as most folks are vaccinated, but we do see some cases in kids who are intentionally not vaccinated or in seniors who haven’t gotten a tetanus booster in a long while.

The unvaccinated child with the toe nail injury?

“A 4-year-old Caucasian boy presented with a one-week history of general malaise, mild fever, indolence and anorexia. He subsequently developed dysphagia, sialorrhoea, difficulties opening the mouth and eventually dehydration… Together with the lack of immunization and a toe nail infection, this lead to the suspicion of a generalized tetanus infection… The frequency and severity of paroxysmal muscle spasms increased progressively during his PICU stay, despite high doses of sedatives. Not before two weeks after admittance, extubation and careful weaning off sedatives was achieved.”

Generalized tetanus in a 4-year old boy presenting with dysphagia and trismus: a case report

He was unvaccinated “based on religious grounds” and had recently injured his toe, resulting “in a small local hematoma and loose toenail.” It also resulted in his getting tetanus and a 30 day stay in the hospital.

What Are the Symptoms of Tetanus?

Unvaccinated children can develop symptoms of tetanus two days to two months (average incubation period is two weeks) after getting a wound that is contaminated by tetanus spores.

“It was hideous. He was spasming every three minutes. He was biting his tongue and bleeding. His arms were spasming and he was arching his back and his whole face and jaw was completely locked.”

Linda Williams on her unvaccinated 7-year-old son’s bout of tetanus

The most characteristic symptoms are painful muscle spasms that gradually get worse over a week, including:

  • spasms of the muscles around their mouth, giving the typical “lockjaw” appearance of tetanus
  • spasms of the muscles around the throat, which can make it hard to swallow
  • spasms of the chest muscles, making it difficult to breath
  • spasms of the muscles in the neck, back, arms, legs, and abdomen

Other associated symptoms can include fever, headache, irritability, tachycardia (high heart rate), urinary retention (secondary to bladder muscle spasm), low blood pressure or high blood pressure.

How Do You Diagnose Tetanus?

Tetanus is usually diagnosed in someone with painful muscle spasms and history of a dirty wound.

It is important to keep in mind that your child is not only at risk for tetanus following the classic case of stepping on a rusty nail – a classic myth about tetanus.

Tetanus spores live in the soil and so almost any dirty wound can lead to tetanus infections. Although puncture wounds are the most common that lead to tetanus, scrapes, burns, snake bites, dog bites, and even spider bites can also cause tetanus if the wounds becomes contaminated with dirt or feces.

Testing for the Clostridium tetani in the original wound is sometimes possible, but is not necessary for a diagnosis of tetanus, since it is technically difficult to do.

Neonatal tetanus can occur in newborns if their mother isn’t immunized against tetanus and their umbilical cord stump gets contaminated.

How Do You Treat Tetanus?

The treatments for tetanus can include sedation and mechanical ventilation and:

  • human tetanus immunoglobulin (TIG) to try and neutralize the tetanus toxin
  • antibiotics, such as penicillin G, metronidazole, erythromycin, or tetracycline
  • muscle relaxants, such as diazepam, magnesium sulfate, midazolam, and baclofen
  • neuromuscular blocking agents, such as vecuronium and pancuronium, which cause paralysis

If you have ever read a story about a child who has needed treatment for tetanus, you will likely opt for a tetanus shot instead.

Do I Need a Tetanus Shot?

Like other vaccine-preventable diseases, keeping up-to-date on your child’s immunizations can help to prevent your child from ever getting tetanus.

One thing that complicates tetanus is that your child may still need a tetanus shot, even if they are fully vaccinated, if it has been five or more years since his last tetanus shot and he has:

  • a wound that is contaminated with dirt, feces, or saliva
  • a puncture wound
  • an avulsion wound, in which part of the wound is pulled away from the other part
  • a wound caused by crush injury, burn, or frostbite

So if your child had a tetanus shot at age four (the DTaP vaccine kids get before starting kindergarten), then he may need a tetanus shot if he gets a dirty wound before he gets a tetanus booster when he is 11 or 12 years old (the Tdap vaccine).

And yes, a tetanus shot will work in these situations, even if you have already been exposed to the tetanus spores. But no, letting a wound bleed a lot won’t flush out the spores. These are other myths about tetanus and tetanus shots that you might hear.

What to Know About Tetanus and Tetanus Shots

See your pediatrician as soon as possible if your child needs a tetanus shot after getting a dirty wound.

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