Illnesses rarely seen in the US, vol 1: Tetanus

Tetanus is a nervous system disorder known since the days of antiquity as "lockjaw". It is caused by a bacteria (Clostridium tetani) that gains access to the body from traumatic injury or the use of dirty instruments to cut a newborn's umbilical cord.

Tetanus is very rare in the developed world due to widespread immunization programs- there are approximately 40 cases per year in the United States. Worldwide, however, there are about 1 million cases each year with about 250,000 deaths, especially in newborns.

When the causative bacteria gains entry through injured tissue, it produces a toxin that travels up nerves to the spinal cord and brainstem. The toxin then attaches irreversibly to nerve receptors leading to an imbalance in nerve transmission which results in widespread muscle spasm. Since this is an irreversible binding of toxin to nerve receptor, recovery depends on the growth of new nerve terminals which takes several weeks to occur.

After an injury, it takes anywheres from a few days to a month for the muscle spasms to develop. Typically seen are a stiff jaw, tense neck, a fixed smile ("risus sardonicus"), generalized body rigidity, and intermittent spasms.

Treatment involves:

1) cleaning of the wound to remove any residual bacteria

2) antibiotics (often penicillin) to kill any residual bacteria
3) tetanus antitoxin to neutralize any toxin that has not yet bound to nerves

4) large doses of muscle relaxants like valium to control spasms and provide relief to the patient

5) time - it may take several weeks for the situation to improve -patients are often kept in a "dark room" to minimize stimulation.

The outlook in tetanus is fairly good in developed countries where there are intensive care units and availability of ventilators to assist breathing, if needed. However, death rates as high as 50% are reported in developing countries.

We have seen several cases during our first 2
weeks in Niger. Pictured here is a 3 year old

girl with clear evidence of neck and jaw tenseness.

With the treatment outlined above, she is stable and we pray for her improvement soon !