✔ REPORTABLE DISEASE
ICD-9: 037
Description
Tetanus is an acute, life-threatening infectious disease characterized by persistent, painful contractions of skeletal muscles. The disease may affect any person at any time, but children are at greater risk because of their tendency to develop skin wounds as a result of play activities. Tetanus is acquired from the environment; it is not transmitted person to person.
Etiology
The disease is caused by Clostridium tetani, a bacterium commonly found in soil. The bacillus becomes pathogenic when its spores enter the body through a puncture wound. Burns, surgical incisions, and chronic skin ulcers may also provide opportunities for C. tetani spores to enter the body, as may generalized conditions, such as otitis media and dental infections. The spores produce a powerful toxin that attacks the central nervous system and that also acts directly on voluntary muscles to produce contraction.
Signs and Symptoms
The onset of symptoms may be either gradual or abrupt. Stiffness of the jaw, esophageal muscles, and some neck muscles is often the first sign of the disease. Later, in the most common manifestation of tetanus, the jaws become rigidly fixed (lockjaw), the voice is altered, and the facial muscles contract, contorting the individual’s face into a grimace. Finally, the muscles of the back and the extremities may become rigid, or the individual may experience extremely severe convulsive spasms of muscles. This final phase of the disease often is accompanied by high fever, profuse sweating, tachycardia, dysphagia, and intense pain.
Diagnostic Procedures
Tetanus is diagnosed on the basis of its classic symptomatology.
Treatment
The site of the wound or the point of infection must be thoroughly cleaned and debrided. Antibiotics to kill the bacteria are administered. Human tetanus immune globulin (TIG) often is administered. Muscle relaxants may be prescribed. Meticulous care and support are required to maintain adequate nutrition and hydration and to avoid the development of decubitus ulcers. Tracheostomy is routinely performed in moderate to severe cases of tetanus to prevent choking.
Complementary Therapy
No significant complementary therapy is indicated.
CLIENT COMMUNICATION
The disease process can be frightening; however, education about the disease helps alleviate anxiety and fears. It is important to follow clients carefully and watch for any complications. Special attention should be given to ensure a proper diet and ample fluids.
Prognosis
The disease usually runs its course in about 6 to 7 weeks, seldom producing any lasting disability. However, despite effective treatment measures, tetanus is frequently fatal, especially among unimmunized people, most often in developing countries. Death may result from asphyxiation, a host of possible complications, and sometimes from sheer exhaustion.
Prevention
Surprisingly enough, having tetanus does not confer future immunity to the disease. Immunization with DTaP should be routinely started at 3 months of age. Boosters are required periodically throughout life. The risk of contracting tetanus also can be minimized by wearing protective clothing and by prompt cleansing and care of wounds and other skin lesions.
