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==Overview==
==Overview==
Tetanus can have an incubation period of 2 to 38 days with the man being 7 to days post exposure. The presentation and progression may vary depending on the type tetanus. Generalized tetanus can involve the respiratory muscles making it difficult to breathe. The complications of tetanus include [[fracture]]s, [[laryngospasm]], aspiration [[pneumonia]] and [[pulmonary embolism]].Tetanus has a fatality rate of almost 11%. The fatality rate of tetanus might be associated with prolonged  [[convulsions]] and [[contractions]].<ref name="pmid25149223">{{cite journal| author=Thwaites CL, Beeching NJ, Newton CR| title=Maternal and neonatal tetanus. | journal=Lancet | year= 2015 | volume= 385 | issue= 9965 | pages= 362-70 | pmid=25149223 | doi=10.1016/S0140-6736(14)60236-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25149223  }} </ref>
Tetanus can have an incubation period of 2 to 38 days. The presentation and progression may vary depending on the type of tetanus. Generalized tetanus can involve the diaphragm making it difficult to breathe. The complications of tetanus include respiratory arrest, [[fracture]]s, [[laryngospasm]], aspiration [[pneumonia]] and [[pulmonary embolism]]. Tetanus has a case fatality rate of approximately 11%. The fatality rate of tetanus is associated with prolonged  [[convulsions]] and [[contractions]]. Tetanus without [[spasm]]s has an excellent prognosis. Early diagnosis is associated with a good prognosis.<ref name="pmid25149223">{{cite journal| author=Thwaites CL, Beeching NJ, Newton CR| title=Maternal and neonatal tetanus. | journal=Lancet | year= 2015 | volume= 385 | issue= 9965 | pages= 362-70 | pmid=25149223 | doi=10.1016/S0140-6736(14)60236-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25149223  }} </ref><ref>{{Cite journal
| author = [[J. C. Patel]] & [[B. C. Mehta]]
| title = Tetanus: study of 8,697 cases
| journal = [[Indian journal of medical sciences]]
| volume = 53
| issue = 9
| pages = 393–401
| year = 1999
| month = September
| pmid = 10710833
}}</ref>


==Natural History==
==Natural History==
Tetanus can have an incubation period of 2 to 38 days with the man being 7 to days post exposure. Patients with generalized type can have spasmodic contractions of the muscles associated with inability to breathe an thus [[apnea]] develops. This can lead to the death of the individual if not addressed immediately.<ref name="pmid25149223">{{cite journal| author=Thwaites CL, Beeching NJ, Newton CR| title=Maternal and neonatal tetanus. | journal=Lancet | year= 2015 | volume= 385 | issue= 9965 | pages= 362-70 | pmid=25149223 | doi=10.1016/S0140-6736(14)60236-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25149223  }} </ref><ref name="urlTetanus | Symptoms and Complications | Lockjaw | CDC">{{cite web |url=https://www.cdc.gov/tetanus/about/symptoms-complications.html |title=Tetanus &#124; Symptoms and Complications &#124; Lockjaw &#124; CDC |format= |work= |accessdate=}}</ref>
Tetanus can have an incubation period of 2 to 38 days. Initial presentation involves neck and jaw stiffness. Spasms are common in the first week and may persist for up to 3 weeks, followed by rigidity that can persist for 4-8 weeks. Patients with the generalized type can have spasmodic contractions of the muscles associated with inability to breathe which may lead to [[apnea]]. If left untreated this can lead to the death.<ref name="pmid25149223">{{cite journal| author=Thwaites CL, Beeching NJ, Newton CR| title=Maternal and neonatal tetanus. | journal=Lancet | year= 2015 | volume= 385 | issue= 9965 | pages= 362-70 | pmid=25149223 | doi=10.1016/S0140-6736(14)60236-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25149223  }} </ref><ref name="urlTetanus | Symptoms and Complications | Lockjaw | CDC">{{cite web |url=https://www.cdc.gov/tetanus/about/symptoms-complications.html |title=Tetanus &#124; Symptoms and Complications &#124; Lockjaw &#124; CDC |format= |work= |accessdate=}}</ref>


==Complications==
==Complications==
There are many complications associated with tetanus infection. Some of the complications are as follows:
Complications of a tetanus infection may include:
 
*Respiratory or diaphragmatic paralysis
*[[Laryngospasm]]
*[[Laryngospasm]]
**This can be associated with [[spasms]] of the [[muscles]] of [[respiration]] which leads to breathing difficulties.
**This can be associated with [[spasms]] of the [[muscles]] of [[respiration]] which leads to breathing difficulties.
Line 20: Line 30:
*[[Nosocomial]] infections
*[[Nosocomial]] infections
**Common because of prolonged hospitalization
**Common because of prolonged hospitalization
*There are commonly some secondary infections including:
 
**[[Sepsis]] from indwelling catheters
**[[Hospital-acquired pneumonia]]
**[[Decubitus ulcers]]
*[[Pulmonary embolism]]
*[[Pulmonary embolism]]
**Apparent in drug users and the elderly
**Apparent in drug users and the elderly
Line 29: Line 36:
**Common late complication
**Common late complication
**Found in 50%-70% of autopsied cases
**Found in 50%-70% of autopsied cases
Common secondary complications of prolonged hospitalization for tetanus include:
*[[Sepsis]] from indwelling catheters
*[[Hospital-acquired pneumonia]]
*[[Decubitus ulcers]]


==Prognosis==
==Prognosis==
Tetanus results in death in almost 10-20% of cases. The rate of death is higher among older people. The fatality rate of tetanus might be associated with prolonged [[contractions]] and [[convulsions]].<ref name="pmid25149223">{{cite journal| author=Thwaites CL, Beeching NJ, Newton CR| title=Maternal and neonatal tetanus. | journal=Lancet | year= 2015 | volume= 385 | issue= 9965 | pages= 362-70 | pmid=25149223 | doi=10.1016/S0140-6736(14)60236-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25149223  }} </ref> In the recent years:
Tetanus results in death in approximately 10-20% of cases. The mortality rate is higher among older people. The fatality rate of tetanus is associated with prolonged [[contractions]] and [[convulsions]]. Tetanus without [[spasm]]s has an excellent prognosis. Early diagnosis is associated with a good prognosis.<ref name="pmid25149223">{{cite journal| author=Thwaites CL, Beeching NJ, Newton CR| title=Maternal and neonatal tetanus. | journal=Lancet | year= 2015 | volume= 385 | issue= 9965 | pages= 362-70 | pmid=25149223 | doi=10.1016/S0140-6736(14)60236-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25149223  }} </ref><ref>{{Cite journal
| author = [[C. Louise Thwaites]], [[Nicholas J. Beeching]] & [[Charles R. Newton]]
| title = Maternal and neonatal tetanus
| journal = [[Lancet (London, England)]]
| volume = 385
| issue = 9965
| pages = 362–370
| year = 2015
| month = January
| doi = 10.1016/S0140-6736(14)60236-1
| pmid = 25149223
}}</ref><ref>{{Cite journal
| author = [[Martha H. Roper]], [[Jos H. Vandelaer]] & [[Francois L. Gasse]]
| title = Maternal and neonatal tetanus
| journal = [[Lancet (London, England)]]
| volume = 370
| issue = 9603
| pages = 1947–1959
| year = 2007
| month = December
| doi = 10.1016/S0140-6736(07)61261-6
| pmid = 17854885
}}</ref><ref>{{Cite journal
| author = [[M. H. Trujillo]], [[A. Castillo]], [[J. Espana]], [[A. Manzo]] & [[R. Zerpa]]
| title = Impact of intensive care management on the prognosis of tetanus. Analysis of 641 cases
| journal = [[Chest]]
| volume = 92
| issue = 1
| pages = 63–65
| year = 1987
| month = July
| pmid = 3595250
}}</ref><ref>{{Cite journal
| author = [[J. C. Patel]] & [[B. C. Mehta]]
| title = Tetanus: study of 8,697 cases
| journal = [[Indian journal of medical sciences]]
| volume = 53
| issue = 9
| pages = 393–401
| year = 1999
| month = September
| pmid = 10710833
}}</ref>


*Tetanus has been fatal in approximately 11% of reported cases
*Poor prognostic factors include:
*Most commonly fatal cases found in:
**Individuals of age 60 years or older (approximately 18%)
**People of 60 years or older (approximately 18%)
**Unvaccinated people (approximately 22%)
**Unvaccinated people (approximately 22%)
*In about 20% of deaths, no obvious pathology is detected
**Delayed diagnosis
**Death is attributed directly to the direct effects of tetanus toxin.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Disease]]
[[Category:Disease]]
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[[Category:Needs overview]]
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[[Category:Bacterial diseases]]
[[Category:Bacterial diseases]]
[[Category:Emergency mdicine]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Primary care]]
[[Category:Neurology]]
 
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Tetanus can have an incubation period of 2 to 38 days. The presentation and progression may vary depending on the type of tetanus. Generalized tetanus can involve the diaphragm making it difficult to breathe. The complications of tetanus include respiratory arrest, fractures, laryngospasm, aspiration pneumonia and pulmonary embolism. Tetanus has a case fatality rate of approximately 11%. The fatality rate of tetanus is associated with prolonged convulsions and contractions. Tetanus without spasms has an excellent prognosis. Early diagnosis is associated with a good prognosis.[1][2]

Natural History

Tetanus can have an incubation period of 2 to 38 days. Initial presentation involves neck and jaw stiffness. Spasms are common in the first week and may persist for up to 3 weeks, followed by rigidity that can persist for 4-8 weeks. Patients with the generalized type can have spasmodic contractions of the muscles associated with inability to breathe which may lead to apnea. If left untreated this can lead to the death.[1][3]

Complications

Complications of a tetanus infection may include:

Common secondary complications of prolonged hospitalization for tetanus include:

Prognosis

Tetanus results in death in approximately 10-20% of cases. The mortality rate is higher among older people. The fatality rate of tetanus is associated with prolonged contractions and convulsions. Tetanus without spasms has an excellent prognosis. Early diagnosis is associated with a good prognosis.[1][4][5][6][7]

  • Poor prognostic factors include:
    • Individuals of age 60 years or older (approximately 18%)
    • Unvaccinated people (approximately 22%)
    • Delayed diagnosis

References

  1. ↑ 1.0 1.1 1.2 Thwaites CL, Beeching NJ, Newton CR (2015). "Maternal and neonatal tetanus". Lancet. 385 (9965): 362–70. doi:10.1016/S0140-6736(14)60236-1. PMID 25149223.
  2. ↑ J. C. Patel & B. C. Mehta (1999). "Tetanus: study of 8,697 cases". Indian journal of medical sciences. 53 (9): 393–401. PMID 10710833. Unknown parameter |month= ignored (help)
  3. ↑ "Tetanus | Symptoms and Complications | Lockjaw | CDC".
  4. ↑ C. Louise Thwaites, Nicholas J. Beeching & Charles R. Newton (2015). "Maternal and neonatal tetanus". Lancet (London, England). 385 (9965): 362–370. doi:10.1016/S0140-6736(14)60236-1. PMID 25149223. Unknown parameter |month= ignored (help)
  5. ↑ Martha H. Roper, Jos H. Vandelaer & Francois L. Gasse (2007). "Maternal and neonatal tetanus". Lancet (London, England). 370 (9603): 1947–1959. doi:10.1016/S0140-6736(07)61261-6. PMID 17854885. Unknown parameter |month= ignored (help)
  6. ↑ M. H. Trujillo, A. Castillo, J. Espana, A. Manzo & R. Zerpa (1987). "Impact of intensive care management on the prognosis of tetanus. Analysis of 641 cases". Chest. 92 (1): 63–65. PMID 3595250. Unknown parameter |month= ignored (help)
  7. ↑ J. C. Patel & B. C. Mehta (1999). "Tetanus: study of 8,697 cases". Indian journal of medical sciences. 53 (9): 393–401. PMID 10710833. Unknown parameter |month= ignored (help)

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