Tetanus natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural history
Complications
There are many complications associated with tetanus infection. Some of the complications are as follows:
- Laryngospasm
- This can be associated with spasms of the muscles of respiration which leads to breathing difficulties.
- Fractures of the spine or long bones
- This may result from prolonged contractions and convulsions
- Hyperactivity of autonomic nervous system
- This may lead to an abnormal heart rhythm and/or hypertension
- Nosocomial infections
- Common because of prolonged hospitalization
- There are commonly some secondary infections including:
- Sepsis from indwelling catheters
- Hospital-acquired pneumonia
- Decubitis ulcers
- Pulmonary embolism
- Apparent in drug users and the elderly
- Aspiration pneumonia
- Common late complication
- Found in 50%-70% of autopsied cases
Risk Stratification and Prognosis
Death in about 10-20% of cases, higher among older people.
Laryngospasm (spasm of the vocal cords) and/or spasm of the muscles of respiration leads to interference with breathing. Fractures of the spine or long bones may result from sustained contractions and convulsions. Hyperactivity of the autonomic nervous system may lead to hypertension and/or an abnormal heart rhythm. Nosocomial infections are common because of prolonged hospitalization.
Secondary infections may include sepsis from indwelling catheters, hospital-acquired pneumonias, and decubitus ulcers. Pulmonary embolism is particularly a problem in drug users and elderly patients. Aspiration pneumonia is a common late complication of tetanus, found in 50%–70% of autopsied cases. In recent years, tetanus has been fatal in approximately 11% of reported cases. Cases most likely to be fatal are those occurring in persons 60 years of age and older (18%) and unvaccinated persons (22%). In about 20% of tetanus deaths, no obvious pathology is identified and death is attributed to the direct effects of tetanus toxin.