Clostridium tetani (tetanus or lockjaw) is a large, Gram-positive, spore-forming, motile, obligate, rod-shaped bacterium that produces spores that are found abundantly in soil and the feces of both animals and humans. It is an anaerobic organism, thriving on injured or dead wound tissue. Even though wounds are often contaminated with soil and the bacterium is present, the disease does not always develop in a great majority of cases. The condition of the wound must contain the proper environment for the spores to germinate, the bacteria to proliferate, and the toxins to be produced.
Tetanus still frequently crops up among drug abusers. Without treatment, the disease is always fatal. To show how fast the toxin travels once it enters the bloodstream, a Japanese scientist, Shibasaburo Kitasato, injected the bacteria into the tail tip of a mouse and then chopped it off an hour later, but it was too late to stop the action.
Signs and symptoms of disease usually occur four to ten days after injury, but it can be delayed by several months. As the spores multiply in the wounds, they produce an exotoxin (tetanospasmin), which is the actual cause of the disease. Therefore, the disease cannot be considered contagious. The toxin travels through the blood and nerves to the brain and spinal cord, interfering with messages sent out to the muscles. The muscles then go into spasms because they are not receiving their normal messages. As the facial muscles start to disfigure, the characteristic “grin” it causes (risus sardonicus) and the locking of the jaw are first telltale signs. It is the difficulty in opening the mouth that will clue in medical personnel as to with what they are dealing. As the disease progresses, spasms in other muscles occur. They can be brief, but are often frequent enough to cause great pain and exhaustion. In some cases, the spasms are so powerful, they cause bones to break. Respiratory complications are common, and death rates are high, especially in young children and the elderly. In nonfatal cases, recovery takes several weeks.
In those who show clinical symptoms of the disease, an antitoxin is administered to prevent the formation of new toxins. This is called tetanus immune globulin. It will not reverse the toxic activity of the toxin bound to nerve tissue, but it will inactivate toxins in the blood. Antispasmodic drugs often are given as well. There is a vaccine available which is usually given in conjuction with diphtheria and whooping cough (pertussis) as a DPT vaccine.
A frequently encountered form of tetanus is one involving the umbilical cords of babies born in underdeveloped countries. Often the cords are cut with nonsterile instruments, sharp rocks or stones, and the area packed with dirt, according to tribal custom. More than ½ million babies die each year in Asia and Africa because their unbilical cords have been treated in this manner. Tetanus was recognized by Hippocrates in the 5th century BCE and most probably in ancient Egypt as well since dung was the favored cure of the day.
