Tetanus is a rare bacterial infection that stands out amongst other common infections, such as staph (staphylococcus) infections and tonsillitis, because of its severity and effect on the nervous system. 

Let’s delve deeper into the complexities of tetanus, what to look out for, and how its treatment and symptoms differ from those of other bacterial infections. 

Introduction

Bacteria are found in abundance in our bodies and are necessary for our survival. The necessary bacteria are considered to be ‘good bacteria’. Although only a small percentage of bacteria are harmful to us, they can cause a lot of damage to our bodies. These ‘bad’ bacteria invade our bodies and cause infections.

It’s important to understand the different types of bacterial infections, how to treat them and whether prompt medical assistance is needed. The most common infections humans can get are staphylococcal (staph), streptococcus (strep) and salmonella. Tetanus is rarer to contract now, thanks to the development of vaccines and antibiotics. 

Furthermore, in countries like the United Kingdom and the United States of America, it is rarer to not only contract but to suffer severely from tetanus due to better availability of medical resources.¹ However, due to its rarity in these countries, delays in diagnosis and treatments are likely to occur. Therefore it is important to understand the symptoms and causes, and how they differ from other bacterial infections.² 

What is tetanus?

Tetanus is a bacterial infection caused by a gram-negative bacterium called Clostridium tetani (C. tetani). In anaerobic conditions (in an environment where when more oxygen is being consumed than produced, such as in injured human tissue without enough oxygen-rich blood e.g. skin), dormant C. tetani spores germinate into bacilli, which produce the endotoxin, tetanospasmin, which is essentially the neurotoxin that causes the characteristic muscle spasms of tetanus infection. These symptoms are due to the toxins inhibiting the presynaptic release of the neurotransmitters, GABA and glycine, in the brain and spinal cord.³ Tetanus has been around for a long time, dating back to the first century AD, when the ancient Greek physicians wrote of “spasms of painful nature”.

Tetanus can also be contracted by neonates mainly due to non-sterile deliveries. This usually occurs in developing countries due to lack of resources. However, it was found that pregnant parents who were vaccinated had a lower risk of giving birth to a neonate with tetanus.⁴ 

The most common method of transmission is through open wounds or severe tissue injury. The bacteria can also enter the body through small cuts, scrapes or insect bites, although this is less common. C tetani is found predominantly in soil, dust, and the gastrointestinal tract of various animals, including animals infected with tetanus. It’s also worth noting that natural disasters, such as earthquakes can generate the optimal environment for a tetanus outbreak. This is mainly due to the increase in wounds and reduced availability of and timely access to medical resources.⁵ 

Symptoms of tetanus

Early symptoms of tetanus arise within 7-14 days of infection. These symptoms include:

• Trismus (more commonly known as lockjaw) – when the muscles around your jaw and neck become rigid. When someone suffers from trismus, they usually find it difficult to comfortably move their jaw, often resulting in pain and muscle spasms. Some report swelling in the neck and jaw area
• Risus sardonicus (rictus grin) – when the muscle rigidity affects facial expression. People experiencing risus sardonicus present with an anxious facial expression, usually with their mouth slightly ajar 
• Headaches

As the bacterial infection progresses, more severe symptoms can be seen:

• Muscle spasms throughout the body
• Muscle stiffness, especially in, but not limited to, the calves and neck
• Difficulty swallowing
• Fever
• Dysrhythmia due to smooth muscle rigidity 
• Heart problems such as bradycardia (too low heart rate below 60 bpm), hypotension (low blood pressure), and sometimes myocardial necrosis (heart muscle tissue death, usually following heart injury or heart attack) 

If tetanus is left untreated, premature death can occur.⁶ 

Treatment of tetanus

The best treatment option available is technically a preventative measure, a vaccine. Modern medicine has allowed immunisation programmes to successfully prevent tetanus. A diphtheria-tetanus-pertussis (DTP) vaccine is given to children at approximately the age of 3 months and 6 months in most countries. A tetanus-diphtheria (TD) vaccine is given to older children (typically 7 years and above), adolescents, and adults. Usually, TD is used as a booster vaccination for children who have had the DTP vaccine, but adults who have not yet received the DTP also take the TD vaccine. Neonates are protected passively through the transfer of maternal antibodies across the placenta during pregnancy.⁷ 

Immediate care upon infection

It is important that any open wounds, cuts, and/or scrapes are thoroughly cleaned with water and disinfected, removing any dirt, debris, and dead skin cells from the area if you believe you may have been infected with the bacterial spores. Ensuring the exposed cuts are not a breeding ground for this bacteria to replicate is crucial. 

Initial treatments also include management with antibiotics. Common antibiotics used to treat tetanus are metronidazole or penicillin, given intravenously (IV, given through the vein). Tetanus antitoxin is also administered once within the 7-10 day initial treatment period, which prevents any more toxins from entering the nervous system if they have not already. This wound is also cleaned and treated with the antitoxin because your adaptive immune system will not be able to provide your body with immunity against tetanus on its own.

To treat the toxins that may have already entered the nervous system, the antitoxin must be administered intrathecally (in the fluid-filled space between the spinal cord and its membranes) via lumbar puncture, for example. Some studies show that this is a better treatment method than the intramuscular route.² 

Benzodiazepines or propofol may be used long-term to reduce muscle spasms and rigidity, alleviating some of the painful symptoms affecting the respiratory and circulatory systems mentioned above.⁸  One case study discussed the use of magnesium to reduce muscle spasms and autonomic dysfunction in a patient with tetanus.⁹

Other common bacterial infections

Without going into too much depth about the numerous other bacterial infections, here is a general overview with specific examples of how other bacterial infections may present in the body and how they differ from tetanus.

Staphylococcal infections

Staphylococcus is a major human pathogen, causing most skin and soft tissue infections in our bodies. Tetanus, on the other hand, mainly affects the nervous system. Unlike C. tetani, S. aureus (Staphylococcus aureus, or staph) infections are not always life-threatening. In fact, most human encounters with this bacteria are harmless, apart from a few weeks of experiencing various symptoms such as boils, abscesses (swellings on the skin containing pus) and high temperatures.¹⁰

Similar to tetanus, antibiotics such as penicillin may be used to treat a staph infection, although some strains have started becoming antibiotic-resistant. 

Overall, the main differences between staph infection and other types are the physical symptoms of boils and abscesses, which can be easily distinguishable from other bacterial infections, including tetanus.¹¹ 

Streptococcal infections

Streptococcus is the main culprit for throat infections, tonsillitis, and skin infections, with characteristic symptoms like sore throats, skin rashes and fever.

Other than the fever, most of the symptoms present during infection with the majority of streptococcal bacterial strains are easily distinguishable from tetanus. However, like tetanus (and many other bacterial infections), these may be treated with antibiotics such as penicillin.¹²

One specific strain of this bacteria, called the Streptococcus pneumoniae is known for causing 72% of bacterial meningitis cases, with various other bacteria causing the rest of the cases. This is a rare form of meningitis as most cases are caused by a virus (viral). In fact, 0.9 in every 100,000 individuals are reported to have this disease in resource-rich countries; and 80 per 100,000 individuals in low-income countries. Most of these cases are due to bacteria from ear or nose infections travelling up into the central nervous system (CNS). This bacterial infection has similar symptoms as tetanus, such as a stiff neck, fever, headaches, and respiratory issues. Treatment includes intravenous (IV) antibiotic therapy and the administration of a steroid called dexamethasone.¹³ 

Summary

Tetanus is a rare bacterial infection caused by the bacterial spores of C. tetani entering open cuts, scrapes, or wounds on the body. The bacteria is usually found in soil, dust and the gastrointestinal tract of animals. A vaccine has been developed for immunity against tetanus, which is administered to infants, with booster doses during adolescence and adulthood. This vaccine may also be used as a treatment in cases of infection, along with various other antibiotics and antitoxins. 

Most symptoms are easily distinguishable from other bacterial infections, as tetanus symptoms are mainly movement-related. The biggest factor that sets tetanus apart from most other bacterial infections is the fact that it is not contagious between humans.