David M. Berry M.D.

What is tetanus?
We hear this name all the time. Anytime we go to the doctor with a scrape or cut, what is the first thing they ask us?
“Is your tetanus shot up to date?”
 So why do we need one other than we don’t want to get tetanus? Well, really that is the only reason but let’s talk about why it is important.
Clostridium tetani is a common bacteria that lives in dirt and most commonly cow manure. While tetanus can be a rapidly fatal condition the bacteria itself does not cause harm.
There is a toxin released by the bacteria that does this microorganism’s dirty work. Fortunately, tetanus is now rarely seen in the U.S. This is in part to the success of the vaccination and, maybe more importantly, to the use of chemical fertilizers rather than cow manure.
Organic is not always best!
One usually becomes infected with C. tetani and its dangerous toxin when sustaining a puncture wound that is “dirty” (i.e. has cow manure or other products that contain this bacteria).
This usually occurs to the bottom of one’s foot but can be anywhere.
The symptoms of tetanus don’t begin right away. It needs time to do what we call “incubate.” This usually takes a week to happen and can begin its damage up to 21 days after being introduced to the body.
However, in some cases the incubation period can be as short as 2-3 days but this is less likely.
So what happens once this nasty little toxin sets up shop?
The most common or pathonumonic symptom is “lockjaw.” We have all heard this term and some of us have associated it with tetanus but what is happening?
When our C. tetani bacteria releases its toxin that toxin attaches and stimulates receptors that cause our muscles to contract uncontrollably. Not only is this painful but is why this condition is life threatening.
In addition to causing the muscles in our jaw to contract the toxin eventually causes all the muscles in our body to follow suit.
It is slightly more complicated than this but suffice it to say this toxin will prohibit us from using any affected muscle. Now keep in mind there are three types of muscles in our body and we are primarily talking about our skeletal muscles.
These are the muscles that allow us to move our arms, pick things up, stand and probably most importantly, breathe. Obviously, if we can not use the muscles we need to breathe we give that the term “bad”!
Once a person reaches this point in the process they must be put on a ventilator to be kept alive. Hopefully, we don’t get to this point.
The primary prevention is to keep our tetanus shot or vaccine up to date. We usually recommend anyone who has gone ten years without a booster shot be re-immunized.
As well, anyone with a high risk cut or puncture that is over five years from their last tetanus immunization go ahead and get a booster shot.
Nowadays we have included diphtheria (another discussion) with the tetanus shot and it is known as a Tdap. This should be given to any adult being given a booster shot for tetanus that is age 75 or younger.
There is another medication for tetanus that is different from the tetanus vaccine. This is called the tetanus immuglobin.
The immunoglobulin is reserved for those who have contracted tetanus and are being actively treated for such. Hopefully, most of us will never have to worry about this branch of the tetanus care.
So what have we learned? Tetanus comes from the toxin excreted by a bacteria called C. tetani. It is commonly found in cow manure. While tetanus is rare in the U.S. it is often lethal and must be treated quickly. Most importantly, keep those tetanus shots up to date so we can keep this condition on the outs!
Ask Dr. Berry a question!
David M. Berry, M.D.
Tri-Lakes Medical Center