infectious diseases
Tetanus
Introduction
Tetanus is acute poisoning resulting from a neurotoxin produced byClostridium tetani. Symptoms are intermittent tonic spasms of voluntary muscles. Spasm of the masseters accounts for the name lockjaw. Diagnosis is clinical. Treatment is with human tetanusimmune globulinand intensive support. (See also Overview of Anaerobic Bacteria and Tetanus bacilli form durable spores that occur in soil and animal feces and remain viable for years. Worldwide in 2019, tetanus was estimated to have caused 34,700 deaths, mostly in South Asia and Sub-Saharan Africa ( General references ), but the disease is so rarely reported that this figure is only a rough estimate. According to the World Health Organization, in 2015 about 34,000 newborns died of neonatal tetanus, which was a 96% reduction since 1988 ( In the United States since 1947, reported tetanus cases have declined more than 95%, and deaths resulting from tetanus have declined more than 99% ( General references ). From 2009 to 2017, 264 cases of tetanus and 19 deaths resulting from tetanus were reported. Age distribution for cases was 23% in people ≥ 65 years, 64% in people aged 20 to 64 years, and 13% in people < 20 years, including 3 cases of tetanus neonatorum; all tetanus-related deaths occurred in people > 55 years ( Disease incidence is directly related to the immunization level in a population, attesting to the effectiveness of preventive efforts. In the United States, immunity levels tend to be lower in older age groups. Patients with burns, surgical wounds, or a history of injection drug use are especially prone to developing tetanus. However, tetanus may follow trivial or even inapparent wounds. Infection may also develop postpartum in the uterus (maternal tetanus) and in a neonate's umbilicus (tetanus neonatorum) as a result of unsanitary delivery and umbilical cord care practices. Diabetes and a history of immunosuppression may be risk factors for tetanus. 