Lecture Notes: Tetanus and Its Historical Context

Introduction

• Hippocrates, a Greek physician, documented one of the first cases of tetanus in the 5th century.
• A shipmaster suffered from severe symptoms and died six days later.
• Modern medicine is better equipped to handle tetanus today.

Understanding Tetanus

• Tetanus is caused by the bacterium Clostridium tetani.
• Unlike other bacterial infections (e.g. tuberculosis, strep throat), tetanus does not spread from person to person.
• It infects through cuts and abrasions.

Sources of Infection

• Tetanus is associated with rusty nails and scrap metal but the connection is indirect.
• Clostridium tetani is often found in:
  • Soil
  • Manure
  • Dead leaves
• Bacteria can survive for years as spores, even in extreme conditions.
• Old, rusty metal can conceal bacteria, increasing infection risks through jagged, deoxygenated wounds.

Pathophysiology of Tetanus

• Spores germinate in the body, releasing toxins, including tetanus toxin.
• Toxin disrupts neurotransmission in the brain and spinal cord by blocking neurotransmitters.
• Causes uncontrollable muscle contractions and spasms.

Symptoms

• Symptoms typically appear 7 to 10 days post-infection:
  • General aches
  • Trouble swallowing
  • Lockjaw
• The head and neck show the first symptoms, followed by stronger muscle groups.
• Severe symptoms can lead to back arching and muscle stiffness in the windpipe and chest, risking suffocation.

Treatment

• Without treatment, tetanus has a low survival rate.
• Modern treatment includes:
  1. Cleaning the infected wound
  2. Administering antibiotics to kill bacteria
  3. Injecting antitoxin to neutralize existing toxins
  4. Supportive care (muscle relaxants, ventilators)
• Treatment has advanced since Hippocrates' time when waiting was the only option.

Prevention

• Tetanus vaccines are crucial for prevention.
• Developed in the early 1920s, the vaccination schedule includes:
  • Series of shots starting at two months old
  • Complete course around age 12
• Over 20,000 infants die from tetanus annually, mainly in low/middle-income countries.
• Newborns are at higher risk if mothers are unvaccinated; vaccinating mothers during pregnancy helps.

Conclusion

• Tetanus remains a significant health threat.
• Importance of vaccination and preventive measures after injuries.