Tetanus: Why you should not ignore that wound

Tetanus can be fatal if not treated in time. A deep cut or wound from a dirty object like a piece of metal shsould be treated as an emergency by visiting a medical facility as soon as possible.

Tetanus can be fatal if not treated in time. A deep cut or wound from a dirty object like a piece of metal shsould be treated as an emergency by visiting a medical facility as soon as possible.

The fact that the condition can affect one’s nervous system makes it one to look out for. Tetanus does not only lead to painful muscle contractions, but it also can interfere with one’s ability to breathe which makes it a threat to life, medics say.

Dr Janvier Rusizana, a general practitioner at La Nouvelle Clinic, Kigali, says tetanus is an illness caused by a microbe called clostridium tetani. This can happen through an open wound which is dirty, and when the bacteria stay in the wound, it becomes infected leading to pus formation. The bacteria then sends toxins to the body.

Dr Gerald Kirenga, a senior resident in critical care and anesthesia at King Faisal Hospital, Kigali, describes tetanus as a serious bacterial disease that can survive for years.

He explains that it has two forms of survival; if it is inactive it can lay dormant in things like organic soil, cow dung, old metallic things and can live for so many years. All it needs is activation by getting in the right place which is our bodies and then it comes back to life.

“The bacterium gets to the body through cuts because there has to be a breach of the skin for it to access the body. The worst part is that it is hard for one to know they have tetanus because in most cases signs show when the disease has advanced,” he says.

Some of the other causes of tetanus include using unsterilised equipment.

Kirenga also notes that unborn babies can be at greater risk of contracting this disease if the necessary measures are not taken.

“Tetanus can be passed on to the baby through the placenta. However, if you are immunised and you have been having your antenatal care, you confer some degree of immunity to the baby prior to the immunisation they receive when they are born.”

He says women who don’t do antenatal care and are not immunised have zero immunity to themselves and for the babies.

The medic stresses that immunisation is the primary way of preventing this, noting that the immunization one gets at birth is not enough to protect them for a life time since it only provides immunity for 10 to 15 years.

Signs to look out for

Kirenga points out that in most cases one doesn’t know or get to beware that the symptoms they are having are indicating a tetanus infection, until one gets to the hospital.

He, however, notes that this condition can lock up jaws, this being the first sign. One can also experience a fever, difficulty in breathing and muscle spasms.

Rusizana also notes that when one experiences a halt of muscles in the face, it can indicate a high possibility of tetanus infection.

“At times the trismus goes down to the throat, and it can be hard to breathe. The whole body can freeze in some cases including the arms and legs. It can even be difficult to breathe when the muscles in the chest are blocked, and if nothing is done, the patient dies,” he says.

Rusizana advises that when someone suspects tetanus due to a previous encounter, they should go to the hospital and start treatment immediately because for the condition to transform from one stage to another, it doesn’t take long.

Dr Rachna Pande, an internal medicine specialist, says a tight jaw or inability to open the jaw is the most common symptom of tetanus, explaining that it occurs due to contraction of the jaw muscles.

“This is accompanied by spasms of muscles of head and neck, limbs and trunk, that is generalized spasmodic contractions. Untreated, it can be fatal due to respiratory depression. As such it can occur in any age or gender,” she says.

Could men be more prone?

Pande, however, notes that men are more prone to tetanus due to greater outdoor activities.

Women if not immunised, can develop tetanus after delivery, especially if the cord is cut with unhygienic tools. The newborn can develop neonatal tetanus, if the cord is cut using unhygienic tools. Risk is more, if the mother is not vaccinated during pregnancy against tetanus, she says.

Kirenga also adds that since women get a chance of additional vaccinations during pregnancy, this is not the case for men.

“In the last four years we have treated a few major cases and all of them were men. They come in with tetanus and are in critical condition, staying in the intensive care unit for months. Most contract it from motor accidents,” he says.

Treatment

Pande says since the infectious illness is caused by the microbe that only gains entry in the body from a cut or wound contaminated with dust or soil or manure, prevention lies in using clean tools for any intervention.

She advises cleaning a contaminated wound with adequate amounts of soap, water and antiseptic solution since the germs also settle on rusted tools.

“Vaccination against tetanus is part of childhood vaccination schedule, where it is administered as a vaccine combined with that of diphtheria and whooping cough. As such, after any injury particularly where the wound is soiled with soil, dust, among others, tetanus vaccine is given for protection against tetanus.”

Pande also says for an unimmunised person who develops tetanus, immune globulin is injected to help the body fight against the infection. Tetanus toxoid is given for active immunisation afterwards to help build up antibodies to fight the microbes.

“It is a bacterial infection, so immunisation once or developing the disease once does not provide lifelong immunity against tetanus,” she adds.

Rusizana says with treatment of tetanus, medics first clean the wound on the body, and then the person is given antibiotics to kill the microbe such that the bacteria don’t continue to send in toxins.

The patient is also given medicine for stabilisation. These are the first measures taken. Neutralisation can then be done for the toxic tetanus. The antibiotics are given in form of injections, he says.

“Some people have immunoglobulin because they were immunised, and this can help neutralise the tetanus toxin.

“What can also be done when the condition is grave is that the throat can be opened, since one can’t breathe. A tube is then through the trachea to the lungs to give them oxygen such that they can breathe. A tube can also be passed through the mouth to help feed the patient; this is done till the tetanus is completely treated,” he adds.

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