A Vacation Is Ruined by Tetanus

Q: I recently went on vacation, spent a lot of time barefoot on the beach. I ended up stepping on a metal bottle cap that caused a pretty nasty wound. I thought my childhood tetanus shots would protect me, but I ended up in the ER with muscle spasms and breathing difficulties. I sure wish I'd known more about how to handle this when it happened. What should I have done?

A: It's always easy to look back and second-guess situations, but the fact is you didn't know the tetanus vaccines you received as a child wouldn't provide long-lasting protection as an adult. The current recommendations call for a tetanus booster between the ages of 11 and 18 (assuming the shot was initially given in early childhood), and then once every 10 years as an adult.

Protect yourself with knowledge

Fortunately, you sought immediate treatment when your symptoms began. I can't stress the importance of that fact, because the death rate from complications due to a tetanus infection is 10 percent in those who received proper treatment, and around 30 percent in those where treatment was not sought, or was unavailable. Additionally, the death rate tends to be higher in the very young and elderly, as these age groups are more susceptible to medical complications resulting from the tetanus infection.

Needless to say, this is one infection you want to avoid, and certainly one you can prevent. The key to staying healthy is a combination of proper wound care and vaccination. That said, here are some facts you may not know about tetanus:

1. Don't blame the rust on the nail

It's not the rust that causes the infection, but rather tiny spores containing the bacterium known as Clostridium tetani (C. tetani). These spores are found in many locations that include soil, animal waste and even dust. An infection can develop if the spores enter the body through an injury or a wound. Once there, the bacteria release the C. tetani bacteria, which in turn multiply and produce a toxin known as tetanospasmin. This toxin blocks nerve communication from the spinal cord to the muscles, causing them to become stiff and go into spasm.

While wounds containing dead tissue or foreign bodies—a dirty nail, splinter, etc.—have a higher risk for developing tetanus, it has the potential to occur from other injuries or skin penetration. These include:

• Frostbite
• Surgery
• Intravenous drug use
• Puncture or crushing wounds, or those that become dirty
• Burns
• Animal bites
• Abrasions and lacerations
• Body piercing and tattooing, if unsterilized equipment or improper technique are used

2. There's more to a tetanus infection than "lockjaw"

While uncontrollable spasms of the muscles of the jaw (lockjaw) are often an early sign of infection, other muscles tend to be affected with similar types of spasms. This may result in difficulty swallowing, breathing and walking, as well as with movement of the hands and fingers.

In fact, these muscle spasms can be so powerful as to cause arching of the neck and back, abdominal pain, muscle tears and even dislocations and fractures of the bones to which the muscles are attached. Other symptoms may include fever, drooling, inability to control bladder or bowel function, and excessive perspiration. In severe cases, additional complications such as pneumonia, heart failure and respiratory arrest may occur, leading to a higher potential for brain damage and death.