Tetanus natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Tetanus can have an incubation period of 2 to 38 days. The presentation and progression may vary depending on the type of tetanus. Generalized tetanus can involve the diaphragm making it difficult to breathe. The complications of tetanus include respiratory arrest, fractures, laryngospasm, aspiration pneumonia and pulmonary embolism. Tetanus has a case fatality rate of approximately 11%. The fatality rate of tetanus is associated with prolonged convulsions and contractions. Tetanus without spasms has an excellent prognosis. Early diagnosis is associated with a good prognosis.[1][2]
Natural History
Tetanus can have an incubation period of 2 to 38 days. Initial presentation involves neck and jaw stiffness. Spasms are common in the first week and may persist for up to 3 weeks, followed by rigidity that can persist for 4-8 weeks. Patients with the generalized type can have spasmodic contractions of the muscles associated with inability to breathe which may lead to apnea. If left untreated this can lead to the death.[1][3]
Complications
Complications of a tetanus infection may include:
- Respiratory or diaphragmatic paralysis
- Laryngospasm
- This can be associated with spasms of the muscles of respiration which leads to breathing difficulties.
- Fractures of the spine or long bones
- This may result from prolonged contractions and convulsions
- Hyperactivity of autonomic nervous system
- This may lead to an abnormal heart rhythm and/or hypertension
- Nosocomial infections
- Common because of prolonged hospitalization
- Pulmonary embolism
- Apparent in drug users and the elderly
- Aspiration pneumonia
- Common late complication
- Found in 50%-70% of autopsied cases
Common secondary complications of prolonged hospitalization for tetanus include:
- Sepsis from indwelling catheters
- Hospital-acquired pneumonia
- Decubitus ulcers
Prognosis
Tetanus results in death in approximately 10-20% of cases. The mortality rate is higher among older people. The fatality rate of tetanus is associated with prolonged contractions and convulsions. Tetanus without spasms has an excellent prognosis. Early diagnosis is associated with a good prognosis.[1][4][5][6][7]
- Poor prognostic factors include:
- Individuals of age 60 years or older (approximately 18%)
- Unvaccinated people (approximately 22%)
- Delayed diagnosis
References
- ↑ 1.0 1.1 1.2 Thwaites CL, Beeching NJ, Newton CR (2015). "Maternal and neonatal tetanus". Lancet. 385 (9965): 362–70. doi:10.1016/S0140-6736(14)60236-1. PMID 25149223.
- ↑ J. C. Patel & B. C. Mehta (1999). "Tetanus: study of 8,697 cases". Indian journal of medical sciences. 53 (9): 393–401. PMID 10710833. Unknown parameter
|month=ignored (help) - ↑ "Tetanus | Symptoms and Complications | Lockjaw | CDC".
- ↑ C. Louise Thwaites, Nicholas J. Beeching & Charles R. Newton (2015). "Maternal and neonatal tetanus". Lancet (London, England). 385 (9965): 362–370. doi:10.1016/S0140-6736(14)60236-1. PMID 25149223. Unknown parameter
|month=ignored (help) - ↑ Martha H. Roper, Jos H. Vandelaer & Francois L. Gasse (2007). "Maternal and neonatal tetanus". Lancet (London, England). 370 (9603): 1947–1959. doi:10.1016/S0140-6736(07)61261-6. PMID 17854885. Unknown parameter
|month=ignored (help) - ↑ M. H. Trujillo, A. Castillo, J. Espana, A. Manzo & R. Zerpa (1987). "Impact of intensive care management on the prognosis of tetanus. Analysis of 641 cases". Chest. 92 (1): 63–65. PMID 3595250. Unknown parameter
|month=ignored (help) - ↑ J. C. Patel & B. C. Mehta (1999). "Tetanus: study of 8,697 cases". Indian journal of medical sciences. 53 (9): 393–401. PMID 10710833. Unknown parameter
|month=ignored (help)