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Tetanus, sometimes known as lockjaw, is a disease manifested by uncontrolled muscle spasms. The disease is frequently fatal especially to the very old or very young, and is preventable by immunization. It occurs predominantly in developing countries among newborn infants, children, and young adults, but it is still encountered in the United States, especially in unimmunized or inadequately immunized adults over fifty years of age.

The tetanus bacterium depends upon the introduction of its spores into damaged tissue along with foreign bodies and/or another bacteria to provide the necessary conditions favorable for its growth. Tetanus is not directly transmitted from person to person. Instead tetanus spores may be introduced into the body through a puncture wound contaminated with soil, street dust, animal feces, injected contaminated street drugs, lacerations, burns and even trivial or unnoticed wounds.

Tetanus disease is due to a potent poison produced by the bacteria. The poison has a stimulating effect on certain muscle groups. Most of the time the muscles of the jaw, face, and neck are affected first and then progressively more distant muscles such as the arms and legs. In this type of generalized tetanus, which is the most frequent form of the disease, the release of larger quantities of poison from a wound into the bloodstream will tend to produce both a quicker onset and a more rapid progression of symptoms, as well as more severe disease.

The tetanus bacteria spores are found everywhere. Any wound can serve as an entry point for the disease. The number of cases of Tetanus in any given population decreases as more of the population receives effective immunization. Thus, tetanus is a major problem in developing countries where compulsory immunization of children is not required or enforced. It is often among the ten most frequent causes of death in such countries, and the number of cases per year worldwide has been estimated at one million.

In the United States, tetanus cases average between fifty and one hundred per year, mostly in under-immunized older adults, and the source is usually a wound. About thirty percent of the people who get tetanus die from it.

The time between an injury and the occurrence of first symptoms is typically less than two weeks but may range from two days to months. Usually the shorter the period the more severe the disease. Initially symptoms of tetanus may include such complaints as localized or generalized weakness, stiffness or cramping, or difficulty chewing and swallowing food. An early sign is often the complaint of “lockjaw.” Increasing muscle rigidity follows in the generalized disease and progressively involves more muscle groups.

For patients who survive tetanus, recovery can be long (1-2 months) and arduous. Muscle spasms may begin to decrease after ten to fourteen days and disappear after another week or two. Residual weakness, stiffness, and other complaints may persist for a prolonged period, but complete recovery can occur from uncomplicated tetanus.

Illness with tetanus usually does not result in immunity, therefore immunization for all recovered patients is recommended.