Symptoms of tetanus in adults

1. About tetanus Tetanus is a severe acute infection with a high mortality rate caused by the potent toxin of the tetanus bacillus - Clostridium tetani. When infected with Clostridium tetani, a protein toxin is secreted tetanospasmin that affects the whole body of the patient, causing brain damage, central nervous system, muscle stiffness and rapid death. Tetanus bacilli are often present in sandy soil, poultry and livestock manure, old surgical equipment that is not disinfected...
Mortality rate of tetanus is very high, from 25 to 90%, especially Neonatal tetanus mortality can be as high as 95%. The disease can occur at any time of the year and anyone can get it, especially if the patient has not previously participated in a tetanus vaccination program.
Tetanus spores will enter the patient's body through wounds, lacerations, burns, contamination or through the injection of contaminated needles. In addition, currently tetanus can be transmitted to adults through plastic surgery, abortion in unsanitary conditions. For newborns, the process of cutting the umbilical cord and taking care of the umbilical cord after birth is not guaranteed can also cause tetanus spores to enter the baby's body and cause illness. This case often occurs in remote areas, high mountains when women give birth, do not make it to the hospital in time or because the postnatal care process is not hygienic. However, tetanus is not contagious from person to person.

2. Who is at high risk for tetanus? As mentioned, anyone is at risk for tetanus. However, there are subjects that are more susceptible because they are often exposed to the environment with potential Clostridium tetani bacilli:
Farmers working on livestock and poultry farms; Farmer gardening; Construction workers; People who work as cleaners; Soldiers, volunteers.

3. Symptoms of tetanus in adults Tetanus symptoms in adults will not appear immediately upon infection but must go through a long incubation period. Usually tetanus will go through 4 stages including incubation, onset, full-blown disease and remission. Corresponding to each period, the manifestation of tetanus in adults will be different.
3.1. Initial symptoms of tetanus incubation period The primary symptom of tetanus after incubation period exposure is jaw stiffness. The incubation period of tetanus bacilli is about 3-21 days, an average of 7 days, and especially when the incubation period is shorter (less than 7 days), the disease progression is more severe and complicated.
Signs of jaw stiffness caused by tetanus often have accompanying features such as jaw fatigue, difficulty speaking, difficulty chewing, difficulty swallowing and difficulty opening the mouth wide. Jaw stiffness will get worse over time and the frequency of occurrence is continuous.
Very few cases of tetanus are detected at this stage because most of the patients do not have a proactive mentality to prevent and monitor this abnormal manifestation. Besides, the symptoms of stiff jaw muscles are a manifestation of many other benign diseases, so it often makes patients subjective.
3.2. Symptoms of tetanus in adults during the onset period After the incubation period, patients with tetanus will develop muscle spasms of the whole body or pharynx lasting from 1 to 7 days. Of more concern, the shorter the duration of muscle contraction (less than 48 hours), the more severe the disease will be, and the prognosis is very poor. At the same time, the manifestation of jaw stiffness in the incubation period continued to occur at a more severe level.
The generalized muscle twitching of tetanus at the onset often has the following manifestations:
Abdominal spasticity: When palpating the abdominal wall, the abdominal wall feels stiff and the two anterior rectus muscles may be raised; Spasticity of pectoral and intercostal muscles: Makes it difficult for the patient to move the chest; Back muscle spasticity: The outward manifestation is that the back is bent or straightened, difficult to adjust; Stiff neck muscles: The patient's neck is stiff and tends to lean back; Spasticity of lower extremities: Characterized by an upright position of the legs; Spasticity of the muscles of the upper extremities: Manifested through the folded arms position. Muscle spasms increase in intensity when subjected to external stimuli, causing pain and limiting body movements according to the patient's wishes. Accompanied by other systemic manifestations such as sweating, restlessness, increased heart rate and especially serious when it can cause respiratory arrest due to respiratory muscle stiffness and lead to death very quickly.

3.3. Manifestations of tetanus in adults during the full-blown period The full-blown period occurs about 1-3 weeks after the onset of the first symptoms of the onset. During this period, the symptoms of systemic muscle spasms are very clear, continuous and create many dangers if the patient does not receive medical support. The usual presentation of the full course of tetanus has the following features:
Generalized muscle spasticity : This condition is very painful for the patient, is characterized by the typical flexed posture and is aggravated by subject to external stimuli; Sphincter spasm: This leads to the patient having difficulty urinating; Oropharyngeal spasm: Difficulty swallowing, easy to choke on food. Therefore, the nutrition of tetanus patients at this time needs special attention; Laryngeal spasm: Manifested by signs of difficulty breathing, asphyxiation, cyanosis of the whole body, leading to respiratory failure or cardiac arrest; In addition, a characteristic manifestation of tetanus in adults during this period is generalized muscle twitching against the background of pre-existing muscle spasms. The duration of the convulsion lasts from a few seconds to a few minutes with typical posture: 2 hands clenched in a flexed position, 2 legs extended, back flexed. During convulsions, the patient often stops breathing due to laryngospasm and inhibition of respiratory muscle activity. The longer the convulsion lasts, the more likely the patient will die. In the full-blown stage, tetanus bacilli strongly attack the nervous system, so the symptoms of autonomic dysfunction are often obvious and gradually worsening such as sweating, pale skin and mucous membranes. increased phlegm secretion, high fever over 39 degrees Celsius... Among them, special attention should be paid to blood pressure and heart rate because they often change very erratically, leading to a very high risk of cardiac arrest.
3.4. Symptoms of tetanus in remission period If medical intervention is timely and effective in the full stage, the patient will have a chance to recover quickly. Generalized convulsions or spasms of the larynx and pharynx gradually decrease in frequency and intensity, meaning that tetanus patients are entering the stage of remission and recovery. However, the generalized muscle spasticity will continue for some time (weeks to months) but the degree of muscle stiffness will gradually decrease. Finally, with luck, the patient can gradually control basic movements such as opening the mouth wide, swallowing and eating normally again.

4. Prevention of tetanus The most effective way to prevent tetanus is to get vaccinated according to the National Expanded Program on Immunization. However, many cases have been vaccinated against tetanus according to schedule but still need a booster dose regularly:
For children under 7 years old, 5 times of tetanus vaccination and people over 7 years old who have not been vaccinated strains require at least 3 doses of vaccine. The tetanus vaccine for children will be accompanied by 2 other diseases, diphtheria and pertussis (named DTaP, DT) with a higher dose than the adult vaccine (called Tdap, Td); Children were vaccinated with DTaP at the following ages: 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years old. The child should then receive a booster dose of Tdap at 11 to 12 years of age and Td every 10 years; Adults who have not been previously immunized against tetanus should receive the first dose of Tdap vaccine, followed by the first dose of Tdap vaccine 4 weeks and 6 to 12 months later. At the same time, adults should get a booster shot with Td vaccine every 10 years; For people over 65 who are likely to have close contact with infants under 12 months of age and who have not been previously vaccinated with Tdap, an additional dose of Tdap should be given; Pregnant women should get the Tdap vaccine between 27 and 36 weeks' gestation, regardless of when the last shot was given. The fetus can develop passive immunity when the mother is vaccinated at this time. After an injury, the patient should be vaccinated against tetanus depending on the type of wound and vaccination history. At the same time, the use of tetanus immune globulin should be indicated. In addition, because tetanus does not cause post-infection immunity, patients who have recovered from the disease still need to be vaccinated.
Currently, at Vinmec International General Hospital, tetanus vaccination is performed with combination vaccines produced in Belgium and France. The combination of multiple vaccines will reduce the number of injections and reduce the disadvantages of multiple injections. The benefits of combination vaccination include: increasing the vaccination rate of dangerous diseases, increasing the rate of vaccination on time, reducing the cost of transporting and storing vaccines, reducing travel costs and vaccination.
The advantages of vaccination at Vinmec include:
Children are examined by pediatricians - vaccines, fully screened for their physical condition and health, and advised on vaccines and prevention regimens. vaccination, how to monitor and care for children after vaccination. Undertake medical supervision before, during and after vaccination, have an emergency team ready to coordinate with the vaccination department to handle cases of anaphylaxis, respiratory failure - circulatory arrest, ensuring timely and correct handling plan when something goes wrong. The vaccination room is airy, with a play area, helping children feel comfortable as if they are walking and have a good mentality before and after vaccination. Vaccines are imported and stored in a modern cold storage system, with a cold chain that meets GSP standards, keeping vaccines in the best conditions to ensure quality. Parents will receive a reminder message before the vaccination date and their child's vaccination information will be synchronized with the national immunization information system. Vinmec International General Hospital is currently providing a Package Immunization Program with a variety of vaccines for different audiences, from infants, young children, adults, and women before and during pregnancy pregnant.