# Tetanus

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{{short description|Bacterial infection characterized by muscle spasms}}
{{about|the disease|the physiological use of the term|Tetanic contraction}}
{{Infobox medical condition (new)
| name          = Tetanus
| synonyms      = Lockjaw
| image         = Opisthotonus_in_a_patient_suffering_from_tetanus_-_Painting_by_Sir_Charles_Bell_-_1809.jpg
| caption       = [Muscle spasm](/source/Muscle_spasm)s (specifically [opisthotonos](/source/opisthotonos)) in a person with tetanus. Painting by [Sir Charles Bell](/source/Sir_Charles_Bell), 1809.
| field         = [Infectious disease](/source/Infectious_disease_(medical_specialty)), [neurology](/source/neurology), [critical care medicine](/source/critical_care_medicine)
| symptoms      = [fever](/source/fever), cramped-up jaw, [muscle spasm](/source/muscle_spasm)s, [headache](/source/headache), [seizure](/source/seizure)s, sweating, and trouble swallowing
| onset         = 3–21 days following exposure
| duration      = Months
| causes        = ''[Clostridium tetani](/source/Clostridium_tetani)''
| risks         = Break in the skin, being unvaccinated
| diagnosis     = Based on symptoms
| differential  =
| complications = [Laryngospasm](/source/Laryngospasm), [respiratory failure](/source/respiratory_failure), [bone fractures](/source/bone_fractures)
| prevention    = [Tetanus vaccine](/source/Tetanus_vaccine)
| treatment     = [Tetanus immune globulin](/source/Tetanus_immune_globulin), [muscle relaxant](/source/muscle_relaxant)s, [mechanical ventilation](/source/mechanical_ventilation)
| medication    = [diazepam](/source/diazepam) and [methocarbamol](/source/methocarbamol)
| frequency     = 209,000 (2015)
| deaths        = 56,700 (2015)
| prognosis     = 6.4% risk of death
}}

'''Tetanus''' ({{etymology|grc|{{wikt-lang|grc|τέτανος}}|tension', 'stretched', 'rigid}}), also known as '''lockjaw''', is a [bacterial infection](/source/bacterial_infection) caused by ''[Clostridium tetani](/source/Clostridium_tetani)'' and characterized by [muscle spasm](/source/muscle_spasm)s. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually lasts for a few minutes. Spasms occur frequently for three to four weeks.<ref name="CDC2012Pink" /><ref name="Sudarshan"/> Some spasms may be severe enough to [fracture bones](/source/bone_fracture).<ref name="CDC2013S">{{cite web |date=January 9, 2013 |title=Tetanus Symptoms and Complications |url=https://www.cdc.gov/tetanus/about/symptoms-complications.html |url-status=live |archive-url=https://web.archive.org/web/20150212225108/http://www.cdc.gov/tetanus/about/symptoms-complications.html |archive-date=12 February 2015 |access-date=12 February 2015 |publisher=Centers for Disease Control and Prevention}}</ref> Other symptoms of tetanus may include [fever](/source/fever), [sweating](/source/sweating), [headache](/source/headache), [trouble swallowing](/source/dysphagia), [high blood pressure](/source/hypertension), and a [fast heart rate](/source/tachycardia). The onset of symptoms is typically 3 to 21 days following infection. Recovery may take months; about 10% of cases prove to be [fatal](/source/death).<ref name=CDC2012Pink>{{cite book|last1=Atkinson|first1=William|title=Tetanus Epidemiology and Prevention of Vaccine-Preventable Diseases|date=May 2012|publisher=Public Health Foundation|isbn=978-0-9832631-3-5|pages=291–300|edition=12|url=https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html|access-date=12 February 2015|url-status=live|archive-url=https://web.archive.org/web/20150213010501/http://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html|archive-date=February 13, 2015}} {{CDC}}</ref>

''C. tetani'' is commonly found in soil, saliva, dust, and manure. The bacteria generally enter through a break in the skin, such as a cut or puncture wound caused by a contaminated object.<ref name="CDC2012Pink" /><ref name="CDC2013C">{{cite web |date=January 9, 2013 |title=Tetanus Causes and Transmission |url=https://www.cdc.gov/tetanus/about/causes-transmission.html |url-status=live |archive-url=https://web.archive.org/web/20150212223308/http://www.cdc.gov/tetanus/about/causes-transmission.html |archive-date=12 February 2015 |access-date=12 February 2015 |publisher=Centers for Disease Control and Prevention}}</ref> They produce [toxin](/source/toxin)s that interfere with normal muscle contractions.<ref name=CDC2013Doc>{{cite web|title=Tetanus For Clinicians|url=https://www.cdc.gov/tetanus/clinicians.html|publisher=Centers for Disease Control and Prevention|access-date=12 February 2015|date=January 9, 2013|url-status=live|archive-url=https://web.archive.org/web/20150212224705/http://www.cdc.gov/tetanus/clinicians.html|archive-date=12 February 2015}}</ref> Diagnosis is based on the presenting signs and symptoms. The disease does not spread between people.<ref name=CDC2012Pink/>

Tetanus can be prevented by [immunization](/source/immunization) with the [tetanus vaccine](/source/tetanus_vaccine). In those with a significant wound and who have had fewer than three doses of the vaccine, both vaccination and [tetanus immune globulin](/source/tetanus_immune_globulin) are recommended. The wound should be cleaned, and any dead tissue removed. In those who are infected, tetanus immune globulin, or, if unavailable, [intravenous immunoglobulin](/source/intravenous_immunoglobulin) (IVIG) is used.<ref name=CDC2012Pink/> [Muscle relaxant](/source/Muscle_relaxant)s may be used to control spasms. [Mechanical ventilation](/source/Mechanical_ventilation) may be required if a person's breathing is affected.<ref name=CDC2013Doc/>

Tetanus occurs in all parts of the world but is most frequent in hot and wet climates where the soil has a high organic content.<ref name=CDC2012Pink/> In 2015, there were about 209,000 infections and about 59,000 deaths globally.<ref name=GBD2015Pre>{{cite journal |vauthors=Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, etal |collaboration=GBD 2015 Disease and Injury Incidence and Prevalence Collaborators |title=Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=The Lancet |volume=388 |issue=10053 |pages=1545–1602 |date=October 2016 |pmid=27733282 |pmc=5055577 |doi=10.1016/S0140-6736(16)31678-6}}</ref><ref name=GBD2015De>{{cite journal |vauthors=Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, etal |collaboration=GBD 2015 Mortality and Causes of Death Collaborators |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=The Lancet |volume=388 |issue=10053 |pages=1459–1544 |date=October 2016 |pmid=27733281 |pmc=5388903 |doi=10.1016/S0140-6736(16)31012-1}}</ref> This is down from 356,000 deaths in 1990.<ref name=GBD2014>{{cite journal |vauthors=Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, etal |collaboration=GBD 2013 Mortality and Causes of Death Collaborators |title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 |journal=The Lancet |volume=385 |issue=9963 |pages=117–71 |date=January 2015 |pmid=25530442 |pmc=4340604 |doi=10.1016/S0140-6736(14)61682-2}}</ref> In the US, since 2010, there have been less than 40 reported cases each year, almost all of which were in people who had not been vaccinated.<ref>{{cite web |title=Tetanus Surveillance and Trends |url=https://www.cdc.gov/tetanus/php/surveillance/index.html |publisher=Centers for Disease Control and Prevention |access-date=21 May 2026}}</ref> An early description of the disease was made by [Hippocrates](/source/Hippocrates) in the 5th century BC. The cause of the disease was determined in 1884 by [Antonio Carle](/source/Antonio_Carle) and [Giorgio Rattone](/source/Giorgio_Rattone) at the [University of Turin](/source/University_of_Turin), and a [vaccine](/source/vaccine) was developed in 1924.<ref name=CDC2012Pink/>

== Signs and symptoms ==

Tetanus often begins with mild [spasm](/source/spasm)s in the [jaw muscles](/source/Muscles_of_mastication)—also known as lockjaw. Similar spasms can also be a feature of [trismus](/source/trismus).<ref name="OCF">{{cite web |title=Trismus – The Oral Cancer Foundation |date=19 September 2016 |url=https://oralcancerfoundation.org/complications/trismus/ |access-date=5 April 2022}}</ref> The spasms can also affect the [facial muscles](/source/facial_muscles), resulting in an appearance called ''[risus sardonicus](/source/risus_sardonicus)''. Chest, neck, back, abdominal muscles, and buttocks may be affected. [Back muscle](/source/Human_back) spasms often cause arching, called [opisthotonus](/source/opisthotonus). Sometimes, the spasms affect [muscles utilized during inhalation and exhalation](/source/Muscles_of_respiration), which can lead to breathing problems.<ref name=CDC2020Pink>{{cite web |title=Tetanus - Epidemiology of Vaccine-Preventable Diseases |publisher=Centers for Disease Control and Prevention |date=2020-05-10 |url=https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html |archive-url=https://web.archive.org/web/20200510154018/https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html |archive-date=2020-05-10 |url-status=live |access-date=2020-05-18|quote=Laryngospasm (spasm of the vocal cords) and/or spasm of the muscles of respiration leads to interference with breathing.}}</ref>

Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups, called [tetany](/source/tetany). These episodes can cause fractures and muscle tears. Other symptoms include [fever](/source/fever), [headache](/source/headache), restlessness, [irritability](/source/irritability), feeding difficulties, [breathing problems](/source/respiratory_failure), [burning sensation during urination](/source/dysuria), [urinary retention](/source/urinary_retention), and [loss of stool control](/source/Fecal_incontinence).<ref>{{Cite book| vauthors=Schleiss MR |title=Nelson Textbook of Pediatrics|editor=Kliegman, Robert |publisher=Elsevier |year=2020|isbn=978-0-323-52950-1 |page=6253|chapter=Chapter 238: Tetanus}}</ref>

Even with treatment, about 10% of people who contract tetanus die.<ref name=CDC2012Pink/> The [mortality rate](/source/mortality_rate) is higher in unvaccinated individuals, and in people over 60 years of age.<ref name=CDC2012Pink/>

=== Incubation period ===
The [incubation period](/source/incubation_period) of tetanus may be up to several months, but is usually about ten days.<ref name="pmid12850356">{{cite journal |vauthors=Vandelaer J, Birmingham M, Gasse F, Kurian M, Shaw C, Garnier S |title=Tetanus in developing countries: an update on the Maternal and Neonatal Tetanus Elimination Initiative |journal=Vaccine |volume=21 |issue=24 |pages=3442–5 |date=July 2003 |pmid=12850356 |doi=10.1016/S0264-410X(03)00347-5}}</ref><ref name="pmid12122532">{{cite journal |vauthors=Brauner JS, Vieira SR, Bleck TP |title=Changes in severe accidental tetanus mortality in the ICU during two decades in Brazil |journal=Intensive Care Medicine |volume=28 |issue=7 |pages=930–5 |date=July 2002 |pmid=12122532 |doi=10.1007/s00134-002-1332-4 |s2cid=21772357 |doi-access=free}}</ref> In general, the farther the injury site is from the [central nervous system](/source/central_nervous_system), the longer the incubation period. Shorter incubation periods will have more severe symptoms.<ref name=Farrar>{{cite journal |vauthors=Farrar JJ, Yen LM, Cook T, Fairweather N, Binh N, Parry J, Parry CM |title=Tetanus |journal=Journal of Neurology, Neurosurgery and Psychiatry |volume=69 |issue=3 |pages=292–301 |date=September 2000 |pmid=10945801 |pmc=1737078 |doi=10.1136/jnnp.69.3.292}}</ref> In ''[trismus nascentium](/source/Neonatal_tetanus)'' (i.e., neonatal tetanus), symptoms usually appear from 4 to 14 days after birth, averaging about 7 days. Based on clinical findings, four different forms of tetanus have been described.<ref name=CDC2012Pink/>

=== Generalized tetanus ===
Generalized tetanus is the most common type, representing about 80% of cases. The generalized form usually presents with a descending pattern. The first sign is trismus or lockjaw, then facial spasms (called ''[risus sardonicus](/source/risus_sardonicus)),'' followed by stiffness of the neck, difficulty in swallowing, and rigidity of pectoral and [calf](/source/Calf_(anatomy)) muscles. Other symptoms include elevated temperature, sweating, elevated [blood pressure](/source/blood_pressure), and episodic rapid heart rate. [Spasm](/source/Spasm)s may occur frequently and last for several minutes, with the body shaped into a characteristic form called [opisthotonos](/source/opisthotonos). Spasms continue for up to four weeks, and complete recovery may take months.<ref name=CDC2012Pink/>

=== Neonatal tetanus ===
{{main|Neonatal tetanus}}
Neonatal tetanus (''trismus nascentium'') is a form of generalized tetanus that occurs in newborns, usually those born to mothers who themselves have not been vaccinated. If the mother has been vaccinated against tetanus, the infants acquire protection through [passive immunity](/source/passive_immunity).<ref>{{cite web|url=http://www.wpro.who.int/immunization/factsheets/tetanus_nt/en/|title=Tetanus and neonatal tetanus (NT)|publisher=WHO Western Pacific Region|archive-url=https://web.archive.org/web/20140503223407/http://www.wpro.who.int/immunization/factsheets/tetanus_nt/en/|archive-date=2014-05-03}}</ref> It usually occurs through infection of the unhealed [umbilical stump](/source/Umbilical_cord), particularly when the stump is cut with a non-sterile instrument. As of 1998, neonatal tetanus was common in many [developing countries](/source/Developing_country), and was responsible for about 14% (215,000) of all neonatal deaths.<ref name="WHO_2000">{{cite web |title=Maternal and Neonatal Tetanus Elimination by 2005 |date=November 2000 |publisher=UNICEF |url=http://www.unicef.org/immunization/files/MNTE_strategy_paper.pdf |access-date=2007-01-26 |url-status=live |archive-url=https://web.archive.org/web/20070111051802/http://www.unicef.org/immunization/files/MNTE_strategy_paper.pdf |archive-date=2007-01-11}}</ref> In 2010, the worldwide death toll was approximately 58,000 newborns. As a result of a public health campaign, the death toll from neonatal tetanus was reduced by 90% between 1990 and 2010. By 2013, the disease had been largely eliminated from all but 25 countries.<ref name="elimination">{{cite web|url=http://www.unicef.org/health/index_43509.html|title=Elimination of Maternal and Neonatal Tetanus|publisher=UNICEF|access-date=17 February 2014|url-status=live|archive-url=https://web.archive.org/web/20140221230401/http://www.unicef.org/health/index_43509.html|archive-date=21 February 2014}}</ref> Neonatal tetanus is rare in [developed countries](/source/Developed_country).

=== Local tetanus ===
Local tetanus is an uncommon form of the disease, in which people have persistent muscle contractions in the same anatomic area as the injury. The contractions may persist for many weeks before gradually subsiding. Local tetanus is generally milder; only about 1% of cases are fatal, but it may precede the onset of generalized tetanus.<ref name="CDC2012Pink" />

=== Cephalic tetanus ===
Cephalic tetanus is the rarest form of the disease (0.9–3% of cases),<ref name=doshi >{{cite journal |vauthors=Doshi A, Warrell C, Dahdaleh D, Kullmann D |title=Just a graze? Cephalic tetanus presenting as a stroke mimic |journal=Practical Neurology |volume=14 |issue=1 |pages=39–41 |date=February 2014 |pmid=24052566 |doi=10.1136/practneurol-2013-000541 |s2cid=32389452}}</ref> and is limited to muscles and nerves in the head.<ref name=morales >{{cite journal |vauthors=Del Pilar Morales E, Bertrán Pasarell J, Cardona Rodriguez Z, Almodovar Mercado JC, Figueroa Navarro A |title=Cephalic tetanus following penetrating eye trauma: a case report |journal=Boletin Asociacion Medica de Puerto Rico |volume=106 |issue=2 |pages=25–9 |date=2014 |pmid=25065047}}</ref> It usually occurs after trauma to the head area, including: [skull fracture](/source/skull_fracture),<ref name=adeleye >{{cite journal |vauthors=Adeleye AO, Azeez AL |title=Fatal tetanus complicating an untreated mild open head injury: a case-illustrated review of cephalic tetanus |journal=Surgical Infections |volume=13 |issue=5 |pages=317–20 |date=October 2012 |pmid=23039234 |doi=10.1089/sur.2011.023}}</ref> laceration,<ref name=adeleye /> eye injury,<ref name=morales /> [dental extraction](/source/dental_extraction),<ref name=ajayi >{{cite journal |vauthors=Ajayi E, Obimakinde O |title=Cephalic tetanus following tooth extraction in a woman from Nigeria. |journal=Journal of Neurosciences in Rural Practice |volume=2 |issue=2 |pages=201–2 |date=July 2011 |pmid=21897694 |pmc=3159367 |doi=10.4103/0976-3147.83597 |doi-access=free}}</ref> and [otitis media](/source/otitis_media),<ref name="pmid23468033">{{cite journal |vauthors=Ugwu GI, Okolugbo NE |title=Otogenic tetanus: case series |journal=West Africa Journal of Medicine |volume=31 |issue=4 |pages=277–9 |date=2012 |pmid=23468033}}</ref> but it has been observed from injuries to other parts of the body.<ref name="pmid23346010">{{cite journal |vauthors=Kwon JC, Park Y, Han ZA, Song JE, Park HS |title=Trismus in cephalic tetanus from a foot injury |journal=The Korean Journal of Internal Medicine |volume=28 |issue=1 |page=121 |date=January 2013 |pmid=23346010 |pmc=3543954 |doi=10.3904/kjim.2013.28.1.121}}</ref> Paralysis of the [facial nerve](/source/facial_nerve) is most frequently implicated, which may cause lockjaw, [facial palsy](/source/Bell's_palsy), or [ptosis](/source/Ptosis_(eyelid)), but other cranial nerves can also be affected.<ref name=ajayi /><ref name=seo >{{cite journal |vauthors=Seo DH, Cho DK, Kwon HC, Kim TU |title=A case of cephalic tetanus with unilateral ptosis and facial palsy |journal=Annals of Rehabilitation Medicine |volume=36 |issue=1 |pages=167–70 |date=February 2012 |pmid=22506253 |pmc=3309317 |doi=10.5535/arm.2012.36.1.167}}</ref> Cephalic tetanus may progress to a more generalized form of the disease.<ref name=doshi /><ref name=seo /> Due to its rarity, clinicians may be unfamiliar with the clinical presentation and may not suspect tetanus as the illness.<ref name=morales /> Treatment can be complicated, as symptoms may be concurrent with the initial injury that caused the infection.<ref name=adeleye /> Cephalic tetanus is more likely than other forms of tetanus to be fatal, with the progression to generalized tetanus carrying a 15–30% case fatality rate.<ref name=doshi /><ref name=adeleye /><ref name=seo />

== Cause ==
[[File:Clostridium Tetani.svg|thumb|''Clostridium tetani'' is durable due to its [endospore](/source/endospore)s. Pictured is the bacterium alone, with a spore being produced, and the spore alone.]]

''[Clostridium tetani](/source/Clostridium_tetani)'' bacteria cause tetanus.<ref name=CDC2012Pink/> The disease is an international health problem, as ''C.&nbsp;tetani'' [endospore](/source/endospore)s are ubiquitous. Endospores can be introduced into the body through a puncture wound ([penetrating trauma](/source/penetrating_trauma)). Since ''C.&nbsp;tetani'' is an anaerobic bacterium, it and its endospores thrive in environments that lack [oxygen](/source/oxygen), such as a puncture wound. With the changes in oxygen levels, the turkey drumstick-shaped endospore can quickly spread.<ref>{{cite journal |vauthors=Hanif H, Anjum A, Ali N, Jamal A, Imran M, Ahmad B, Ali MI |title=Isolation and Antibiogram of Clostridium tetani from Clinically Diagnosed Tetanus Patients |journal=The American Journal of Tropical Medicine and Hygiene |volume=93 |issue=4 |pages=752–6 |date=October 2015 |pmid=26175031 |pmc=4596594 |doi=10.4269/ajtmh.15-0040}}</ref>

The disease occurs almost exclusively in people who are inadequately immunized.<ref name="Baron">{{cite book|chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK8219/|title=Baron's Medical Microbiology|publisher=Univ of Texas Medical Branch|year=1996|isbn=978-0-9631172-1-2|chapter=Clostridia: Sporeforming Anaerobic Bacilli|vauthors=Wells CL, Wilkins TD|pmid=21413315 |veditors=Baron S|url-status=live|archive-url=https://web.archive.org/web/20090206221707/http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1099|archive-date=2009-02-06}}</ref> It is more common in hot, damp climates with soil rich in [organic matter](/source/Soil_organic_matter). [Manure](/source/Manure)-treated soils may contain spores, as they are widely distributed in the intestines and feces of many animals, such as horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens.<ref name=CDC2012Pink/> In agricultural areas, a significant number of human adults may harbor the organism.<ref>{{cite web |title=Pinkbook: Tetanus {{!}} CDC |url=https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html |publisher=Centers for Disease Control and Prevention |access-date=28 September 2021 |language=en-us |date=17 August 2021}}</ref>

The spores can also be found on skin surfaces and in contaminated [heroin](/source/heroin).<ref name=CDC2012Pink/> Rarely, tetanus can be contracted through surgical procedures, intramuscular injections, compound fractures, and dental infections.<ref name=CDC2012Pink/> Animal bites can transmit tetanus.<ref name=CDC2012Pink/>

Tetanus is often associated with [rust](/source/rust), especially rusty nails. Although rust itself does not cause tetanus, rusty objects are often found outdoors or in places where soil bacteria are present. Additionally, the rough surface of rusty metal provides crevices for dirt containing [''C.&nbsp;tetani''](/source/Clostridium_tetani), while a nail affords a means to puncture the skin and deliver endospores deep within the body at the site of the wound.<ref>{{cite web|url=http://science.howstuffworks.com/science-vs-myth/everyday-myths/rusty-nail-tetanus1.htm|title=Causes of Tetanus|website=HowStuffWorks| vauthors=Edmonds M |access-date=9 November 2015|url-status=live|archive-url=https://web.archive.org/web/20151122031152/http://science.howstuffworks.com/science-vs-myth/everyday-myths/rusty-nail-tetanus1.htm|archive-date=22 November 2015|date=2009-07-29}}</ref> An [endospore](/source/endospore) is a non-metabolizing survival structure that begins to metabolize and cause infection once in an adequate environment. Hence, stepping on a nail (rusty or not) may result in a tetanus infection, as the low-oxygen (anaerobic) environment may exist under the skin, and the puncturing object can deliver endospores to a suitable environment for growth.<ref>{{cite web|url=http://textbookofbacteriology.net/themicrobialworld/Tetanus.html|title=Tetanus| vauthors=Todar K |publisher=University of Wisconsin, Madison - Dept. of Bacteriology|work=Lectures in Microbiology|archive-url=https://web.archive.org/web/20130311070553/http://textbookofbacteriology.net/themicrobialworld/Tetanus.html|archive-date=2013-03-11}}</ref> It is a [common misconception](/source/List_of_common_misconceptions) that rust itself is the cause; a related misconception is that a puncture from a rust-free nail is not a risk.<ref>{{cite news |url=https://nytimes.com/2005/02/22/health/the-claim-stepping-on-a-rusty-nail-can-cause-tetanus.html |title=The Claim: Stepping on a Rusty Nail Can Cause Tetanus |vauthors=O'Connor A |date=February 22, 2005 |newspaper=[The New York Times](/source/The_New_York_Times)}}</ref><ref name="Jennings2013">{{cite book|vauthors=Jennings K|title=Because I Said So!: The Truth Behind the Myths, Tales, and Warnings Every Generation Passes Down to Its Kids|url=https://books.google.com/books?id=udIPAQAAQBAJ&pg=PA13|date=2013-10-08|publisher=Simon and Schuster|isbn=978-1-4767-0696-2|pages=13–}}</ref>

== Pathophysiology ==
thumb|upright=1.4|A neurotransmitter-filled vesicle before and after exposure to the tetanus toxin. The cleavage of the VAMP protein by the toxin inhibits vesicle fusion and neurotransmitter release into the synapse.
Tetanus [neurotoxin](/source/neurotoxin) (TeNT) binds to the [presynaptic membrane](/source/presynaptic_membrane) of the [neuromuscular junction](/source/neuromuscular_junction), is internalized, and is transported back through the axon until it reaches the [central nervous system](/source/central_nervous_system).<ref name=":0">{{cite journal |vauthors=Pellizzari R, Rossetto O, Schiavo G, Montecucco C |title=Tetanus and botulinum neurotoxins: mechanism of action and therapeutic uses |journal=Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences |volume=354 |issue=1381 |pages=259–68 |date=February 1999 |pmid=10212474 |pmc=1692495 |doi=10.1098/rstb.1999.0377 |veditors=Clementi F, Fesce R}}</ref><ref name="Sudarshan"/> Here, it selectively binds to and is transported into inhibitory neurons via [endocytosis](/source/endocytosis).<ref name=":1">{{cite journal |vauthors=Montecucco C, Schiavo G, Meldolesi J, Valtorta F |title=Mechanism of action of tetanus and botulinum neurotoxins |journal=Molecular Microbiology |volume=13 |issue=1 |pages=1–8 |date=July 1994 |pmid=7527117 |doi=10.1111/j.1365-2958.1994.tb00396.x |s2cid=45069991 |doi-access=free}}</ref> It then leaves the vesicle for the neuron cytosol, where it cleaves [vesicle associated membrane protein](/source/Vesicle-associated_membrane_protein) (VAMP) [synaptobrevin](/source/synaptobrevin), which is necessary for membrane fusion of small synaptic vesicles (SSV's).<ref name=":0" /> SSV's carry [neurotransmitter](/source/neurotransmitter) to the membrane for release, so inhibition of this process blocks neurotransmitter release.<ref>{{Cite journal |last=Jung |first=Jae Hoon |date=2019-05-31 |title=Synaptic Vesicles Having Large Contact Areas with the Presynaptic Membrane are Preferentially Hemifused at Active Zones of Frog Neuromuscular Junctions Fixed during Synaptic Activity |journal=International Journal of Molecular Sciences |volume=20 |issue=11 |page=2692 |doi=10.3390/ijms20112692 |doi-access=free |issn=1422-0067 |pmc=6600287 |pmid=31159267}}</ref>

Tetanus toxin specifically blocks the release of the neurotransmitters [GABA](/source/Gamma-Aminobutyric_acid) and [glycine](/source/glycine) from inhibitory neurons. These neurotransmitters stop overactive motor neurons from firing and also play a role in muscle relaxation after contraction. When inhibitory neurons are unable to release their neurotransmitters, motor neurons fire out of control, and muscles have difficulty relaxing. This causes the muscle spasms and [spastic paralysis](/source/Spasticity) seen in tetanus infection.<ref name=":0" />

The tetanus toxin, [tetanospasmin](/source/tetanospasmin), is made up of a heavy chain and a light chain. There are three domains, each of which contributes to the toxin's pathophysiology.<ref name=":2">{{cite journal |vauthors=Masuyer G, Conrad J, Stenmark P |title=The structure of the tetanus toxin reveals pH-mediated domain dynamics |journal=EMBO Reports |volume=18 |issue=8 |pages=1306–1317 |date=August 2017 |pmid=28645943 |pmc=5538627 |doi=10.15252/embr.201744198}}</ref> The heavy chain has two domains. The N-terminal side of the heavy chain helps with membrane translocation, and the C-terminal side helps the toxin locate the specific receptor site on the correct neuron. The light chain domain cleaves the VAMP protein once it arrives in the inhibitory neuron cytosol.<ref name=":2" />

There are four main steps in tetanus's mechanism of action: binding to the neuron, internalization of the toxin, membrane translocation, and cleavage of the target VAMP.<ref>{{cite book |last=Plumlee |first=Konnie H. |chapter=18 - Biotoxins |date=2004-01-01 |url=https://www.sciencedirect.com/science/article/pii/B032301125X500212 |title=Clinical Veterinary Toxicology |pages=98–116 |editor-last=Plumlee |editor-first=Konnie H. |place=Saint Louis |publisher=Mosby |language=en |isbn=978-0-323-01125-9 |access-date=2022-06-21}}</ref>

=== Neurospecific binding ===

The toxin travels from the wound site to the [neuromuscular junction](/source/neuromuscular_junction) through the bloodstream, where it binds to the [presynaptic membrane](/source/presynaptic_membrane) of a [motor neuron](/source/motor_neuron). The heavy chain C-terminal domain aids in binding to the correct site, recognizing and binding to the correct [glycoprotein](/source/glycoprotein)s and [glycolipid](/source/glycolipid)s in the presynaptic membrane. The toxin binds to a site that is taken into the neuron as an [endocytic vesicle](/source/Endocytosis), which will travel down the axon, past the cell body, and down the dendrites to the dendritic terminal at the spine and central nervous system. Here, it will be released into the [synaptic cleft](/source/synaptic_cleft) and allowed to bind to the presynaptic membrane of inhibitory neurons in a similar manner to binding to the motor neuron.<ref name=":1" />

=== Internalization ===

Tetanus toxin is then internalized again via [endocytosis](/source/endocytosis), this time, in an acidic vesicle.<ref name=":2" /> In a mechanism not well understood, [depolarization](/source/depolarization) caused by the firing of the inhibitory neuron causes the toxin to be pulled into the neuron inside vesicles.{{citation needed|date=June 2021}}

=== Membrane translocation ===

The toxin then needs a way to exit the vesicle and enter the neuron cytosol to act on its target. The low pH of the vesicle lumen causes a conformational change in the toxin, shifting it from a water-soluble form to a [hydrophobic](/source/Hydrophobe) form.<ref name=":1" /> With the hydrophobic patches exposed, the toxin can slide into the vesicle membrane. The toxin forms an [ion channel](/source/ion_channel) in the membrane that is nonspecific for Na<sup>+</sup>, K<sup>+</sup>, Ca<sup>2+</sup>, and Cl<sup>−</sup> ions.<ref name=":0" /> There is a consensus among experts that this new channel is involved in the translocation of the toxin's light chain from the inside of the vesicle to the neuron [cytosol](/source/cytosol). The mechanism is not well understood or agreed upon. It has been proposed that the channel could allow the light chain (unfolded from the low pH environment) to leave through the toxin pore,<ref>{{cite journal |vauthors=Beise J, Hahnen J, Andersen-Beckh B, Dreyer F |title=Pore formation by tetanus toxin, its chain, and fragments in neuronal membranes and evaluation of the underlying motifs in the structure of the toxin molecule |journal=Naunyn-Schmiedeberg's Archives of Pharmacology |volume=349 |issue=1 |pages=66–73 |date=January 1994 |pmid=8139702 |doi=10.1007/BF00178208 |s2cid=9398335}}</ref> or that the pore could alter the [electrochemical gradient](/source/electrochemical_gradient) enough, by letting in or out ions, to cause [osmotic lysis](/source/Cytolysis) of the [vesicle](/source/Vesicle_(biology_and_chemistry)), spilling the vesicle's contents.<ref>{{cite journal |vauthors=Cabiaux V, Lorge P, Vandenbranden M, Falmagne P, Ruysschaert JM |title=Tetanus toxin induces fusion and aggregation of lipid vesicles containing phosphatidylinositol at low pH |journal=Biochemical and Biophysical Research Communications |volume=128 |issue=2 |pages=840–9 |date=April 1985 |pmid=3994725 |doi=10.1016/0006-291X(85)90123-8 |bibcode=1985BBRC..128..840C}}</ref>

=== Enzymatic target cleavage ===

The light chain of the tetanus toxin is zinc-dependent [protease](/source/protease). It shares a common zinc protease motif (His-Glu-Xaa-Xaa-His) that researchers hypothesized was essential for target cleavage until this was more recently confirmed by experiment: when all [zinc](/source/zinc) was removed from the neuron with heavy metal [chelators](/source/Chelation), the toxin was inhibited, only to be reactivated when the zinc was added back in.<ref name=":0" /> The light chain binds to VAMP, and cleaves it between Gln<sup>76</sup> and Phe<sup>77</sup>. Without VAMP, vesicles holding the neurotransmitters needed for motor neuron regulation ([GABA](/source/Gamma-Aminobutyric_acid) and [glycine](/source/glycine)) cannot be released, causing the above-mentioned deregulation of [motor neurons](/source/Motor_neuron) and muscle tension.<ref>{{cite journal |vauthors=Foran P, Shone CC, Dolly JO |title=Differences in the protease activities of tetanus and botulinum B toxins revealed by the cleavage of vesicle-associated membrane protein and various sized fragments |journal=Biochemistry |volume=33 |issue=51 |pages=15365–74 |date=December 1994 |pmid=7803399 |doi=10.1021/bi00255a017}}</ref>

==Diagnosis==
There are currently no blood tests for diagnosing tetanus. The diagnosis is based on the presentation of tetanus symptoms. It does not depend upon isolation of the bacterium, which is recovered from the wound in only 30% of cases. ''C.&nbsp;tetani'' can be isolated from people without tetanus. Laboratory identification of ''C.&nbsp;tetani'' can be demonstrated only by the production of [tetanospasmin](/source/tetanospasmin) in mice.<ref name=CDC2012Pink/> Having recently experienced head trauma may indicate cephalic tetanus--a rare form of tetanus resulting in weakened facial muscles and spasms--if no other diagnosis has been made.<ref>{{Cite web |title=Tetanus - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/tetanus/symptoms-causes/syc-20351625#:~:text=Cephalic%20tetanus,can%20progress%20to%20generalized%20tetanus. |access-date=2025-01-28 |publisher=Mayo Clinic |language=en}}</ref>

The "spatula test" is a clinical test for tetanus that involves touching the [posterior](/source/Anatomical_terms_of_location) [pharyngeal](/source/Pharynx) wall with a soft-tipped instrument and observing the effect. A positive test result is the involuntary contraction of the jaw (biting down on the "spatula"), and a negative test result would normally be a [gag reflex](/source/Pharyngeal_reflex) attempting to expel the foreign object. A short report in ''The American Journal of Tropical Medicine and Hygiene'' states that, in an affected subject research study, the spatula test had a high [specificity](/source/Sensitivity_and_specificity) (zero [false-positive](/source/False_positives_and_false_negatives) test results) and a high [sensitivity](/source/Sensitivity_and_specificity) (94% of infected people produced a positive test).<ref name="AJTMH1995">{{cite journal |title=Short Report: The Spatula Test: A Simple Bedside Test to Diagnose Tetanus |vauthors=Apte NM, Karnad DR |date=October 1995 |volume=53 |issue=4 |journal=American Journal of Tropical Medicine and Hygiene |pages=386–7 |pmid=7485691 |doi=10.4269/ajtmh.1995.53.386}}</ref>

== Prevention ==
Unlike many infectious diseases, recovery from naturally acquired tetanus does not usually result in [immunity](/source/immunity_(medical)). This is due to the extreme potency of tetanospasmin. Tetanospasmin will likely be lethal before it provokes an immune response.<ref>{{cite web| title=CDC Pink Book Chapter 21: Tetanus| url=https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html| website=CDC.gov| date=August 2021| access-date=18 March 2023}}</ref>

Tetanus can be prevented by [vaccination](/source/vaccination) with [tetanus toxoid](/source/tetanus_vaccine).<ref name=MMWR_1991>{{cite journal |title=Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures. Recommendations of the Immunization Practices Advisory Committee (ACIP) |journal=MMWR Recommendations and Reports |volume=40 |issue=RR-10 |pages=1–28 |date=August 1991 |pmid=1865873}}</ref> The [CDC](/source/Centers_for_Disease_Control_and_Prevention) recommends that adults receive a [booster shot](/source/booster_shot) every ten years,<ref name=CDC2012Pink/> and standard care practice in many places is to give the booster to any person with a puncture wound who is uncertain of when they were last vaccinated, or if they have had fewer than three lifetime doses of the vaccine. The booster may not prevent a potentially fatal case of tetanus from the current wound, as it can take up to two weeks for tetanus antibodies to form.<ref name="pmid1574917">{{cite journal |vauthors=Porter JD, Perkin MA, Corbel MJ, Farrington CP, Watkins JT, Begg NT |title=Lack of early antitoxin response to tetanus booster |journal=Vaccine |volume=10 |issue=5 |pages=334–6 |date=1992 |pmid=1574917 |doi=10.1016/0264-410X(92)90373-R}}</ref>

In children under the age of seven, the tetanus vaccine is often administered as a combined vaccine, [DPT/DTaP vaccine](/source/DPT_vaccine), which also includes vaccines against [diphtheria](/source/diphtheria) and [pertussis](/source/pertussis). For adults and children over seven, the [Td vaccine](/source/Td_vaccine) (tetanus and diphtheria) or Tdap (tetanus, diphtheria, and acellular pertussis) is commonly used.<ref name=MMWR_1991 />

The [World Health Organization](/source/World_Health_Organization) certifies countries as having eliminated maternal or [neonatal tetanus](/source/neonatal_tetanus). Certification requires at least 2 years of rates of 1 case or fewer per 1,000 live births. In 1998 in [Uganda](/source/Uganda), 3,433 tetanus cases were recorded in newborn babies; of these, 2,403 died. After a major public health effort, Uganda was certified as having eliminated maternal and neonatal tetanus in 2011.<ref>{{cite web |url=http://www.unicef.org/uganda/media_9662.html |title=Uganda announces elimination of Maternal and Neonatal Tetanus |access-date=2011-07-14 |url-status=live |archive-url=https://web.archive.org/web/20150211184728/http://www.unicef.org/uganda/media_9662.html |archive-date=2015-02-11}}</ref>

===Post-exposure prophylaxis===
Tetanus toxoid can be given in cases of suspected tetanus exposure. In such cases, it can be given with or without tetanus [immunoglobulin](/source/immunoglobulin) (also called ''tetanus antibodies'' or ''tetanus antitoxin'').<ref name=britannica2013/>) It can be given as [intravenous therapy](/source/intravenous_therapy) or by [intramuscular injection](/source/intramuscular_injection).<ref>{{cite book |last1=Rabadi |first1=Thomas |chapter=Tetanus Toxoid |date=2024 |title=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK557415/ |access-date=2024-06-23 |place=Treasure Island, Fla. |publisher=StatPearls Publishing |pmid=32491347 |last2=Brady |first2=Mark F.}}</ref>

The guidelines for such events in the United States for people at least 11 years old (and not pregnant) are as follows:<ref name=CDC2012Pink/>

{| class="wikitable"
! Vaccination status !! Clean, minor wounds !! All other wounds
|-
| Unknown or less than 3 doses of tetanus toxoid containing vaccine || [Tdap](/source/Tdap) and recommend catch-up vaccination || [Tdap](/source/Tdap) and recommend catch-up vaccination<br /> Tetanus [immunoglobulin](/source/immunoglobulin)
|-
| 3 or more doses of tetanus toxoid-containing vaccine AND less than 5 years since the last dose
|| No indication || No indication
|-
| 3 or more doses of tetanus toxoid-containing vaccine AND 5–10 years since the last dose
|| No indication || Tdap preferred (if not yet received) or [Td](/source/DPT_vaccine)
|-
| 3 or more doses of tetanus toxoid-containing vaccine AND more than 10 years since the last dose
|| Tdap preferred (if not yet received) or [Td](/source/DPT_vaccine) || Tdap preferred (if not yet received) or Td
|}

==Treatment==
thumb|upright=1.3|Tetanus deaths per million persons in 2012{{Div col|small=yes|colwidth=10em}}{{legend|#ffff20|0–1}}{{legend|#ffa020|1–2}}{{legend|#ff9a20|2–3}}{{legend|#f08015|4–8}}{{legend|#e06815|9–13}}{{legend|#d85010|14–28}}{{legend|#d02010|29–151}}{{div col end}}Treatment of adult tetanus was covered in a state-of-the-art review in 2025.<ref name="Sudarshan">{{Cite journal |last1=Sudarshan |first1=Raghav |last2=Sayo |first2=Ana Ria |last3=Renner |first3=David Roman |last4=Saram |first4=Sophia de |last5=Godbole |first5=Gauri |last6=Warrell |first6=Clare |last7=Duong |first7=Ha Thi Hai |last8=Thwaites |first8=C. Louise |last9=Mehta |first9=Arpan R. |last10=Coughlan |first10=Charles |date=2025-06-18 |title=Tetanus: recognition and management |journal=The Lancet Infectious Diseases |issue=11 |pages=e645–e657 |language=English |volume=25 |doi=10.1016/S1473-3099(25)00292-0 |pmid=40543524 |issn=1473-3099|pmc=7617864}}</ref>

=== Mild tetanus ===
Mild cases of tetanus can be treated with:<ref name="World Health Organization">{{cite web|last=World Health Organization|title=Current recommendations for treatment of tetanus during humanitarian emergencies|url=https://www.who.int/diseasecontrol_emergencies/publications/who_hse_gar_dce_2010.2/en/|work=Disease Control in Humanitarian Emergencies (English)|publisher=WHO|access-date=12 June 2013|archive-url=https://web.archive.org/web/20140313073904/http://www.who.int/diseasecontrol_emergencies/publications/who_hse_gar_dce_2010.2/en/|archive-date=13 March 2014}}</ref>
* [Tetanus immunoglobulin](/source/Tetanus_immunoglobulin) (TIG),<ref name="CDC2012Pink"/> also called ''tetanus antibodies'' or ''tetanus antitoxin.''<ref name=britannica2013>[http://global.britannica.com/EBchecked/topic/588853/tetanus-antitoxin tetanus] in [Encyclopædia Britannica](/source/Encyclop%C3%A6dia_Britannica). Last Updated 7-17-2013</ref> It can be given as [intravenous therapy](/source/intravenous_therapy) or by [intramuscular injection](/source/intramuscular_injection).
* Antibiotic therapy to reduce toxin production. [Metronidazole](/source/Metronidazole) intravenous (IV) is a preferred treatment.<ref name="World Health Organization" />
* [Benzodiazepines](/source/Benzodiazepines) can be used to control muscle spasms. Options include [diazepam](/source/diazepam) and [lorazepam](/source/lorazepam), oral or IV.<ref name="World Health Organization" />

=== Severe tetanus ===
Severe cases will require admission to [intensive care](/source/intensive_care). In addition to the measures listed above for mild tetanus:<ref name="World Health Organization"/>
* Human tetanus immunoglobulin injected [intrathecal](/source/intrathecal)ly (which increases clinical improvement from 4% to 35%).
* [Tracheotomy](/source/Tracheotomy) and [mechanical ventilation](/source/mechanical_ventilation) for 3 to 4 weeks. Tracheotomy is recommended for securing the airway because the presence of an endotracheal tube is a stimulus for spasm.
* [Magnesium sulfate](/source/Magnesium_sulfate_(medical_use)), as an intravenous infusion, to control spasm and autonomic dysfunction.
* [Diazepam](/source/Diazepam) as a continuous IV infusion.
* The [autonomic](/source/Autonomic_nervous_system) effects of tetanus can be difficult to manage (alternating hyper- and [hypotension](/source/hypotension) [hyperpyrexia](/source/hyperpyrexia)/[hypothermia](/source/hypothermia)), and may require IV [labetalol](/source/labetalol), magnesium, [clonidine](/source/clonidine), or [nifedipine](/source/nifedipine).

Drugs, such as diazepam or other [muscle relaxant](/source/muscle_relaxant)s, can be given to control the muscle spasms. In extreme cases, it may be necessary to paralyze the person with [curare](/source/curare)-like drugs, and use a mechanical ventilator.{{citation needed|date=June 2022}}

To survive a tetanus infection, a patent airway must be maintained, and proper [nutrition](/source/nutrition) is required. An intake of {{convert|3500|to|4000|Cal}} and at least 150&nbsp;g of protein per day is often given in liquid form through a tube directly into the stomach ([percutaneous endoscopic gastrostomy](/source/percutaneous_endoscopic_gastrostomy)), or through a drip into a vein ([parenteral nutrition](/source/parenteral_nutrition)). This high-calorie diet is required because of the increased metabolic strain from the increased muscle activity. Full recovery takes 4 to 6 weeks because the body must regenerate destroyed nerve [axon](/source/axon) terminals.<ref>{{Cite web |date=2014-12-31 |title=Tetanus – CheckOrphan |url=https://checkorphan.org/disease/tetanus/ |access-date=2024-09-06 |language=en-US}}</ref>

The antibiotic of choice is [metronidazole](/source/metronidazole). It can be given intravenously, by mouth, or by rectum.<ref>{{cite book|last1=Thwaites|first1=C. Louise|last2=Yen|first2=Lam Minh |editor=J. Larry Jameson|others=Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, Joseph Loscalzo|title=Harrison's Principles of Internal Medicine |edition=Twentieth |volume=1 and 2 |url=https://books.google.com/books?id=XGQntQEACAAJ|date=13 August 2018|publisher=McGraw-Hill Education|isbn=978-1-259-64403-0|chapter=Tetanus|page=2884}}</ref><ref name="World Health Organization"/> Of likewise efficiency is [penicillin](/source/penicillin), but some raise the concern of provoking spasms because it inhibits [GABA receptor](/source/gamma-Aminobutyric_acid), which is already affected by tetanospasmin.<ref>{{cite journal |vauthors=Rodrigo C, Fernando D, Rajapakse S |title=Pharmacological management of tetanus: an evidence-based review |journal=Critical Care |volume=18 |issue=2 |article-number=217 |date=March 2014 |pmid=25029486 |pmc=4057067 |doi=10.1186/cc13797 |publisher=Springer Science and Business Media LLC |doi-access=free}}</ref>

== Epidemiology ==
[[File:Tetanus-deaths-by-age-group.png|thumb|alt=Tetanus deaths between 1990 and 2017 by age group|Tetanus deaths between 1990 and 2017 by age group.<ref>{{cite web |title=Deaths from tetanus, by age |url=https://ourworldindata.org/grapher/tetanus-deaths-by-age-group |website=[Our World in Data](/source/Our_World_in_Data) |access-date=13 January 2020}}</ref>]]
In 2013, it caused about 59,000 deaths—down from 356,000 in 1990.<ref name=GBD2014/> Tetanus, notably the [neonatal](/source/neonatal) form, remains a significant public health problem in non-industrialized countries, with 59,000 newborns dying worldwide in 2008 as a result of neonatal tetanus.<ref>{{cite journal |title=Maternal and Neonatal Tetanus Elimination Initiative |journal=Pampers UNICEF 2010 Campaign |page=2 |url=http://www.unicef.org/corporate_partners/files/APPROVED_MNT_Report_05.06.10.pdf |url-status=live |archive-url=https://web.archive.org/web/20140201172830/http://www.unicef.org/corporate_partners/files/APPROVED_MNT_Report_05.06.10.pdf |archive-date=2014-02-01}}</ref><ref>{{cite journal |vauthors=Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C |display-authors=6 |title=Global, regional, and national causes of child mortality in 2008: a systematic analysis |journal=The Lancet |volume=375 |issue=9730 |pages=1969–87 |date=June 2010 |pmid=20466419 |doi=10.1016/S0140-6736(10)60549-1 |author14=Child Health Epidemiology Reference Group of WHO and UNICEF |s2cid=27812760}}</ref> In the United States, from 2000 through 2007, an average of 31 cases were reported per year.<ref name=CDC2012Pink/> Nearly all of the cases in the United States occur in unimmunized individuals, or individuals who have allowed their [inoculation](/source/inoculation)s to lapse.<ref name=CDC2012Pink/>
{{-}}
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|start        = 2021
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== Other animals ==
Tetanus is found primarily in [goats](/source/Goat) and [sheep](/source/sheep). The following are clinical symptoms found in affected goats and sheep. Extended head and neck, tail rigors 
(tail becomes rigid and straight), abnormal gait (walking becomes stiff and abnormal), arched back, stiffness of the jaw muscles, lockjaw,
twitching of eyes, drooping eyelids, difficulty swallowing, difficulty or inability to eat and drink, abdominal bloat, spasms (uncontrolled muscular contractions) before death.  
Death sometimes is due to asphyxiation, secondary to respiratory paralysis.<ref>{{Cite web |title=Tetanus in Goat and sheep |url=https://bscvet.com/tetanus-in-goat-and-sheep-locked-jaw/ |access-date=2023-07-31 |website=bscvet.com}}</ref>

==History==
Tetanus was well known to ancient civilizations, who recognized the relationship between wounds and fatal muscle spasms.<ref name="PMC1073859">{{cite journal |author=Pearce JM |title=Notes on tetanus (lockjaw) |journal=Journal of Neurology, Neurosurgery, and Psychiatry |volume=60 |issue=3 |page=332 |year=1996 |pmid=8609513 |doi=10.1136/jnnp.60.3.332|pmc=1073859}}</ref> In 1884, [Arthur Nicolaier](/source/Arthur_Nicolaier) isolated the [strychnine](/source/strychnine)-like toxin of tetanus from free-living, anaerobic soil bacteria. The etiology of the disease was further elucidated in 1884 by Antonio Carle and Giorgio Rattone, two pathologists at the [University of Turin](/source/University_of_Turin), who demonstrated, for the first time, the transmissibility of tetanus. They produced tetanus in rabbits by injecting pus from a person with fatal tetanus into their sciatic nerves, and testing their reactions while tetanus was spreading.<ref name=CDC2012Pink/>

In 1891, ''[Clostridium tetani](/source/Clostridium_tetani)'' (''C. tetani'') was isolated from a human victim by [Kitasato Shibasaburō](/source/Kitasato_Shibasabur%C5%8D), who later showed that the organism could produce disease when injected into animals and that the toxin could be neutralized by specific [antibodies](/source/antibodies). In 1897, [Edmond Nocard](/source/Edmond_Nocard) showed that tetanus antitoxin induced [passive immunity](/source/passive_immunity) in humans, and could be used for [prophylaxis](/source/prophylaxis) and treatment. [Tetanus toxoid vaccine](/source/Tetanus_vaccine) was developed by P. Descombey in 1924, and was widely used to prevent tetanus induced by battle wounds during [World War II](/source/World_War_II).<ref name=CDC2012Pink/>

===Etymology===
The word tetanus comes from the Greek {{langx|grc|τέτανος|tetanos|taut|label=none}}, which is further from the Greek {{langx|grc|τείνειν|teinein|to stretch|label=none}}.<ref>[http://www.collinsdictionary.com/dictionary/english/Tetanus tetanus] {{webarchive|url=https://web.archive.org/web/20120626182039/http://www.collinsdictionary.com/dictionary/english/tetanus |date=2012-06-26}}. CollinsDictionary.com. Collins English Dictionary - Complete & Unabridged 11th Edition. Retrieved October 01, 2012</ref>

== Research ==
There is insufficient evidence that tetanus can be treated or prevented by [vitamin C](/source/vitamin_C). This is at least partially because the historical trials conducted to investigate a possible connection between vitamin C and alleviating tetanus patients were of poor quality.<ref>{{cite journal |vauthors=Hemilä H, Koivula T |title=Vitamin C for preventing and treating tetanus |journal=The Cochrane Database of Systematic Reviews |issue=11 |article-number=CD006665 |date=November 2013 |pmid=24226506 |doi=10.1002/14651858.CD006665.pub3 |hdl-access=free |hdl=10138/225863}}</ref>

==See also==
* [Renshaw cell](/source/Renshaw_cell)
* [Tetanized state](/source/Tetanized_state)
{{clear}}

== References ==
{{Reflist}}

==External links==
{{offline|med}}
{{Commons}}
* [https://www.medlineplus.gov/ency/article/000615.htm Tetanus Information from Medline Plus]
* [https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5203a1.htm Tetanus Surveillance -- United States, 1998-2000 (Data and Analysis)]
* {{cite web |url=https://medlineplus.gov/tetanus.html |publisher=U.S. National Library of Medicine |work=MedlinePlus |title=Tetanus}}

{{Medical condition classification and resources
 | ICD10 = {{ICD10|A|33||a|30}}-{{ICD10|A|35||a|30}}
 | ICD9 = {{ICD9|037}}, {{ICD9|771.3}}
 | ICDO =
 | OMIM =
 | MedlinePlus = 000615
 | eMedicineSubj = emerg
 | eMedicineTopic = 574
 | DiseasesDB = 2829
 | MeshID = D013742
}}
{{Gram-positive bacterial diseases}}
{{Authority control}}

Category:Tetanus
Category:Bacterial diseases
Category:Wikipedia medicine articles ready to translate
Category:Wikipedia emergency medicine articles ready to translate
Category:Vaccine-preventable diseases
Category:Articles containing video clips

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Adapted from the Wikipedia article [Tetanus](https://en.wikipedia.org/wiki/Tetanus) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Tetanus?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.