If you have a wound on your hand, be careful! If you don't pay attention, it may endanger your life!

In our daily lives, it is inevitable that our bodies will encounter some "little bumps and stumbles", such as cutting our fingers while cutting vegetables, being pricked by fish bones while cooking, or being accidentally injured by fireworks and firecrackers.

However, these small wounds that are easily overlooked can sometimes be life-threatening .

"A small wooden splinter sent a man to the intensive care unit for a month of rescue" and "A 53-year-old man scratched his toe and was admitted to the ICU" are common real-life news.

Image source: Baidu search

Image source: Baidu search

Image source: Baidu search In the Korean movie “Memories of Murder”, the police officer whose calf was pierced by a nail did not take the wound seriously, and was finally told by the doctor that the only way to save his life was amputation.

Rescue, amputation, death, these are the deadly diseases that are always associated with these terrifying words: tetanus .

01

How dangerous is tetanus?

Tetanus is not a strange word to many people, but as an infectious disease, its high mortality rate is often overlooked. Studies have shown that the mortality rate of severe tetanus patients, especially the elderly and infants, is close to 100% without medical intervention.

Even with active comprehensive treatment, the mortality rate is still as high as 30%-50% worldwide.

For such a dangerous and deadly disease, it is not difficult to find its culprit - Clostridium tetani (commonly known as C. tetani).

Clostridium tetani is the pathogen of tetanus, which is widely distributed in the human environment in the form of spores, in soil mud, rusty ironware, and even in the intestines of mammals.

Due to its strictly anaerobic nature, Clostridium tetani can survive for years in dry soil and dust, but once it encounters the right conditions, its aggressiveness will be revealed.

Generally speaking, three conditions are required for Clostridium tetani to infect humans:

① Open tissue injury with deep wound

Damaged skin and mucous membranes are the most common infection routes, and there are some less common infection routes, such as epidermal wounds, open fractures, chronic wounds, etc.

②Invasion by Clostridium tetani from outside

Tetanus infection is usually caused by wounds caused by contaminated objects, wounds contaminated by dirt, feces, or sputum, puncture wounds caused by rusty nails or needles, burns, crush injuries, and injuries caused by fireworks and firecrackers.

③ There is devitalized tissue in the wound, or local tissue ischemia and hypoxia

The deeper the contaminated wound, the less oxygen there will be. In this anaerobic environment, the spores of Clostridium tetani will quickly grow into proliferative bodies, releasing exotoxins and causing disease.

02

Symptoms of tetanus infection

In fact, Clostridium tetani produces two exotoxins in an anaerobic environment. One is the oxygen-sensitive tetanus hemolytic toxin, and the other is the main pathogenic substance that causes tetanus - tetanospasmodic toxin . It is a neurotoxin with extremely strong toxicity, so infected patients usually experience general discomfort, fatigue, dizziness, chewing weakness, muscle tightness and pain, etc.

However, these are just prodromal symptoms. Since tetanus toxin has a high affinity for the anterior horn cells of the spinal cord and the nerve cells of the brainstem, tetanus patients usually have two obvious symptoms during the actual onset of the disease:

① Generalized muscle rigidity and paroxysmal spasms

After the toxin is released, the muscle poisoning reaction has a sequence: usually first appears in the chewing muscles, followed by the facial expression muscles, the typical manifestation is difficulty in opening the mouth and a wry smile;

Then the muscles of the neck, back, abdomen, and limbs gradually lost control, and the body showed an opisthotonos or lateral opisthotonos posture with the head tilted back;

Finally it reaches the diaphragm and intercostal muscles, causing cyanosis of the face and lips, difficulty breathing, or even breathing arrest.

Image source: Wikipedia, Charles Bell 1809

②Autonomic dysfunction

Early symptoms include sweating and tachycardia, while in the later stages of the disease, symptoms often include profuse sweating, arrhythmias, unstable hypertension or hypotension, and fever.

Image source: Reference [1]

Each attack lasts from a few seconds to a few minutes. The duration of muscle spasms in generalized tetanus is generally 3-4 weeks. Sometimes severe muscle spasms can even cause muscle rupture or even fractures.

At the same time, the above-mentioned attacks can be triggered by slight stimulation (such as light, sound, touch, drinking water, etc.), and the more frequent the attacks, the more serious the condition.

03

Facing Tetanus Correctly

Focus on improving awareness and prevention

In clinical types, there are usually three types of tetanus: systemic tetanus accounts for about 88%, local tetanus accounts for about 12%, and cephalic tetanus accounts for about 1%.

Therefore, no matter where the wound occurs on the body, there is a probability of contracting tetanus.

In addition, tetanus is an infectious disease with a short incubation period, mostly around 10 days, and the shorter the incubation period, the more serious the disease.

When there are some small and deep wounds on your body caused by foreign objects, especially when they are accompanied by pollutants such as rust, wood chips, and dirt, you must not be careless.

Although humans have no natural immunity to tetanus, don't panic after being injured. Currently, tetanus infection can be prevented through artificial immunization.

But you need to understand the difference between tetanus vaccine and tetanus shot.

At present, tetanus prevention in my country is achieved through two approaches: active immunization and passive immunization. Tetanus vaccine (TT) belongs to active immunization.

Tetanus vaccine is a "virus toxin" that has been artificially attenuated to reduce toxins and activity before being injected into the body, allowing the immune system to fight the virus first. When the body produces antibodies, it will be able to hit the real virus with one strike.

In order for the human body to reach a sufficient antibody titer level to prevent tetanus infection, at least three consecutive doses of TT-containing vaccines are required. Usually, the first two injections are given 4-8 weeks apart, and the third booster injection is given six months or a year later.

The tetanus vaccine takes a relatively long time to take effect, but the immune effect is more lasting.

Passive immunization is a tetanus shot. One is called human tetanus immunoglobulin (TIG), which is extracted from human blood with tetanus antibodies; the other is called tetanus antitoxin (TAT), which is extracted from the blood of horses that have produced antibodies after being vaccinated.

The tetanus shot is an "antibody body". Since it bypasses the patient's own antibody production process, it is more effective, but it can only maintain the immune effect for a short period of time (TIG is 2-3 weeks, TAT is only 2-4 days). It is generally used for the treatment of tetanus and short-term emergency prevention.

For people who have received tetanus vaccination and are at risk of tetanus infection, five years is generally used as the judgment standard.

If you have completed full immunization within 5 years, it means that your body has a high level of antibody protection and you do not need to get vaccinated or tetanus shots if you have wounds.

If the last dose of the vaccine was given more than 5 years ago, then for low-risk wounds (abrasions or superficial open wounds), you only need to clean the wound and do not need to get vaccinated or given a tetanus shot.

However, if the wound is deep and contaminated, or if it is a head and face infection close to the central part, you need to get another shot of vaccine to increase the antibody level in your body. This is because tetanus is an anaerobic bacillus, and small and deep wounds will form a small local enclosed space, which is suitable for the growth of anaerobic bacteria and makes it easier to get tetanus.

If the last dose of the vaccine was given more than 10 years ago, you will need a booster shot of the vaccine for any type of wound, but you do not need a tetanus shot.

If full immunization has not been completed or the immunization history is unknown, when facing a low-risk wound, the first thing to do is to clean the wound, then get a tetanus vaccine shot, and then get the remaining immunization shots to complete the full immunization of three shots.

If the wound is severely contaminated, it is best to get a tetanus shot within 24 hours to give the body temporary protection, and then get a tetanus vaccine afterwards.

However, if it has been more than 24 hours, it is still recommended to get a tetanus shot. After all, the incubation period of tetanus is between 7 days and several months, so there is still a chance to protect the body at this time.

Image source: Reference [2]

Every year, about 1 million people die from tetanus worldwide, and tetanus seriously threatens human life and health.

Since the implementation of planned immunization in the 1970s, my country has included tetanus immunization in the plan, and the incidence rate has dropped significantly. Therefore, we should raise awareness of active immunization against tetanus and attach importance to strengthening immunization, which is the solution to tetanus.

Protect yourself in life, don’t ignore minor wounds, and use a responsible attitude to provide a “protective umbrella” for your body.

References:

[1] Zhang Wei. Expert consensus on emergency prevention and diagnosis and treatment of tetanus in adults[J]. Journal of Clinical Emergency Medicine, 2018, 19(12): 801-811.

[2] Wang Chuanlin. Guidelines for the use of post-traumatic tetanus vaccines and passive immunization preparations[J]. Chinese Journal of Vaccines and Immunization, 2020, 26(1): 111-127.

[3] SONG Xin. Current status, problems and prospects of tetanus immunization in China[J]. Chinese Journal of Vaccines and Immunization, 2019, 25(6): 743-746.

[4] UpToDate Clinical Advisor: Tetanus

Author: jting

Review | Wang Qian, Chief Physician of the Emergency Department, the Third Medical Center, PLA General Hospital