If you suspect that you might be at risk to tetanus you should seek medical help immediately. The wound should be washed clean to remove any dirt and foreign particles from the wound. If it is a particularly dirty or severe wound then dead and infected tissue may be removed by surgery debridement (this involves cutting away the dead tissue).
In mild cases:
Antibiotics such as metronidazole can be prescribed to fight the anaerobic bacteria. It reduces the number of bacteria present but it has no effect on the toxin that the bacteria produce. If metronidazole isn’t available penicillin may be prescribed but it is not as effective. If you aren’t sure when you had your last tetanus vaccine or have not had a complete course of immunisation then you may be given a booster shot, however this will not prevent potentially fatal cases of tetanus as it takes up to 2 weeks to develop tetanus antibodies to fight the bacteria. Diazepam, also known as valium, can be given as a muscle relaxant.
Passive immunisation with anti-tetanospasmin immunoglobulin is vital. Immunoglobulins are antibodies and form part of the body’s immune response. In this case the immunoglobulin used is an antitoxin which means it blocks the toxins released by bacteria. The antibodies are taken from blood donors who have recently been vaccinated against tetanus and inserted into a vein or muscle (intravenously or intramuscular injections). These provide immediate protection, however they are only temporary because it is a form of artificial passive immunity and the body’s own immune cells haven’t produced the antibodies so memory cells aren’t made therefore if there is a second exposure then the body will still have to make its own antibodies which take time. Also the body regards the donated antibodies as foreign and they are removed from the circulation and destroyed in the liver and spleen.
In severe cases:
This must be treated in an intensive care unit in hospital. Injecting immunoglobulins is important as it increases clinical improvement from 4 to 35%. Maintaining an open airway is vital; in some cases a tracheostomy is performed which involves creating a hole in the neck through to the windpipe and inserting a tube in to allow you to keep breathing freely although your mouth or throat may be blocked higher up, you may be supported on mechanical ventilation for 3-4weeks. In very severe cases the patient may have to be paralysed and supported on mechanical ventilation.
Magnesium can be given as intravenous injection as this prevents muscle spasms, diazepam may also be given as it is a muscle relaxant.
Proper nutrition is required: 3500-4000 calories are needed every day with at least 150g of protein a day. The amount must be so high because of the increased metabolic strain caused by the increased muscle activity of spasms. It can often be given in liquid form through tubes directly into the stomach or through a drip into a vein.
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