Tetanus: Cause, Transmission, Prevention, and Treatment (CDC-Aligned)

Tetanus is caused by Clostridium tetani, a spore-forming, anaerobic, gram-positive bacillus ubiquitous in soil, dust, and animal feces.

Transmission

Spores enter through any break in skin—puncture wounds, burns, crush injuries, surgical wounds, even minor abrasions. Deep, devitalized, anaerobic wounds favor germination and toxin production.

Pathogenesis

Tetanospasmin (neurotoxin) blocks inhibitory neurotransmitter release (GABA, glycine) in the spinal cord and brainstem → unopposed motor neuron firing → generalized rigidity, painful spasms (trismus/lockjaw, risus sardonicus, opisthotonos), autonomic instability.

Prevention

• Vaccination: DTaP (children), Tdap (adolescents/adults), Td boosters every 10 years.
• Wound Management: Clean all wounds thoroughly. Tetanus-prone wounds (deep, contaminated, devitalized) → Td/Tdap booster if >5 years since last dose + TIG (tetanus immune globulin) if immunization incomplete/unknown.

Treatment

TIG (neutralizes unbound toxin), wound debridement, metronidazole/penicillin, supportive care (airway, spasm control with benzodiazepines, autonomic management). Mortality 10–20% even with ICU care.

Vaccination is nearly 100% protective.