Naked Science Forum
Life Sciences => Physiology & Medicine => Topic started by: Carolyn on 12/07/2006 03:54:05
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What is a tetanus shot? I've heard all my life that you could get "lock jaw". What the heck is that?
I stepped on a nail Sunday evening. It wasn't rusty, in fact it was shiny and bright. My foot is very sore. I haven't had a tetanus shot in at least 20 years. My husband is having a fit and insisting that I have one. Is it really necessary?
Carolyn
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http://en.wikipedia.org/wiki/Tetanus
quote:
Tetanus is a serious and often fatal disease caused by the neurotoxin tetanospasmin which is produced by the Gram-positive, obligate anaerobic bacterium Clostridium tetani. Infection usually originates from a contaminated wound, often a cut or deep puncture wound. Common symptoms are muscle spasms in the jaw (hence the common name lockjaw), followed by difficulty swallowing and general muscle stiffness in other parts of the body. Infection can be prevented by proper immunization, as well as by post-exposure prophylaxis.
Symptoms
The incubation period for tetanus is 3 days to as long as 15 weeks (with the average being about 8 days) [1]. For neonates, the incubation period is 4 to 14 days, with 7 days being the average. Most of the time, the further the wound is from the central nervous system, the longer the incubation period. Incubation period length and likelihood of death are inversely proportional; a deep, contaminated wound that allows the bacteria to flourish and causes a quick, aggressive infection is much more life-threatening than a shallower, less-contaminated wound that causes milder symptoms to appear days or weeks later.
The first sign of tetanus is a mild jaw muscle spasm called lockjaw (trismus), followed by stiffness of the neck and back, risus sardonicus, difficulty swallowing, and muscle rigidity in the abdomen. The stiffness and spasming of muscles expands throughout the body inferiorly, and can be so powerful that they cause muscle tears and even fractures[2]. These muscle contractions are due to tetanospasmin—a chemical released by C. tetani—which inhibits the release of both GABA and glycine, the neurotransmitters that serve to inhibit muscle contraction.
Typical signs of tetanus include an increase in body temperature by 2 to 4°C, diaphoresis (excessive sweating), an elevated blood pressure, and an episodic rapid heart rate. Spasms and muscle contraction last for 3 to 4 weeks, and complete recovery may take months. About 30% of tetanus victims die, most of whom are elderly patients. In developing countries, the mortality rate may be as high as 60%.
Complications of the disease include spasms of the larynx (vocal cords), accessory muscles (chest muscles used to aid in breathing), and the diaphragm (the primary breathing muscle); fractures of long bones secondary to violent muscle spasms; and hyperactivity of the autonomic nervous system.
Treatment
The wound must be cleaned; dead and infected tissue should be removed by surgical debridement. Metronidazole will help decrease the amount of bacteria but has no effect on the bacterial toxin. Penicillin has been used in the past to treat tetanus, but is no longer the treatment of choice because there is a theoretical risk that it can increase spasms; however, if metronidazole is not available penicillin should still be used. Human anti-tetanospasmin immunoglobulin (or tetanus immune globulin) is a crucial part of treatment; if specific anti-tetanospasmin immunoglobulin is not available then human normal immunoglobulin may be given instead. All tetanus victims should be vaccinated against tetanus or offered a booster vaccine if they have been previously vaccinated.
Mild tetanus
Mild cases of tetanus can be treated on the ward. In addition to the measures given above:
5000 units tetanus immune globulin IV or IM
metronidazole 500mg IV for 10 days
diazepam 5 to 20mg tds PO
tetanus vaccination
Severe tetanus
These patients will require admission to intensive care. In additional to the measures listed above for mild tetanus:
human tetanus immunoglobulin 1000 units intrathecally (increases clinical improvement from 4% to 35%)
tracheostomy and mechanical ventilation for 3 to 4 weeks
diazepam 20 to 100mg per day continuous IV infusion
autonomic features can be difficult to manage (alternating hyper- and hypotension, hyperpyrexia/hypothermia) and may require IV labetalol, magnesium, clonidine, nifedipine, etc.
Prevention
Tetanus can be prevented by vaccination. A booster vaccine is recommended every ten years, and standard care in many places is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated. One Tetanus booster used presently is called TDap or DTaP (a protection from Diphtheria and Pertussis as well). The risk from Tetanus, Diphtheria and Pertussis (whooping cough) is higher than the risk of vaccine side-effects. There was a shortage of tetanus vaccine in the United States in 2001 and 2002, but this supply issue was corrected in 2003.
Worldwide, there are approximately one million cases of tetanus each year. (There are about 100 cases and approximately five deaths each year in the USA.)
Most people, most of the time, will not get tetanus from wounds – the question is whether you wish to be one of the few that do?
George
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Thank you for clearing up another mystery for me George. No I guess I don't want to be one of the few, and that would be just my luck. I had always thought you were only in danger if something rusty penetrated the skin. Hubby insisted that it didn't matter whether it was rusty or not. I hate it when he's is right. He gets entirely too much satisfaction from it. I guess I'll go get the blasted shot tomorrow.
Carolyn
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please help me. I was bit by my friends dog about 10 days ago. I am 28 male caucasian. I was bitten on the nose and put neosporin on it. About a week after being bitten I felt very weak and cold and started shaking a bit. I went to emergency at 4 am and they gave me a tetanus shot as it had been a while maybe 12 yrs. since last one. since then for the last 5 days I have been sweating, no energy, dizzy, little appetite, sore back difficult swallowing etc. went to the er again yesterday to get checked they did a bloodtest and it was fine, no infections, normal. Said I had a virus and to sleep and drink lots of liquids. I am very naustious and I feel like crying sometimes, should I go in to get a TIG shot? What should I do. please get back to me asap.
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Tough Guy - Don't know what could be making you sick, but you need to go back to the doctor. If you feel this ill and the Dr. says everything is fine, find another doctor. You know your body better than anyone. Listen to it.
For 10 years or so, a few times a year, I would get severe pains around the ovaries. I would go to the doctor, they'd run some tests and find nothing. Sometimes they put me on antiobiotics and I felt better. Two years ago I became very ill. I suffered for a few weeks, then I went to the doctor and they said I had IBS. They gave me meds and I felt better for a day or so. I kept taking their meds, but continued to feel worse. Several days later, when my husband came home for lunch and found me on the sofa, shivering and almost in convulsions, he took me back to the doctor and they thought I had appendicitis and sent me to the emergency room. By the time we made it the E.R. my temp was 105, and I was nearly dead. As it turned out I had a severe infection in my ovaries, that had been festering for about 10 years. They put me on very strong antibiotics for a month, but I ended up having to have a complete hysterectomy.
The moral of my long winded story is this. Listen to your body. Go back to the doctor. If you don't get satisfaction, find a new doctor. Good luck and hope you feel better soon.
Please let us know what happens.
Carolyn
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Would Rabbies show up on test or would they test for that a week later or more.. Get checked loss of appetite , how you doing with water and shoot just get checked for Rabbies anyway, you never know! We have had problems here with it off and on for years! wild animal comes and bites your un vaccinated animal and poof Rabbies!
Karen
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RABIES SYMPTOMS Loss of consciousness
Fever
Headache
Anxiety
Insomnia
Hypersalivation (foaming at the mouth)
Convulsions
Symptoms appear within 20 to 60 days
Once symptoms appear, death usually follows
Please don't panic just get checked now! This was just a list of symptoms not a diagnosis of any kind.. I would think they would have checked you for Rabbies !rst thing ...Make sure you see with your own eyes dogs shot papaers up to date with currant rabbies vaccine.. I have had two of my children viciosly attacked by dogs. One on their way to catch the school bus, The other at a friends both very serious attacks very scarey..Owners get scared and claim shots, but see for yourself proof of shots, first get checked and hustle!
Karen
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quote:
Originally posted by toughguy1
please help me. I was bit by my friends dog about 10 days ago. I am 28 male caucasian. I was bitten on the nose and put neosporin on it. About a week after being bitten I felt very weak and cold and started shaking a bit. I went to emergency at 4 am and they gave me a tetanus shot as it had been a while maybe 12 yrs. since last one. since then for the last 5 days I have been sweating, no energy, dizzy, little appetite, sore back difficult swallowing etc. went to the er again yesterday to get checked they did a bloodtest and it was fine, no infections, normal. Said I had a virus and to sleep and drink lots of liquids. I am very naustious and I feel like crying sometimes, should I go in to get a TIG shot? What should I do. please get back to me asap.
Main thing is not to panic, you could also have an infection totally unrelated to the bite!!! Also sounds quite similar to flu - real flu not a cold. If you have got a virus infection it won't show on bacterial swabs, you need to get a blood count done. Also, antibiotics won't help a virus infection (unless you count acyclovir etc as antibiotics) I agree with Carolyn - go see another Doctor.
Hope you feel better soon and, as the Book says in big pink letters on the front cover, DON'T PANIC
Gaia
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Ditto! I agree whole heartedly! When a doctor runs a blood panel, wouldn't they chack for Rabies and other things seeing that the problem originated after initial bite? I would assume that the blood work they did would have included all those tests!
Karen
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I went to another doctor. got a monospot done. no mono. still feel nausea, lack of energy. sweating etc. hard to swallow.
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quote:
I was bit by my friends dog about 10 days ago
toughguy1
If the naughty dog is still ok today forget about rabies. Bats are more dangerous these days...and dogs should be observed for 7-10 days to be sure they aren't sick.
If you had tetanus vaccine booster injection forget about tetanus.
It takes more than two weeks before the bacteria (spores of Clostridium t.) produce their toxin and you are already making up specific antibodies thanks to the shot.
Other types of infection can be managed by antibiotics but your doctors need more testing done to prove an infection and choose the correct antibiotic. Otherwise you would add drug toxicity to a flu-like syndrome that could resolve faster all by itself.
Go and see your doctor if anything new comes out (fever?).
Good rest, drink a lot (water and juices!) and do not panic.
Take care
iko
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Toughguy1 is lucky because he has been bitten by a family dog (probably vaccinated) and he can check by himself that his beast is still healthy.
The vast majority of rabies cases reported to the Centers for Disease Control and Prevention (CDC) each year occur in wild animals like raccoons, skunks, bats, and foxes.
Most of the times it is obviously impossible to check the biter for safety.
Rabies diagnosis in animals
The direct fluorescent antibody test (dFA) is the test most frequently used to diagnose rabies. This test requires brain tissue from animals suspected of being rabid. The test can only be performed post-mortem (after the animal is dead).
quote:
...Once symptoms appear, death usually follows
Please don't panic...just get checked now!...
Karen W
This is a very serious issue: few overspecialized medical centers can face this type of emergency, because -UNFORTUNATELY- it is absolutely tricky and aggressive to exclude rabies just by clinical tests on exposed patients:
Rabies diagnosis in humans
Several tests are necessary to diagnose rabies ante-mortem (before death) in humans; no single test is sufficient. Tests are performed on samples of saliva, serum, spinal fluid, and skin biopsies of hair follicles at the nape of the neck. Saliva can be tested by virus isolation or reverse transcription followed by polymerase chain reaction (RT-PCR). Serum and spinal fluid are tested for antibodies to rabies virus. Skin biopsy specimens are examined for rabies antigen in the cutaneous nerves at the base of hair follicles.
The importance of routine rabies tests
Rapid and accurate laboratory diagnosis of rabies in humans and other animals are essential for timely administration of postexposure prophylaxis. Within a few hours, a diagnostic laboratory can determine whether or not an animal is rabid and inform the responsible medical personnel. The laboratory results may save a patient from unnecessary physical and psychological trauma, and financial burdens, if the animal is not rabid.
In addition, laboratory identification of positive rabies cases may aid in defining current epidemiologic patterns of disease and provide appropriate information for the development of rabies control programs.
...
http://www.cdc.gov/ncidod/dvrd/rabies/diagnosis/diagnosi.htm
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IKO...thank you for your valuable contributions to this site.
Men are the same as women, just inside out !
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You're welcome neilep.
By the way, I'm the cod liver oil (CLO) maniac...you seem to be a five stars Withdrawnmist: what the hell does it mean?
iko
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still feeling ill. The only thing that makes me feel stronger is taking flax seed oil capsules 1000mg
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the nausea is all day and night. still have difficulty swallowing. had a bit of an eye infection and nose infection/ sinus? that comes and goes.
any ideas?
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quote:
Originally posted by toughguy1
the nausea is all day and night. still have difficulty swallowing. had a bit of an eye infection and nose infection/ sinus? that comes and goes.
any ideas?
Have you been to see another doctor yet? Def does NOT sound like either tetanus nor rabies. Do hope you feel better soon!
Gaia xxx
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Someone should take care of this boy(?) bitten by a dog one month ago.
Even veterinary patients get some antibiotic treatment for infected wounds...
You do not need alternative medicine here.
iko
quote:
Bacteriologic analysis of infected dog and cat bites.
...To define better the bacteria responsible for infections of dog and cat bites, we conducted a prospective study at 18 emergency departments. To be eligible for enrollment, patients had to meet one of three major criteria for infection of a bite wound (fever, abscess, and lymphangitis) or four of five minor criteria (wound-associated erythema, tenderness at the wound site, swelling at the site, purulent drainage, and leukocytosis). Wound specimens were cultured for aerobic and anaerobic bacteria at a research microbiology laboratory and, in some cases, at local hospital laboratories.
RESULTS: The infected wounds of 50 patients with dog bites and 57 patients with cat bites yielded a median of 5 bacterial isolates per culture (range, 0 to 16) at the reference laboratory. Significantly more isolates grew at the reference laboratory than at the local laboratories (median, 1; range, 0 to 5; P<0.001). Aerobes and anaerobes were isolated from 56 percent of the wounds, aerobes alone from 36 percent, and anaerobes alone from 1 percent; 7 percent of cultures had no growth. Pasteurella species were the most frequent isolates from both dog bites (50 percent) and cat bites (75 percent). Pasteurella canis was the most common isolate of dog bites, and Past. multocida subspecies multocida and septica were the most common isolates of cat bites. Other common aerobes included streptococci, staphylococci, moraxella, and neisseria. Common anaerobes included fusobacterium, bacteroides, porphyromonas, and prevotella. Isolates not previously identified as human pathogens included Reimerella anatipestifer from two cat bites and Bacteroides tectum, Prevotella heparinolytica, and several porphyromonas species from dog and cat bites. Erysipelothrix rhusiopathiae was isolated from two cat bites. Patients were most often treated with a combination of a beta-lactam antibiotic and a beta-lactamase inhibitor, which, on the basis of the microbiologic findings, was appropriate therapy.
CONCLUSIONS: Infected dog and cat bites have a complex microbiologic mix that usually includes pasteurella species but may also include many other organisms not routinely identified by clinical microbiology laboratories and not previously recognized as bite-wound pathogens.
from: Talan DA et al. N Engl J Med. 1999 Jan 14;340(2):85-92.
Go and see your doctor, take your antibiotics. At least they'll work as a placebo for you (and for all of us too!).
iko
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NKS Forum to Toughguy1...
NKS Forum to Toughguy1...
NKS Forum to Toughguy1...
Toughguy1...How 're you doing?
iko
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quote:
Originally posted by Carolyn
Thank you for clearing up another mystery for me George. No I guess I don't want to be one of the few, and that would be just my luck. I had always thought you were only in danger if something rusty penetrated the skin. Hubby insisted that it didn't matter whether it was rusty or not. I hate it when he's is right. He gets entirely too much satisfaction from it. I guess I'll go get the blasted shot tomorrow.
Carolyn
Yes, Carolyn, it would be advisable that you do so for your protection. It last a long time just in case you have another day like yesterday. Today is a new day, you will not have the same thing 2 days in a row...They are doing a study on how long is long enough now. They think it needs to be more frequently than that long. (probably because most of us forget how long it has been...mine has been about 25 years...and lord knows I am klutzy.) I am with Hubby, which you tell your lil studdiemuffin he is correct from me..hehe [;)] I guess that means he didn't get no lil dance then last night?[:o)] Okay, okay, I will really behave now...
"Just Me, Lo" Loretta
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quote:
Originally posted by moonfire
Yes, Carolyn, it would be advisable that you do so for your protection. It last a long time just in case you have another day like yesterday. Today is a new day, you will not have the same thing 2 days in a row...They are doing a study on how long is long enough now. They think it needs to be more frequently than that long. (probably because most of us forget how long it has been...mine has been about 25 years...and lord knows I am klutzy.) I am with Hubby, which you tell your lil studdiemuffin he is correct from me..hehe [;)] I guess that means he didn't get no lil dance then last night?[:o)] Okay, okay, I will really behave now...
"Just Me, Lo" Loretta
Guess again![;)][:D][;)] Surely you don't think a few cuts, scrapes,[;)] bumps and bruises are gonna keep me from my favorite activty?
Carolyn
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I should've known...hehe
"Just Me, Lo" Loretta
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You too are bad to the bone, but oh so funny!
Karen
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week 5 still nausea, sometimes twitches in leg, shoulder etc.
taking flax seems to help.
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quote:
Originally posted by toughguy1
week 5 still nausea, sometimes twitches in leg, shoulder etc.
taking flax seems to help.
Hi toughguy1, sorry to hear you're still not feeling too good. Did you go and see another doctor? Please do!!! It can't hurt to get a second medical opinion, even if only for reassurance.
Gaia xxx
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This guy is reeeeally TOUGH!
iko
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NKS Forum to Toughguy1...
NKS Forum to Toughguy1...
NKS Forum to Toughguy1...
Toughguy1...How 're you doing?
iko
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Has anyone heard any more from tough guy? Carolyn did you get your Tetnus shot!
Iko thanks for all the great information!