Firecrackers and Tetanus

a child with painful muscle spasm

New Year’s Eve is being celebrated worldwide. Partying and noisemaking with firecrackers and fireworks are common elements of this occasion. If in other countries there are public displays of fireworks organized by city governments or private corporations, in the Philippines almost each household lights up firecrackers to welcome the New Year. It is a tradition that was passed to us by the Chinese.  It is originally meant to drive away bad spirits and bring good luck to the family. Accidents occur most of the time with firecracker usage. Despite the annual campaign by the Department of Health Filipinos could not completely veer away from using firecrackers. As of January 3, 2011 the reported casualty after the New Year celebration reached 794. It was even higher by 8% from last year’s statistics. This includes firecracker-related injuries, injuries due to stray bullet and firecracker ingestion.

Firecracker-related injuries, just like any other injuries presenting with open wounds could be contaminated. Patients with these kinds of wounds can therefore contract tetanus.

What is tetanus?

        Tetanus is a medical condition affecting the nervous system. It is characterized by a prolonged and painful contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, obligate anaerobic bacterium Clostridium tetani. Infection generally occurs through wound contamination and often involves a cut or deep puncture wound. As the infection progresses, muscle spasms develop in the jaw (thus the name "lockjaw") and elsewhere in the body. It can interfere with the ability to breathe and, ultimately, threaten the life of the patient.

The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. It is an anaerobic bacterium, meaning it and its endospores survive well in an environment that lacks oxygen. Tetanus begins when spores of Clostridium tetani enter damaged tissue. The spores transform into rod-shaped bacteria and produce the neurotoxin tetanospasmin.

Mortality rates reported vary from 48% to 73%. In recent years, approximately 11% of reported tetanus cases have been fatal. The highest mortality rates are in unvaccinated people and people over 60 years of age.

The incubation period of tetanus ( the time before the signs and symptoms appear)  may be up to several months but is usually about 8 days. In general, the further the injury site is from the central nervous system, the longer the incubation period; the shorter the incubation period, the more severe the symptoms.

Tetanus cases can also develop from the following types of injuries: puncture wounds (including from splinters, body piercings, tattoos, injection drugs), gunshot wounds, compound fractures, crush injuries, burns, surgical wounds, ear infections, dental infections, animal bites, infected foot ulcers in people with diabetes, infected umbilical stumps in newborns born of inadequately immunized mothers.


Common signs and symptoms of tetanus, in order of appearance, are spasms and stiffness in your jaw muscles, stiffness of your neck muscles, difficulty swallowing, stiffness of your abdominal muscles, painful body spasms, lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light. Other signs and symptoms may include fever, sweating, elevated blood pressure and rapid heart rate.

Treatment

Cleaning the wound is essential to preventing growth of tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound.  Your doctor may give you a tetanus antitoxin, such as human tetanus immune globulin.  Antibiotics are usually given, either orally or by injection, to fight tetanus bacteria In order to prevent future tetanus infection the patient needs to receive tetanus vaccine as well.  Doctors generally use powerful sedatives to control muscle spasms. Severe cases of tetanus require admission to intensive care units for supportive management in ventilation and nutrition.