Medically Reviewed By William C. Lloyd III, MD, FACS
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What is tetanus?

Tetanus is a potentially deadly infection of the nervous system caused by bacteria known as Clostridium tetani (C. tetani). Tetanus can occur when spores of these bacteria enter the body through an open wound that comes in contact with soil contaminated with the bacteria. The bacteria release a poison, called tetanospasmin, into the body, and this blocks the nerve signals from the spinal cord that control muscles.

Tetanus causes painful spasms that can be powerful enough to tear your muscles and even cause fractures of bones. They can also impair your breathing by constricting the intercostal muscles in the chest wall.

Left untreated, tetanus is often fatal. However, the prognosis is much better for patients who receive treatment, for whom the mortality rate is less than 10% (Source: PubMed).

Tetanus is a potentially deadly condition that requires immediate treatment. Seek immediate medical care (call 911) if you have an open wound that may have been contaminated with soil, especially if you have not received a tetanus booster shot in the last 5 years.

What are the symptoms of tetanus?

The symptoms of tetanus begin between 7 and 21 days after exposure to the bacteria. Symptoms include lockjaw, a painful condition caused by muscle spasms in your jaw. Spasms can occur in other areas as well, including your back, chest, neck and abdomen. Your breathing can be constricted if the spasms affect the muscles of the diaphragm and other structures that support your breathing.

Common symptoms of tetanus

Common symptoms of tetanus include:

  • Arching of the back caused by muscle spasms (opisthotonos)
  • Muscle spasms in the jaw, back, chest, neck and abdomen
  • Muscle tears and bone fractures caused by painful contractions of the muscles (tetany)
  • Pain at wound site

Other symptoms of tetanus

Tetanus may be associated with other symptoms including:

  • Breathing problems
  • Drooling
  • Fever
  • Incontinence (inability to control defecation and/or urination)
  • Irritability and mood changes
  • Muscle spasms in your feet or hands
  • Sweating heavily

Serious symptoms that might indicate a life-threatening condition

In some cases, tetanus can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Airway constriction
  • Breathing problems
  • Fever
  • Lockjaw (muscle spasms of the jaw)
  • Muscle spasms of the feet, hands, chest, back, neck and abdomen
  • Wound that may have been exposed to contaminated soil

What causes tetanus?

Tetanus infections occur when C. tetani bacteria, found in soil, enter your body through an injury or wound. The bacteria release a poison known as tetanospasmin that causes extremely powerful muscle spasms by blocking signals that your spinal cord normally sends to your muscles to allow you to move.

Contrary to popular belief, you will not get tetanus by stepping on a rusty nail unless the nail contains dirt that has been contaminated with C. tetani.

C. tetani bacteria are present in soil from all over the world. Although the C. tetani spores may remain inactive in soil, they have the ability to produce infection for up to 40 years.

What are the risk factors for tetanus?

A number of factors increase the risk of developing tetanus. Not all people with risk factors will get tetanus. Risk factors for tetanus include:

  • IV drug use

  • Not being immunized against tetanus

  • Poor hygiene

  • Receiving an open wound from an object that contains contaminated soil

    Reducing your risk of tetanus

    Tetanus is completely preventable with an active tetanus immunization. Should you become injured, you can help reduce the risk of infection by cleaning your wounds carefully.

    You may be able to reduce your risk of tetanus by:

    • Cleaning and sterilizing any injuries thoroughly, especially puncture-type wounds

    • Receiving a booster immunization for tetanus right away if it has been more than 10 years since you last received one

    • Receiving an immunization for tetanus with the DTaP (diphtheria, tetanus, pertussis) vaccine, called the “3-in-1” vaccine, when you are a child

    • Receiving an immunization for tetanus with the Td or Tdap vaccine every 10 years beginning at 19 years of age

    How is tetanus treated?

    Treatment of tetanus begins with seeking immediate medical care from your health care provider. Among other things, your health care provider may prescribe medication to combat the infection, such as antibiotics, or take measures to rid your body of the poison.

    Treatment with antibiotics

    Antibiotic therapy is the mainstay of treatment for tetanus and is highly effective. It is important to follow your treatment plan for tetanus precisely and to take all of your antibiotics, as instructed, to avoid re-infection or recurrence.

    Antibiotic medications that are effective for treating tetanus include:

    • Clindamycin (Cleocin)
    • Erythromycin (Eryc)
    • Metronidazole (Flagyl)
    • Penicillin (Penicillin VK)

    Other treatments

    Other treatments include:

    • Antidotal treatment with tetanus immune globulin to remove the toxin
    • Debridement (surgery to clean and remove toxin from the wound)
    • Muscle relaxant medications
    • Respiratory support such as a ventilator (breathing machine)
    • Sedative medications
    • Sleep

    What are the potential complications of tetanus?

    Tetanus should be treated right away because complications can be life threatening.

    Complications of tetanus include:

    • Adverse effects of treatment
    • Adverse effects of vaccination
    • Brain damage due to lack of oxygen
    • Bone fractures
    • Cardiac failure
    • Difficulty breathing due to an obstructed airway
    • Disability
    • Heart failure 
    • Pneumonia (lung infection)
    • Respiratory failure
    • Urinary retention
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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2021 Jan 14
    View All Infections and Contagious Diseases Articles
    THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
    1. Tetanus. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001640/
    2. Tetanus. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000615.htm
    3. Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults aged 65 years and older - Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep 2012; 61:468.
    4. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.