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<ul id="toc-Signs_and_symptoms-sublist" class="vector-toc-list"> <li id="toc-Incubation_period" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Incubation_period"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1</span> <span>Incubation period</span> </div> </a> <ul id="toc-Incubation_period-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Generalized_tetanus" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Generalized_tetanus"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2</span> <span>Generalized tetanus</span> </div> </a> <ul id="toc-Generalized_tetanus-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Neonatal_tetanus" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Neonatal_tetanus"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.3</span> <span>Neonatal tetanus</span> </div> </a> <ul id="toc-Neonatal_tetanus-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Local_tetanus" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Local_tetanus"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.4</span> <span>Local tetanus</span> </div> </a> <ul id="toc-Local_tetanus-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cephalic_tetanus" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cephalic_tetanus"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.5</span> <span>Cephalic tetanus</span> </div> </a> <ul id="toc-Cephalic_tetanus-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Cause" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Cause"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Cause</span> </div> </a> <ul id="toc-Cause-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Pathophysiology</span> </div> </a> <button aria-controls="toc-Pathophysiology-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Pathophysiology subsection</span> </button> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> <li id="toc-Neurospecific_binding" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Neurospecific_binding"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Neurospecific binding</span> </div> </a> <ul id="toc-Neurospecific_binding-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Internalization" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Internalization"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Internalization</span> </div> </a> <ul id="toc-Internalization-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Membrane_translocation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Membrane_translocation"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Membrane translocation</span> </div> </a> <ul id="toc-Membrane_translocation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Enzymatic_target_cleavage" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Enzymatic_target_cleavage"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.4</span> <span>Enzymatic target cleavage</span> </div> </a> <ul id="toc-Enzymatic_target_cleavage-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Prevention</span> </div> </a> <button aria-controls="toc-Prevention-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Prevention subsection</span> </button> <ul id="toc-Prevention-sublist" class="vector-toc-list"> <li id="toc-Post-exposure_prophylaxis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Post-exposure_prophylaxis"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Post-exposure prophylaxis</span> </div> </a> <ul id="toc-Post-exposure_prophylaxis-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Mild_tetanus" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Mild_tetanus"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Mild tetanus</span> </div> </a> <ul id="toc-Mild_tetanus-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Severe_tetanus" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Severe_tetanus"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>Severe tetanus</span> </div> </a> <ul id="toc-Severe_tetanus-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-In_animals" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#In_animals"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>In animals</span> </div> </a> <ul id="toc-In_animals-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>History</span> </div> </a> <button aria-controls="toc-History-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle History subsection</span> </button> <ul id="toc-History-sublist" class="vector-toc-list"> <li id="toc-Etymology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Etymology"> <div class="vector-toc-text"> <span class="vector-toc-numb">9.1</span> <span>Etymology</span> </div> </a> <ul id="toc-Etymology-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Research" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Research"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>Research</span> </div> </a> <ul id="toc-Research-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">12</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">13</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Tetanus</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 93 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-93" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">93 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-af mw-list-item"><a href="https://af.wikipedia.org/wiki/Klem-in-die-kaak" title="Klem-in-die-kaak – Afrikaans" lang="af" hreflang="af" data-title="Klem-in-die-kaak" data-language-autonym="Afrikaans" data-language-local-name="Afrikaans" class="interlanguage-link-target"><span>Afrikaans</span></a></li><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%83%D8%B2%D8%A7%D8%B2" title="كزاز – Arabic" lang="ar" hreflang="ar" data-title="كزاز" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-an mw-list-item"><a href="https://an.wikipedia.org/wiki/Tetanos" title="Tetanos – Aragonese" lang="an" hreflang="an" data-title="Tetanos" data-language-autonym="Aragonés" data-language-local-name="Aragonese" class="interlanguage-link-target"><span>Aragonés</span></a></li><li class="interlanguage-link interwiki-as mw-list-item"><a href="https://as.wikipedia.org/wiki/%E0%A6%A7%E0%A6%A8%E0%A7%81%E0%A6%B7%E0%A7%8D%E0%A6%9F%E0%A6%82%E0%A6%95%E0%A6%BE%E0%A7%B0" title="ধনুষ্টংকাৰ – Assamese" lang="as" hreflang="as" data-title="ধনুষ্টংকাৰ" data-language-autonym="অসমীয়া" data-language-local-name="Assamese" class="interlanguage-link-target"><span>অসমীয়া</span></a></li><li class="interlanguage-link interwiki-ast mw-list-item"><a href="https://ast.wikipedia.org/wiki/T%C3%A9tanu" title="Tétanu – Asturian" lang="ast" hreflang="ast" data-title="Tétanu" data-language-autonym="Asturianu" data-language-local-name="Asturian" class="interlanguage-link-target"><span>Asturianu</span></a></li><li class="interlanguage-link interwiki-gn mw-list-item"><a href="https://gn.wikipedia.org/wiki/T%C3%A9tano" title="Tétano – Guarani" lang="gn" hreflang="gn" data-title="Tétano" data-language-autonym="Avañe'ẽ" data-language-local-name="Guarani" class="interlanguage-link-target"><span>Avañe'ẽ</span></a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Tetanus" title="Tetanus – Azerbaijani" lang="az" hreflang="az" data-title="Tetanus" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target"><span>Azərbaycanca</span></a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%DA%A9%D9%88%D8%B2%D8%A7%D8%B2" title="کوزاز – South Azerbaijani" lang="azb" hreflang="azb" data-title="کوزاز" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target"><span>تۆرکجه</span></a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%A7%E0%A6%A8%E0%A7%81%E0%A6%B7%E0%A7%8D%E0%A6%9F%E0%A6%99%E0%A7%8D%E0%A6%95%E0%A6%BE%E0%A6%B0" title="ধনুষ্টঙ্কার – Bangla" lang="bn" hreflang="bn" data-title="ধনুষ্টঙ্কার" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target"><span>বাংলা</span></a></li><li class="interlanguage-link interwiki-be mw-list-item"><a href="https://be.wikipedia.org/wiki/%D0%A1%D0%BB%D1%83%D0%BF%D0%BD%D1%8F%D0%BA" title="Слупняк – Belarusian" lang="be" hreflang="be" data-title="Слупняк" data-language-autonym="Беларуская" data-language-local-name="Belarusian" class="interlanguage-link-target"><span>Беларуская</span></a></li><li class="interlanguage-link interwiki-be-x-old mw-list-item"><a href="https://be-tarask.wikipedia.org/wiki/%D0%A1%D0%BB%D1%83%D0%BF%D0%BD%D1%8F%D0%BA" title="Слупняк – Belarusian (Taraškievica orthography)" lang="be-tarask" hreflang="be-tarask" data-title="Слупняк" data-language-autonym="Беларуская (тарашкевіца)" data-language-local-name="Belarusian (Taraškievica orthography)" class="interlanguage-link-target"><span>Беларуская (тарашкевіца)</span></a></li><li class="interlanguage-link interwiki-bcl mw-list-item"><a href="https://bcl.wikipedia.org/wiki/Tetanus" title="Tetanus – Central Bikol" lang="bcl" hreflang="bcl" data-title="Tetanus" data-language-autonym="Bikol Central" data-language-local-name="Central Bikol" class="interlanguage-link-target"><span>Bikol Central</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%A2%D0%B5%D1%82%D0%B0%D0%BD%D1%83%D1%81" title="Тетанус – Bulgarian" lang="bg" hreflang="bg" data-title="Тетанус" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-bo mw-list-item"><a href="https://bo.wikipedia.org/wiki/%E0%BD%A2%E0%BE%A9%E0%BC%8B%E0%BD%A0%E0%BD%81%E0%BD%B4%E0%BD%98%E0%BC%8B%E0%BD%93%E0%BD%91%E0%BC%8D" title="རྩ་འཁུམ་ནད། – Tibetan" lang="bo" hreflang="bo" data-title="རྩ་འཁུམ་ནད།" data-language-autonym="བོད་ཡིག" data-language-local-name="Tibetan" class="interlanguage-link-target"><span>བོད་ཡིག</span></a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Tetanus" title="Tetanus – Bosnian" lang="bs" hreflang="bs" data-title="Tetanus" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target"><span>Bosanski</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/T%C3%A8tanus" title="Tètanus – Catalan" lang="ca" hreflang="ca" data-title="Tètanus" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Tetanus" title="Tetanus – Czech" lang="cs" hreflang="cs" data-title="Tetanus" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-cy mw-list-item"><a href="https://cy.wikipedia.org/wiki/Tetanws" title="Tetanws – Welsh" lang="cy" hreflang="cy" data-title="Tetanws" data-language-autonym="Cymraeg" data-language-local-name="Welsh" class="interlanguage-link-target"><span>Cymraeg</span></a></li><li class="interlanguage-link interwiki-dag mw-list-item"><a href="https://dag.wikipedia.org/wiki/Daridari" title="Daridari – Dagbani" lang="dag" hreflang="dag" data-title="Daridari" data-language-autonym="Dagbanli" data-language-local-name="Dagbani" class="interlanguage-link-target"><span>Dagbanli</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Stivkrampe" title="Stivkrampe – Danish" lang="da" hreflang="da" data-title="Stivkrampe" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-se mw-list-item"><a href="https://se.wikipedia.org/wiki/Doa%C5%8Bgegeas%C3%A1hat" title="Doaŋgegeasáhat – Northern Sami" lang="se" hreflang="se" data-title="Doaŋgegeasáhat" data-language-autonym="Davvisámegiella" data-language-local-name="Northern Sami" class="interlanguage-link-target"><span>Davvisámegiella</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Tetanus" title="Tetanus – German" lang="de" hreflang="de" data-title="Tetanus" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-dv mw-list-item"><a href="https://dv.wikipedia.org/wiki/%DE%87%DE%A8%DE%8B%DE%A8%DE%8A%DE%AA%DE%81%DE%A6%DE%81%DE%B0%DE%8B%DE%A6%DE%89%DE%A7_%DE%84%DE%A6%DE%8D%DE%A8" title="އިދިފުށަށްދަމާ ބަލި – Divehi" lang="dv" hreflang="dv" data-title="އިދިފުށަށްދަމާ ބަލި" data-language-autonym="ދިވެހިބަސް" data-language-local-name="Divehi" class="interlanguage-link-target"><span>ދިވެހިބަސް</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Teetanus" title="Teetanus – Estonian" lang="et" hreflang="et" data-title="Teetanus" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%A4%CE%AD%CF%84%CE%B1%CE%BD%CE%BF%CF%82" title="Τέτανος – Greek" lang="el" hreflang="el" data-title="Τέτανος" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/T%C3%A9tanos" title="Tétanos – Spanish" lang="es" hreflang="es" data-title="Tétanos" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Tetanoso" title="Tetanoso – Esperanto" lang="eo" hreflang="eo" data-title="Tetanoso" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target"><span>Esperanto</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Tetanos" title="Tetanos – Basque" lang="eu" hreflang="eu" data-title="Tetanos" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%DA%A9%D8%B2%D8%A7%D8%B2" title="کزاز – Persian" lang="fa" hreflang="fa" data-title="کزاز" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/T%C3%A9tanos" title="Tétanos – French" lang="fr" hreflang="fr" data-title="Tétanos" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Teiteanas" title="Teiteanas – Irish" lang="ga" hreflang="ga" data-title="Teiteanas" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/T%C3%A9tano" title="Tétano – Galician" lang="gl" hreflang="gl" data-title="Tétano" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%ED%8C%8C%EC%83%81%ED%92%8D" title="파상풍 – Korean" lang="ko" hreflang="ko" data-title="파상풍" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%93%D5%A1%D5%B5%D5%BF%D5%A1%D6%81%D5%B8%D6%82%D5%B4" title="Փայտացում – Armenian" lang="hy" hreflang="hy" data-title="Փայտացում" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%A7%E0%A4%A8%E0%A5%81%E0%A4%B8%E0%A5%8D%E0%A4%A4%E0%A4%AE%E0%A5%8D%E0%A4%AD" title="धनुस्तम्भ – Hindi" lang="hi" hreflang="hi" data-title="धनुस्तम्भ" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Tetanus" title="Tetanus – Croatian" lang="hr" hreflang="hr" data-title="Tetanus" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Tetanus" title="Tetanus – Indonesian" lang="id" hreflang="id" data-title="Tetanus" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/St%C3%ADfkrampi" title="Stífkrampi – Icelandic" lang="is" hreflang="is" data-title="Stífkrampi" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target"><span>Íslenska</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Tetano" title="Tetano – Italian" lang="it" hreflang="it" data-title="Tetano" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%98%D7%98%D7%A0%D7%95%D7%A1" title="טטנוס – Hebrew" lang="he" hreflang="he" data-title="טטנוס" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-jv mw-list-item"><a href="https://jv.wikipedia.org/wiki/T%C3%A9tanus" title="Tétanus – Javanese" lang="jv" hreflang="jv" data-title="Tétanus" data-language-autonym="Jawa" data-language-local-name="Javanese" class="interlanguage-link-target"><span>Jawa</span></a></li><li class="interlanguage-link interwiki-kn mw-list-item"><a href="https://kn.wikipedia.org/wiki/%E0%B2%A7%E0%B2%A8%E0%B3%81%E0%B2%B0%E0%B3%8D%E0%B2%B5%E0%B2%BE%E0%B2%A4" title="ಧನುರ್ವಾತ – Kannada" lang="kn" hreflang="kn" data-title="ಧನುರ್ವಾತ" data-language-autonym="ಕನ್ನಡ" data-language-local-name="Kannada" class="interlanguage-link-target"><span>ಕನ್ನಡ</span></a></li><li class="interlanguage-link interwiki-ka mw-list-item"><a href="https://ka.wikipedia.org/wiki/%E1%83%A2%E1%83%94%E1%83%A2%E1%83%90%E1%83%9C%E1%83%A3%E1%83%A1%E1%83%98" title="ტეტანუსი – Georgian" lang="ka" hreflang="ka" data-title="ტეტანუსი" data-language-autonym="ქართული" data-language-local-name="Georgian" class="interlanguage-link-target"><span>ქართული</span></a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D0%A1%D1%96%D1%80%D0%B5%D1%81%D0%BF%D0%B5" title="Сіреспе – Kazakh" lang="kk" hreflang="kk" data-title="Сіреспе" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target"><span>Қазақша</span></a></li><li class="interlanguage-link interwiki-sw mw-list-item"><a href="https://sw.wikipedia.org/wiki/Pepopunda" title="Pepopunda – Swahili" lang="sw" hreflang="sw" data-title="Pepopunda" data-language-autonym="Kiswahili" data-language-local-name="Swahili" class="interlanguage-link-target"><span>Kiswahili</span></a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Tetanus" title="Tetanus – Latin" lang="la" hreflang="la" data-title="Tetanus" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target"><span>Latina</span></a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Stingumkrampji" title="Stingumkrampji – Latvian" lang="lv" hreflang="lv" data-title="Stingumkrampji" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target"><span>Latviešu</span></a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Stablig%C4%97" title="Stabligė – Lithuanian" lang="lt" hreflang="lt" data-title="Stabligė" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target"><span>Lietuvių</span></a></li><li class="interlanguage-link interwiki-ln mw-list-item"><a href="https://ln.wikipedia.org/wiki/Tetan%C9%94%CC%81si" title="Tetanɔ́si – Lingala" lang="ln" hreflang="ln" data-title="Tetanɔ́si" data-language-autonym="Lingála" data-language-local-name="Lingala" class="interlanguage-link-target"><span>Lingála</span></a></li><li class="interlanguage-link interwiki-lg mw-list-item"><a href="https://lg.wikipedia.org/wiki/Okutana" title="Okutana – Ganda" lang="lg" hreflang="lg" data-title="Okutana" data-language-autonym="Luganda" data-language-local-name="Ganda" class="interlanguage-link-target"><span>Luganda</span></a></li><li class="interlanguage-link interwiki-lmo mw-list-item"><a href="https://lmo.wikipedia.org/wiki/Tetan" title="Tetan – Lombard" lang="lmo" hreflang="lmo" data-title="Tetan" data-language-autonym="Lombard" data-language-local-name="Lombard" class="interlanguage-link-target"><span>Lombard</span></a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Tetanusz" title="Tetanusz – Hungarian" lang="hu" hreflang="hu" data-title="Tetanusz" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%A2%D0%B5%D1%82%D0%B0%D0%BD%D1%83%D1%81" title="Тетанус – Macedonian" lang="mk" hreflang="mk" data-title="Тетанус" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target"><span>Македонски</span></a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%9F%E0%B5%86%E0%B4%B1%E0%B5%8D%E0%B4%B1%E0%B4%A8%E0%B4%B8%E0%B5%8D" title="ടെറ്റനസ് – Malayalam" lang="ml" hreflang="ml" data-title="ടെറ്റനസ്" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target"><span>മലയാളം</span></a></li><li class="interlanguage-link interwiki-mr mw-list-item"><a href="https://mr.wikipedia.org/wiki/%E0%A4%A7%E0%A4%A8%E0%A5%81%E0%A4%B0%E0%A5%8D%E0%A4%B5%E0%A4%BE%E0%A4%A4" title="धनुर्वात – Marathi" lang="mr" hreflang="mr" data-title="धनुर्वात" data-language-autonym="मराठी" data-language-local-name="Marathi" class="interlanguage-link-target"><span>मराठी</span></a></li><li class="interlanguage-link interwiki-xmf mw-list-item"><a href="https://xmf.wikipedia.org/wiki/%E1%83%A2%E1%83%94%E1%83%A2%E1%83%90%E1%83%9C%E1%83%A3%E1%83%A1%E1%83%98" title="ტეტანუსი – Mingrelian" lang="xmf" hreflang="xmf" data-title="ტეტანუსი" data-language-autonym="მარგალური" data-language-local-name="Mingrelian" class="interlanguage-link-target"><span>მარგალური</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Kancing_gigi" title="Kancing gigi – Malay" lang="ms" hreflang="ms" data-title="Kancing gigi" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Tetanus" title="Tetanus – Dutch" lang="nl" hreflang="nl" data-title="Tetanus" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ne mw-list-item"><a href="https://ne.wikipedia.org/wiki/%E0%A4%A7%E0%A4%A8%E0%A5%81%E0%A4%B7%E0%A5%8D%E0%A4%9F%E0%A4%99%E0%A5%8D%E0%A4%95%E0%A4%BE%E0%A4%B0" title="धनुष्टङ्कार – Nepali" lang="ne" hreflang="ne" data-title="धनुष्टङ्कार" data-language-autonym="नेपाली" data-language-local-name="Nepali" class="interlanguage-link-target"><span>नेपाली</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E7%A0%B4%E5%82%B7%E9%A2%A8" title="破傷風 – Japanese" lang="ja" hreflang="ja" data-title="破傷風" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Stivkrampe" title="Stivkrampe – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Stivkrampe" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Stivkrampe" title="Stivkrampe – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Stivkrampe" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target"><span>Norsk nynorsk</span></a></li><li class="interlanguage-link interwiki-oc mw-list-item"><a href="https://oc.wikipedia.org/wiki/Tetan%C3%B2s" title="Tetanòs – Occitan" lang="oc" hreflang="oc" data-title="Tetanòs" data-language-autonym="Occitan" data-language-local-name="Occitan" class="interlanguage-link-target"><span>Occitan</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%A7%E0%AC%A8%E0%AD%81%E0%AC%B7%E0%AD%8D%E0%AC%9F%E0%AC%99%E0%AD%8D%E0%AC%95%E0%AC%BE%E0%AC%B0" title="ଧନୁଷ୍ଟଙ୍କାର – Odia" lang="or" hreflang="or" data-title="ଧନୁଷ୍ଟଙ୍କାର" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Qoqshol" title="Qoqshol – Uzbek" lang="uz" hreflang="uz" data-title="Qoqshol" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target"><span>Oʻzbekcha / ўзбекча</span></a></li><li class="interlanguage-link interwiki-pa mw-list-item"><a href="https://pa.wikipedia.org/wiki/%E0%A8%A7%E0%A9%81%E0%A8%A3%E0%A8%96%E0%A8%B5%E0%A8%BE" title="ਧੁਣਖਵਾ – Punjabi" lang="pa" hreflang="pa" data-title="ਧੁਣਖਵਾ" data-language-autonym="ਪੰਜਾਬੀ" data-language-local-name="Punjabi" class="interlanguage-link-target"><span>ਪੰਜਾਬੀ</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/T%C4%99%C5%BCec" title="Tężec – Polish" lang="pl" hreflang="pl" data-title="Tężec" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/T%C3%A9tano" title="Tétano – Portuguese" lang="pt" hreflang="pt" data-title="Tétano" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Tetanos" title="Tetanos – Romanian" lang="ro" hreflang="ro" data-title="Tetanos" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target"><span>Română</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A1%D1%82%D0%BE%D0%BB%D0%B1%D0%BD%D1%8F%D0%BA" title="Столбняк – Russian" lang="ru" hreflang="ru" data-title="Столбняк" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Tetanosi" title="Tetanosi – Albanian" lang="sq" hreflang="sq" data-title="Tetanosi" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target"><span>Shqip</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Tetanus" title="Tetanus – Simple English" lang="en-simple" hreflang="en-simple" data-title="Tetanus" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Tetanus" title="Tetanus – Slovak" lang="sk" hreflang="sk" data-title="Tetanus" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target"><span>Slovenčina</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Tetanus" title="Tetanus – Slovenian" lang="sl" hreflang="sl" data-title="Tetanus" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-ckb mw-list-item"><a href="https://ckb.wikipedia.org/wiki/%D8%AF%DB%95%D8%B1%D8%AF%DB%95%DA%A9%DB%86%D9%BE%D8%A7%D9%86" title="دەردەکۆپان – Central Kurdish" lang="ckb" hreflang="ckb" data-title="دەردەکۆپان" data-language-autonym="کوردی" data-language-local-name="Central Kurdish" class="interlanguage-link-target"><span>کوردی</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A2%D0%B5%D1%82%D0%B0%D0%BD%D1%83%D1%81" title="Тетанус – Serbian" lang="sr" hreflang="sr" data-title="Тетанус" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Tetanus" title="Tetanus – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Tetanus" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-su mw-list-item"><a href="https://su.wikipedia.org/wiki/T%C3%A9tanus" title="Tétanus – Sundanese" lang="su" hreflang="su" data-title="Tétanus" data-language-autonym="Sunda" data-language-local-name="Sundanese" class="interlanguage-link-target"><span>Sunda</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/J%C3%A4ykk%C3%A4kouristus" title="Jäykkäkouristus – Finnish" lang="fi" hreflang="fi" data-title="Jäykkäkouristus" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Stelkramp" title="Stelkramp – Swedish" lang="sv" hreflang="sv" data-title="Stelkramp" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-ta mw-list-item"><a href="https://ta.wikipedia.org/wiki/%E0%AE%87%E0%AE%B0%E0%AE%A3%E0%AE%9C%E0%AE%A9%E0%AF%8D%E0%AE%A9%E0%AE%BF" title="இரணஜன்னி – Tamil" lang="ta" hreflang="ta" data-title="இரணஜன்னி" data-language-autonym="தமிழ்" data-language-local-name="Tamil" class="interlanguage-link-target"><span>தமிழ்</span></a></li><li class="interlanguage-link interwiki-te mw-list-item"><a href="https://te.wikipedia.org/wiki/%E0%B0%A7%E0%B0%A8%E0%B1%81%E0%B0%B0%E0%B1%8D%E0%B0%B5%E0%B0%BE%E0%B0%A4%E0%B0%AE%E0%B1%81" title="ధనుర్వాతము – Telugu" lang="te" hreflang="te" data-title="ధనుర్వాతము" data-language-autonym="తెలుగు" data-language-local-name="Telugu" class="interlanguage-link-target"><span>తెలుగు</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%9A%E0%B8%B2%E0%B8%94%E0%B8%97%E0%B8%B0%E0%B8%A2%E0%B8%B1%E0%B8%81" title="บาดทะยัก – Thai" lang="th" hreflang="th" data-title="บาดทะยัก" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Tetanos" title="Tetanos – Turkish" lang="tr" hreflang="tr" data-title="Tetanos" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%9F%D1%80%D0%B0%D0%B2%D0%B5%D1%86%D1%8C" title="Правець – Ukrainian" lang="uk" hreflang="uk" data-title="Правець" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-ur mw-list-item"><a href="https://ur.wikipedia.org/wiki/%D8%AA%D8%B4%D9%86%D8%AC" title="تشنج – Urdu" lang="ur" hreflang="ur" data-title="تشنج" data-language-autonym="اردو" data-language-local-name="Urdu" 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free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Bacterial infection characterized by muscle spasms</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">This article is about the disease. For the physiological use of the term, see <a href="/wiki/Tetanic_contraction" title="Tetanic contraction">Tetanic contraction</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox infobox-has-images-with-white-backgrounds"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Tetanus</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Lockjaw</td></tr><tr><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Opisthotonus_in_a_patient_suffering_from_tetanus_-_Painting_by_Sir_Charles_Bell_-_1809.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d8/Opisthotonus_in_a_patient_suffering_from_tetanus_-_Painting_by_Sir_Charles_Bell_-_1809.jpg/250px-Opisthotonus_in_a_patient_suffering_from_tetanus_-_Painting_by_Sir_Charles_Bell_-_1809.jpg" decoding="async" width="220" height="168" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d8/Opisthotonus_in_a_patient_suffering_from_tetanus_-_Painting_by_Sir_Charles_Bell_-_1809.jpg/330px-Opisthotonus_in_a_patient_suffering_from_tetanus_-_Painting_by_Sir_Charles_Bell_-_1809.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d8/Opisthotonus_in_a_patient_suffering_from_tetanus_-_Painting_by_Sir_Charles_Bell_-_1809.jpg/500px-Opisthotonus_in_a_patient_suffering_from_tetanus_-_Painting_by_Sir_Charles_Bell_-_1809.jpg 2x" data-file-width="1200" data-file-height="918" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data"><a href="/wiki/Muscle_spasm" class="mw-redirect" title="Muscle spasm">Muscle spasms</a> (specifically <a href="/wiki/Opisthotonos" class="mw-redirect" title="Opisthotonos">opisthotonos</a>) in a person with tetanus. Painting by <a href="/wiki/Sir_Charles_Bell" class="mw-redirect" title="Sir Charles Bell">Sir Charles Bell</a>, 1809.</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Infectious_disease_(medical_specialty)" class="mw-redirect" title="Infectious disease (medical specialty)">Infectious disease</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><a href="/wiki/Fever" title="Fever">fever</a>, cramped-up jaw, <a href="/wiki/Muscle_spasm" class="mw-redirect" title="Muscle spasm">muscle spasms</a>, <a href="/wiki/Headache" title="Headache">headache</a>, <a href="/wiki/Seizure" title="Seizure">seizures</a>, sweating, and trouble swallowing</td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">3–21 days following exposure</td></tr><tr><th scope="row" class="infobox-label">Duration</th><td class="infobox-data">Months</td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><i><a href="/wiki/Clostridium_tetani" title="Clostridium tetani">Clostridium tetani</a></i></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data">Break in the skin</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms</td></tr><tr><th scope="row" class="infobox-label">Prevention</th><td class="infobox-data"><a href="/wiki/Tetanus_vaccine" title="Tetanus vaccine">Tetanus vaccine</a></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="/wiki/Tetanus_immune_globulin" class="mw-redirect" title="Tetanus immune globulin">Tetanus immune globulin</a>, <a href="/wiki/Muscle_relaxant" title="Muscle relaxant">muscle relaxants</a>, <a href="/wiki/Mechanical_ventilation" title="Mechanical ventilation">mechanical ventilation</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medication" title="Medication">Medication</a></th><td class="infobox-data"><a href="/wiki/Diazepam" title="Diazepam">diazepam</a> and <a href="/wiki/Methocarbamol" title="Methocarbamol">methocarbamol</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data">6.4% risk of death</td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">209,000 (2015)</td></tr><tr><th scope="row" class="infobox-label">Deaths</th><td class="infobox-data">56,700 (2015)</td></tr></tbody></table><style data-mw-deduplicate="TemplateStyles:r1236303919">@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}</style> <p><b>Tetanus</b> (from <a href="/wiki/Ancient_Greek_language" class="mw-redirect" title="Ancient Greek language">Ancient Greek</a> <i> <span lang="grc"><a href="https://en.wiktionary.org/wiki/%CF%84%CE%AD%CF%84%CE%B1%CE%BD%CE%BF%CF%82#Ancient_Greek" class="extiw" title="wikt:τέτανος">τέτανος</a></span></i> <span class="gloss-quot">'</span><span class="gloss-text">tension, stretched, rigid</span><span class="gloss-quot">'</span>), also known as <b>lockjaw</b>, is a <a href="/wiki/Bacterial_infection" class="mw-redirect" title="Bacterial infection">bacterial infection</a> caused by <i><a href="/wiki/Clostridium_tetani" title="Clostridium tetani">Clostridium tetani</a></i> and characterized by <a href="/wiki/Muscle_spasm" class="mw-redirect" title="Muscle spasm">muscle spasms</a>. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually lasts for a few minutes. Spasms occur frequently for three to four weeks.<sup id="cite_ref-CDC2012Pink_1-0" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Some spasms may be severe enough to <a href="/wiki/Bone_fracture" title="Bone fracture">fracture bones</a>.<sup id="cite_ref-CDC2013S_2-0" class="reference"><a href="#cite_note-CDC2013S-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Other symptoms of tetanus may include <a href="/wiki/Fever" title="Fever">fever</a>, <a href="/wiki/Sweating" class="mw-redirect" title="Sweating">sweating</a>, <a href="/wiki/Headache" title="Headache">headache</a>, <a href="/wiki/Dysphagia" title="Dysphagia">trouble swallowing</a>, <a href="/wiki/Hypertension" title="Hypertension">high blood pressure</a>, and a <a href="/wiki/Tachycardia" title="Tachycardia">fast heart rate</a>. The onset of symptoms is typically 3 to 21 days following infection. Recovery may take months; about 10% of cases prove to be <a href="/wiki/Death" title="Death">fatal</a>.<sup id="cite_ref-CDC2012Pink_1-1" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p><i>C. tetani</i> is commonly found in soil, saliva, dust, and manure. The bacteria generally enter through a break in the skin, such as a cut or puncture wound caused by a contaminated object.<sup id="cite_ref-CDC2012Pink_1-2" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-CDC2013C_3-0" class="reference"><a href="#cite_note-CDC2013C-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> They produce <a href="/wiki/Toxin" title="Toxin">toxins</a> that interfere with normal muscle contractions.<sup id="cite_ref-CDC2013Doc_4-0" class="reference"><a href="#cite_note-CDC2013Doc-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Diagnosis is based on the presenting signs and symptoms. The disease does not spread between people.<sup id="cite_ref-CDC2012Pink_1-3" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Tetanus can be prevented by <a href="/wiki/Immunization" title="Immunization">immunization</a> with the <a href="/wiki/Tetanus_vaccine" title="Tetanus vaccine">tetanus vaccine</a>. In those who have a significant wound and have had fewer than three doses of the vaccine, both vaccination and <a href="/wiki/Tetanus_immune_globulin" class="mw-redirect" title="Tetanus immune globulin">tetanus immune globulin</a> are recommended. The wound should be cleaned, and any dead tissue should be removed. In those who are infected, tetanus immune globulin, or, if unavailable, <a href="/wiki/Intravenous_immunoglobulin" class="mw-redirect" title="Intravenous immunoglobulin">intravenous immunoglobulin</a> (IVIG) is used.<sup id="cite_ref-CDC2012Pink_1-4" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Muscle_relaxant" title="Muscle relaxant">Muscle relaxants</a> may be used to control spasms. <a href="/wiki/Mechanical_ventilation" title="Mechanical ventilation">Mechanical ventilation</a> may be required if a person's breathing is affected.<sup id="cite_ref-CDC2013Doc_4-1" class="reference"><a href="#cite_note-CDC2013Doc-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>Tetanus occurs in all parts of the world but is most frequent in hot and wet climates where the soil has a high organic content.<sup id="cite_ref-CDC2012Pink_1-5" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> In 2015, there were about 209,000 infections and about 59,000 deaths globally.<sup id="cite_ref-GBD2015Pre_5-0" class="reference"><a href="#cite_note-GBD2015Pre-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-GBD2015De_6-0" class="reference"><a href="#cite_note-GBD2015De-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> This is down from 356,000 deaths in 1990.<sup id="cite_ref-GBD2014_7-0" class="reference"><a href="#cite_note-GBD2014-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> In the US, there are about 30 cases per year, almost all of which were in people who had not been vaccinated.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> An early description of the disease was made by <a href="/wiki/Hippocrates" title="Hippocrates">Hippocrates</a> in the 5th century BC. The cause of the disease was determined in 1884 by <a href="/w/index.php?title=Antonio_Carle&action=edit&redlink=1" class="new" title="Antonio Carle (page does not exist)">Antonio Carle</a> and <a href="/w/index.php?title=Giorgio_Rattone&action=edit&redlink=1" class="new" title="Giorgio Rattone (page does not exist)">Giorgio Rattone</a> at the <a href="/wiki/University_of_Turin" title="University of Turin">University of Turin</a>, and a <a href="/wiki/Vaccine" title="Vaccine">vaccine</a> was developed in 1924.<sup id="cite_ref-CDC2012Pink_1-6" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Tetanus often begins with mild <a href="/wiki/Spasm" title="Spasm">spasms</a> in the <a href="/wiki/Muscles_of_mastication" title="Muscles of mastication">jaw muscles</a>—also known as lockjaw. Similar spasms can also be a feature of <a href="/wiki/Trismus" title="Trismus">trismus</a>.<sup id="cite_ref-OCF_9-0" class="reference"><a href="#cite_note-OCF-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The spasms can also affect the <a href="/wiki/Facial_muscles" title="Facial muscles">facial muscles</a>, resulting in an appearance called <i><a href="/wiki/Risus_sardonicus" title="Risus sardonicus">risus sardonicus</a></i>. Chest, neck, back, abdominal muscles, and buttocks may be affected. <a href="/wiki/Human_back#Muscles" title="Human back">Back muscle</a> spasms often cause arching, called <a href="/wiki/Opisthotonus" title="Opisthotonus">opisthotonus</a>. Sometimes, the spasms affect <a href="/wiki/Muscles_of_respiration" title="Muscles of respiration">muscles utilized during inhalation and exhalation</a>, which can lead to breathing problems.<sup id="cite_ref-CDC2020Pink_10-0" class="reference"><a href="#cite_note-CDC2020Pink-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p>Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups, called <a href="/wiki/Tetany" title="Tetany">tetany</a>. These episodes can cause fractures and muscle tears. Other symptoms include <a href="/wiki/Fever" title="Fever">fever</a>, <a href="/wiki/Headache" title="Headache">headache</a>, restlessness, <a href="/wiki/Irritability" title="Irritability">irritability</a>, feeding difficulties, <a href="/wiki/Respiratory_failure" title="Respiratory failure">breathing problems</a>, <a href="/wiki/Dysuria" title="Dysuria">burning sensation during urination</a>, <a href="/wiki/Urinary_retention" title="Urinary retention">urinary retention</a>, and <a href="/wiki/Fecal_incontinence" title="Fecal incontinence">loss of stool control</a>.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>Even with treatment, about 10% of people who contract tetanus die.<sup id="cite_ref-CDC2012Pink_1-7" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/Mortality_rate" title="Mortality rate">mortality rate</a> is higher in unvaccinated individuals, and in people over 60 years of age.<sup id="cite_ref-CDC2012Pink_1-8" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Incubation_period">Incubation period</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=2" title="Edit section: Incubation period"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The <a href="/wiki/Incubation_period" title="Incubation period">incubation period</a> of tetanus may be up to several months but is usually about ten days.<sup id="cite_ref-pmid12850356_12-0" class="reference"><a href="#cite_note-pmid12850356-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid12122532_13-0" class="reference"><a href="#cite_note-pmid12122532-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> In general, the farther the injury site is from the <a href="/wiki/Central_nervous_system" title="Central nervous system">central nervous system</a>, the longer the incubation period. However, shorter incubation periods will have more severe symptoms.<sup id="cite_ref-Farrar_14-0" class="reference"><a href="#cite_note-Farrar-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> In <i><a href="/wiki/Neonatal_tetanus" title="Neonatal tetanus">trismus nascentium</a></i> (i.e. neonatal tetanus), symptoms usually appear from 4 to 14 days after birth, averaging about 7 days. On the basis of clinical findings, four different forms of tetanus have been described.<sup id="cite_ref-CDC2012Pink_1-9" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Generalized_tetanus">Generalized tetanus</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=3" title="Edit section: Generalized tetanus"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Generalized tetanus is the most common type of tetanus, representing about 80% of cases. The generalized form usually presents with a descending pattern. The first sign is trismus or lockjaw, then facial spasms (called <i><a href="/wiki/Risus_sardonicus" title="Risus sardonicus">risus sardonicus</a>),</i> followed by stiffness of the neck, difficulty in swallowing, and rigidity of pectoral and <a href="/wiki/Calf_(anatomy)" class="mw-redirect" title="Calf (anatomy)">calf</a> muscles. Other symptoms include elevated temperature, sweating, elevated <a href="/wiki/Blood_pressure" title="Blood pressure">blood pressure</a>, and episodic rapid heart rate. <a href="/wiki/Spasm" title="Spasm">Spasms</a> may occur frequently and last for several minutes, with the body shaped into a characteristic form called <a href="/wiki/Opisthotonos" class="mw-redirect" title="Opisthotonos">opisthotonos</a>. Spasms continue for up to four weeks, and complete recovery may take months.<sup id="cite_ref-CDC2012Pink_1-10" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Neonatal_tetanus">Neonatal tetanus</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=4" title="Edit section: Neonatal tetanus"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Neonatal_tetanus" title="Neonatal tetanus">Neonatal tetanus</a></div> <p>Neonatal tetanus (<i>trismus nascentium</i>) is a form of generalized tetanus that occurs in newborns, usually those born to mothers who themselves have not been vaccinated. If the mother has been vaccinated against tetanus, the infants acquire <a href="/wiki/Passive_immunity" title="Passive immunity">passive immunity</a>, and are thus protected.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> It usually occurs through infection of the unhealed <a href="/wiki/Umbilical_cord" title="Umbilical cord">umbilical stump</a>, particularly when the stump is cut with a non-sterile instrument. As of 1998, neonatal tetanus was common in many <a href="/wiki/Developing_country" title="Developing country">developing countries</a>, and was responsible for about 14% (215,000) of all neonatal deaths.<sup id="cite_ref-WHO_2000_16-0" class="reference"><a href="#cite_note-WHO_2000-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> In 2010, the worldwide death toll was approximately 58,000 newborns. As the result of a public health campaign, the death toll from neonatal tetanus was reduced by 90% between 1990 and 2010, and by 2013, the disease had been largely eliminated from all but 25 countries.<sup id="cite_ref-elimination_17-0" class="reference"><a href="#cite_note-elimination-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Neonatal tetanus is rare in <a href="/wiki/Developed_country" title="Developed country">developed countries</a>. </p> <div class="mw-heading mw-heading3"><h3 id="Local_tetanus">Local tetanus</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=5" title="Edit section: Local tetanus"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Local tetanus is an uncommon form of the disease, in which people have persistent contraction of muscles in the same anatomic area as the injury. The contractions may persist for many weeks before gradually subsiding. Local tetanus is generally milder; only about 1% of cases are fatal, but it may precede the onset of generalized tetanus.<sup id="cite_ref-CDC2012Pink_1-11" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Cephalic_tetanus">Cephalic tetanus</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=6" title="Edit section: Cephalic tetanus"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Cephalic tetanus is the rarest form of the disease (0.9–3% of cases),<sup id="cite_ref-doshi_18-0" class="reference"><a href="#cite_note-doshi-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> and is limited to muscles and nerves in the head.<sup id="cite_ref-morales_19-0" class="reference"><a href="#cite_note-morales-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> It usually occurs after trauma to the head area, including: <a href="/wiki/Skull_fracture" title="Skull fracture">skull fracture</a>,<sup id="cite_ref-adeleye_20-0" class="reference"><a href="#cite_note-adeleye-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> laceration,<sup id="cite_ref-adeleye_20-1" class="reference"><a href="#cite_note-adeleye-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> eye injury,<sup id="cite_ref-morales_19-1" class="reference"><a href="#cite_note-morales-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Dental_extraction" title="Dental extraction">dental extraction</a>,<sup id="cite_ref-ajayi_21-0" class="reference"><a href="#cite_note-ajayi-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> and <a href="/wiki/Otitis_media" title="Otitis media">otitis media</a>,<sup id="cite_ref-pmid23468033_22-0" class="reference"><a href="#cite_note-pmid23468033-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> but it has been observed from injuries to other parts of the body.<sup id="cite_ref-pmid23346010_23-0" class="reference"><a href="#cite_note-pmid23346010-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Paralysis of the <a href="/wiki/Facial_nerve" title="Facial nerve">facial nerve</a> is most frequently implicated, which may cause lockjaw, <a href="/wiki/Bell%27s_palsy" title="Bell's palsy">facial palsy</a>, or <a href="/wiki/Ptosis_(eyelid)" title="Ptosis (eyelid)">ptosis</a>, but other cranial nerves can also be affected.<sup id="cite_ref-ajayi_21-1" class="reference"><a href="#cite_note-ajayi-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-seo_24-0" class="reference"><a href="#cite_note-seo-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Cephalic tetanus may progress to a more generalized form of the disease.<sup id="cite_ref-doshi_18-1" class="reference"><a href="#cite_note-doshi-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-seo_24-1" class="reference"><a href="#cite_note-seo-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Due to its rarity, clinicians may be unfamiliar with the clinical presentation, and may not suspect tetanus as the illness.<sup id="cite_ref-morales_19-2" class="reference"><a href="#cite_note-morales-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Treatment can be complicated, as symptoms may be concurrent with the initial injury that caused the infection.<sup id="cite_ref-adeleye_20-2" class="reference"><a href="#cite_note-adeleye-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Cephalic tetanus is more likely than other forms of tetanus to be fatal, with the progression to generalized tetanus carrying a 15–30% case fatality rate.<sup id="cite_ref-doshi_18-2" class="reference"><a href="#cite_note-doshi-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-adeleye_20-3" class="reference"><a href="#cite_note-adeleye-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-seo_24-2" class="reference"><a href="#cite_note-seo-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Cause">Cause</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=7" title="Edit section: Cause"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Clostridium_Tetani.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Clostridium_Tetani.svg/250px-Clostridium_Tetani.svg.png" decoding="async" width="220" height="341" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Clostridium_Tetani.svg/330px-Clostridium_Tetani.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Clostridium_Tetani.svg/500px-Clostridium_Tetani.svg.png 2x" data-file-width="512" data-file-height="793" /></a><figcaption><i>Clostridium tetani</i> is durable due to its <a href="/wiki/Endospore" title="Endospore">endospores</a>. Pictured is the bacterium alone, with a spore being produced, and the spore alone.</figcaption></figure> <p>Tetanus is caused by the tetanus bacterium, <i><a href="/wiki/Clostridium_tetani" title="Clostridium tetani">Clostridium tetani</a></i>.<sup id="cite_ref-CDC2012Pink_1-12" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The disease is an international health problem, as <i>C. tetani</i> <a href="/wiki/Endospore" title="Endospore">endospores</a> are ubiquitous. Endospores can be introduced into the body through a puncture wound (<a href="/wiki/Penetrating_trauma" title="Penetrating trauma">penetrating trauma</a>). Due to <i>C. tetani</i> being an anaerobic bacterium, it and its endospores thrive in environments that lack <a href="/wiki/Oxygen" title="Oxygen">oxygen</a>, such as a puncture wound. With the changes in oxygen levels, the turkey drumstick-shaped endospore can quickly spread.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p><p>The disease occurs almost exclusively in people who are inadequately immunized.<sup id="cite_ref-Baron_26-0" class="reference"><a href="#cite_note-Baron-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> It is more common in hot, damp climates with soil rich in <a href="/wiki/Soil_organic_matter" title="Soil organic matter">organic matter</a>. <a href="/wiki/Manure" title="Manure">Manure</a>-treated soils may contain spores, as they are widely distributed in the intestines and feces of many animals, such as horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens.<sup id="cite_ref-CDC2012Pink_1-13" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> In agricultural areas, a significant number of human adults may harbor the organism.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p><p>The spores can also be found on skin surfaces and in contaminated <a href="/wiki/Heroin" title="Heroin">heroin</a>.<sup id="cite_ref-CDC2012Pink_1-14" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Rarely, tetanus can be contracted through surgical procedures, intramuscular injections, compound fractures, and dental infections.<sup id="cite_ref-CDC2012Pink_1-15" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Animal bites can transmit tetanus.<sup id="cite_ref-CDC2012Pink_1-16" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Tetanus is often associated with <a href="/wiki/Rust" title="Rust">rust</a>, especially rusty nails. Although rust itself does not cause tetanus, objects that accumulate rust are often found outdoors or in places that harbor soil bacteria. Additionally, the rough surface of rusty metal provides crevices for dirt containing <i>C. tetani</i>, while a nail affords a means to puncture the skin and deliver endospores deep within the body at the site of the wound.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> An endospore is a non-metabolizing survival structure that begins to metabolize and cause infection once in an adequate environment. Hence, stepping on a nail (rusty or not) may result in a tetanus infection, as the low-oxygen (anaerobic) environment may exist under the skin, and the puncturing object can deliver endospores to a suitable environment for growth.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> It is a <a href="/wiki/List_of_common_misconceptions" title="List of common misconceptions">common misconception</a> that rust itself is the cause; a related misconception is that a puncture from a rust-free nail is not a risk.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Jennings2013_31-0" class="reference"><a href="#cite_note-Jennings2013-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=8" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Neurotransmitter_vesicle_before_and_after_exposure_to_Tetanus_Toxin.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/47/Neurotransmitter_vesicle_before_and_after_exposure_to_Tetanus_Toxin.jpg/330px-Neurotransmitter_vesicle_before_and_after_exposure_to_Tetanus_Toxin.jpg" decoding="async" width="310" height="206" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/47/Neurotransmitter_vesicle_before_and_after_exposure_to_Tetanus_Toxin.jpg/500px-Neurotransmitter_vesicle_before_and_after_exposure_to_Tetanus_Toxin.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/47/Neurotransmitter_vesicle_before_and_after_exposure_to_Tetanus_Toxin.jpg/960px-Neurotransmitter_vesicle_before_and_after_exposure_to_Tetanus_Toxin.jpg 2x" data-file-width="1472" data-file-height="980" /></a><figcaption>A neurotransmitter-filled vesicle before and after exposure to the tetanus toxin. The cleavage of the VAMP protein by the toxin inhibits vesicle fusion and neurotransmitter release into the synapse.</figcaption></figure> <p>Tetanus <a href="/wiki/Neurotoxin" title="Neurotoxin">neurotoxin</a> (TeNT) binds to the presynaptic membrane of the <a href="/wiki/Neuromuscular_junction" title="Neuromuscular junction">neuromuscular junction</a>, is internalized, and is transported back through the axon until it reaches the <a href="/wiki/Central_nervous_system" title="Central nervous system">central nervous system</a>.<sup id="cite_ref-:0_32-0" class="reference"><a href="#cite_note-:0-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> Here, it selectively binds to and is transported into inhibitory neurons via <a href="/wiki/Endocytosis" title="Endocytosis">endocytosis</a>.<sup id="cite_ref-:1_33-0" class="reference"><a href="#cite_note-:1-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> It then leaves the vesicle for the neuron cytosol, where it cleaves <a href="/wiki/Vesicle-associated_membrane_protein" title="Vesicle-associated membrane protein">vesicle associated membrane protein</a> (VAMP) <a href="/wiki/Synaptobrevin" title="Synaptobrevin">synaptobrevin</a>, which is necessary for membrane fusion of small synaptic vesicles (SSV's).<sup id="cite_ref-:0_32-1" class="reference"><a href="#cite_note-:0-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> SSV's carry <a href="/wiki/Neurotransmitter" title="Neurotransmitter">neurotransmitter</a> to the membrane for release, so inhibition of this process blocks neurotransmitter release.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p><p>Tetanus toxin specifically blocks the release of the neurotransmitters <a href="/wiki/Gamma-Aminobutyric_acid" class="mw-redirect" title="Gamma-Aminobutyric acid">GABA</a> and <a href="/wiki/Glycine" title="Glycine">glycine</a> from inhibitory neurons. These neurotransmitters keep overactive motor neurons from firing and also play a role in the relaxation of muscles after contraction. When inhibitory neurons are unable to release their neurotransmitters, motor neurons fire out of control, and muscles have difficulty relaxing. This causes the muscle spasms and <a href="/wiki/Spasticity" title="Spasticity">spastic paralysis</a> seen in tetanus infection.<sup id="cite_ref-:0_32-2" class="reference"><a href="#cite_note-:0-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p><p>The tetanus toxin, <a href="/wiki/Tetanospasmin" class="mw-redirect" title="Tetanospasmin">tetanospasmin</a>, is made up of a heavy chain and a light chain. There are three domains, each of which contributes to the pathophysiology of the toxin.<sup id="cite_ref-:2_35-0" class="reference"><a href="#cite_note-:2-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> The heavy chain has two of the domains. The N-terminal side of the heavy chain helps with membrane translocation, and the C-terminal side helps the toxin locate the specific receptor site on the correct neuron. The light chain domain cleaves the VAMP protein once it arrives in the inhibitory neuron cytosol.<sup id="cite_ref-:2_35-1" class="reference"><a href="#cite_note-:2-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p><p>There are four main steps in tetanus's mechanism of action: binding to the neuron, internalization of the toxin, membrane translocation, and cleavage of the target VAMP.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Neurospecific_binding">Neurospecific binding</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=9" title="Edit section: Neurospecific binding"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The toxin travels from the wound site to the <a href="/wiki/Neuromuscular_junction" title="Neuromuscular junction">neuromuscular junction</a> through the bloodstream, where it binds to the <a href="/wiki/Presynaptic_membrane" class="mw-redirect" title="Presynaptic membrane">presynaptic membrane</a> of a <a href="/wiki/Motor_neuron" title="Motor neuron">motor neuron</a>. The heavy chain C-terminal domain aids in binding to the correct site, recognizing and binding to the correct <a href="/wiki/Glycoprotein" title="Glycoprotein">glycoproteins</a> and <a href="/wiki/Glycolipid" title="Glycolipid">glycolipids</a> in the presynaptic membrane. The toxin binds to a site that will be taken into the neuron as an <a href="/wiki/Endocytosis" title="Endocytosis">endocytic vesicle</a> that will travel down the axon, past the cell body, and down the dendrites to the dendritic terminal at the spine and central nervous system. Here, it will be released into the <a href="/wiki/Synaptic_cleft" class="mw-redirect" title="Synaptic cleft">synaptic cleft</a>, and allowed to bind with the presynaptic membrane of inhibitory neurons in a similar manner seen with the binding to the motor neuron.<sup id="cite_ref-:1_33-1" class="reference"><a href="#cite_note-:1-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Internalization">Internalization</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=10" title="Edit section: Internalization"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Tetanus toxin is then internalized again via <a href="/wiki/Endocytosis" title="Endocytosis">endocytosis</a>, this time, in an acidic vesicle.<sup id="cite_ref-:2_35-2" class="reference"><a href="#cite_note-:2-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> In a mechanism not well understood, <a href="/wiki/Depolarization" title="Depolarization">depolarization</a> caused by the firing of the inhibitory neuron causes the toxin to be pulled into the neuron inside vesicles.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (June 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Membrane_translocation">Membrane translocation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=11" title="Edit section: Membrane translocation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The toxin then needs a way to get out of the vesicle and into the neuron cytosol for it to act on its target. The low pH of the vesicle lumen causes a conformational change in the toxin, shifting it from a water-soluble form to a <a href="/wiki/Hydrophobe" title="Hydrophobe">hydrophobic</a> form.<sup id="cite_ref-:1_33-2" class="reference"><a href="#cite_note-:1-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> With the hydrophobic patches exposed, the toxin can slide into the vesicle membrane. The toxin forms an <a href="/wiki/Ion_channel" title="Ion channel">ion channel</a> in the membrane that is nonspecific for Na<sup>+</sup>, K<sup>+</sup>, Ca<sup>2+</sup>, and Cl<sup>−</sup> ions.<sup id="cite_ref-:0_32-3" class="reference"><a href="#cite_note-:0-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> There is a consensus among experts that this new channel is involved in the translocation of the toxin's light chain from the inside of the vesicle to the neuron cytosol, but the mechanism is not well understood or agreed upon. It has been proposed that the channel could allow the light chain (unfolded from the low pH environment) to leave through the toxin pore,<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> or that the pore could alter the <a href="/wiki/Electrochemical_gradient" title="Electrochemical gradient">electrochemical gradient</a> enough, by letting in or out ions, to cause osmotic lysis of the vesicle, spilling the vesicle's contents.<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Enzymatic_target_cleavage">Enzymatic target cleavage</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=12" title="Edit section: Enzymatic target cleavage"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The light chain of the tetanus toxin is zinc-dependent <a href="/wiki/Protease" title="Protease">protease</a>. It shares a common zinc protease motif (His-Glu-Xaa-Xaa-His) that researchers hypothesized was essential for target cleavage until this was more recently confirmed by experiment: when all zinc was removed from the neuron with heavy metal <a href="/wiki/Chelation" title="Chelation">chelators</a>, the toxin was inhibited, only to be reactivated when the zinc was added back in.<sup id="cite_ref-:0_32-4" class="reference"><a href="#cite_note-:0-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> The light chain binds to VAMP, and cleaves it between Gln<sup>76</sup> and Phe<sup>77</sup>. Without VAMP, vesicles holding the neurotransmitters needed for motor neuron regulation (<a href="/wiki/Gamma-Aminobutyric_acid" class="mw-redirect" title="Gamma-Aminobutyric acid">GABA</a> and glycine) cannot be released, causing the above-mentioned deregulation of motor neurons and muscle tension.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=13" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are currently no blood tests for diagnosing tetanus. The diagnosis is based on the presentation of tetanus symptoms and does not depend upon isolation of the bacterium, which is recovered from the wound in only 30% of cases and can be isolated from people without tetanus. Laboratory identification of <i>C. tetani</i> can be demonstrated only by the production of <a href="/wiki/Tetanospasmin" class="mw-redirect" title="Tetanospasmin">tetanospasmin</a> in mice.<sup id="cite_ref-CDC2012Pink_1-17" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Having recently experienced head trauma may indicate cephalic tetanus--a rare form of tetanus resulting in weakened facial muscles and spasms--if no other diagnosis has been made.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p>The "spatula test" is a clinical test for tetanus that involves touching the <a href="/wiki/Anatomical_terms_of_location#Anterior_and_posterior" title="Anatomical terms of location">posterior</a> <a href="/wiki/Pharynx" title="Pharynx">pharyngeal</a> wall with a soft-tipped instrument and observing the effect. A positive test result is the involuntary contraction of the jaw (biting down on the "spatula"), and a negative test result would normally be a <a href="/wiki/Pharyngeal_reflex" title="Pharyngeal reflex">gag reflex</a> attempting to expel the foreign object. A short report in <i>The American Journal of Tropical Medicine and Hygiene</i> states that, in an affected subject research study, the spatula test had a high <a href="/wiki/Sensitivity_and_specificity#Specificity" title="Sensitivity and specificity">specificity</a> (zero <a href="/wiki/False_positives_and_false_negatives" title="False positives and false negatives">false-positive</a> test results) and a high <a href="/wiki/Sensitivity_and_specificity#Sensitivity" title="Sensitivity and specificity">sensitivity</a> (94% of infected people produced a positive test).<sup id="cite_ref-AJTMH1995_41-0" class="reference"><a href="#cite_note-AJTMH1995-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=14" title="Edit section: Prevention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Unlike many infectious diseases, recovery from naturally acquired tetanus does not usually result in <a href="/wiki/Immunity_(medical)" class="mw-redirect" title="Immunity (medical)">immunity</a>. This is due to the extreme potency of the tetanospasmin toxin. Tetanospasmin will likely be lethal before it will provoke an immune response.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p><p>Tetanus can be prevented by <a href="/wiki/Vaccination" title="Vaccination">vaccination</a> with <a href="/wiki/Tetanus_vaccine" title="Tetanus vaccine">tetanus toxoid</a>.<sup id="cite_ref-MMWR_1991_43-0" class="reference"><a href="#cite_note-MMWR_1991-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">CDC</a> recommends that adults receive a <a href="/wiki/Booster_shot" class="mw-redirect" title="Booster shot">booster</a> vaccine every ten years,<sup id="cite_ref-CDC2012Pink_1-18" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> and standard care practice in many places is to give the booster to any person with a puncture wound who is uncertain of when they were last vaccinated, or if they have had fewer than three lifetime doses of the vaccine. The booster may not prevent a potentially fatal case of tetanus from the current wound, however, as it can take up to two weeks for tetanus antibodies to form.<sup id="cite_ref-pmid1574917_44-0" class="reference"><a href="#cite_note-pmid1574917-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p><p>In children under the age of seven, the tetanus vaccine is often administered as a combined vaccine, <a href="/wiki/DPT_vaccine" title="DPT vaccine">DPT/DTaP vaccine</a>, which also includes vaccines against <a href="/wiki/Diphtheria" title="Diphtheria">diphtheria</a> and <a href="/wiki/Pertussis" class="mw-redirect" title="Pertussis">pertussis</a>. For adults and children over seven, the <a href="/wiki/DPT_vaccine#Excluding_pertussis" title="DPT vaccine">Td vaccine</a> (tetanus and diphtheria) or Tdap (tetanus, diphtheria, and acellular pertussis) is commonly used.<sup id="cite_ref-MMWR_1991_43-1" class="reference"><a href="#cite_note-MMWR_1991-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> </p><p>The <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> certifies countries as having eliminated maternal or <a href="/wiki/Neonatal_tetanus" title="Neonatal tetanus">neonatal tetanus</a>. Certification requires at least two years of rates of less than 1 case per 1,000 live births. In 1998 in <a href="/wiki/Uganda" title="Uganda">Uganda</a>, 3,433 tetanus cases were recorded in newborn babies; of these, 2,403 died. After a major public health effort, Uganda was certified as having eliminated maternal and neonatal tetanus in 2011.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Post-exposure_prophylaxis">Post-exposure prophylaxis</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=15" title="Edit section: Post-exposure prophylaxis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Tetanus toxoid can be given in case of suspected exposure to tetanus. In such cases, it can be given with or without tetanus <a href="/wiki/Immunoglobulin" class="mw-redirect" title="Immunoglobulin">immunoglobulin</a> (also called <i>tetanus antibodies</i> or <i>tetanus antitoxin</i><sup id="cite_ref-britannica2013_46-0" class="reference"><a href="#cite_note-britannica2013-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup>). It can be given as <a href="/wiki/Intravenous_therapy" title="Intravenous therapy">intravenous therapy</a> or by <a href="/wiki/Intramuscular_injection" title="Intramuscular injection">intramuscular injection</a>.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> </p><p>The guidelines for such events in the United States for people at least 11 years old (and not pregnant) are as follows:<sup id="cite_ref-CDC2012Pink_1-19" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <table class="wikitable"> <tbody><tr> <th>Vaccination status</th> <th>Clean, minor wounds</th> <th>All other wounds </th></tr> <tr> <td>Unknown or less than 3 doses of tetanus toxoid containing vaccine</td> <td><a href="/wiki/Tdap" class="mw-redirect" title="Tdap">Tdap</a> and recommend catch-up vaccination</td> <td><a href="/wiki/Tdap" class="mw-redirect" title="Tdap">Tdap</a> and recommend catch-up vaccination<br /> Tetanus <a href="/wiki/Immunoglobulin" class="mw-redirect" title="Immunoglobulin">immunoglobulin</a> </td></tr> <tr> <td>3 or more doses of tetanus toxoid-containing vaccine AND less than 5 years since the last dose </td> <td>No indication</td> <td>No indication </td></tr> <tr> <td>3 or more doses of tetanus toxoid-containing vaccine AND 5–10 years since the last dose </td> <td>No indication</td> <td>Tdap preferred (if not yet received) or <a href="/wiki/DPT_vaccine#Excluding_pertussis" title="DPT vaccine">Td</a> </td></tr> <tr> <td>3 or more doses of tetanus toxoid-containing vaccine AND more than 10 years since the last dose </td> <td>Tdap preferred (if not yet received) or <a href="/wiki/DPT_vaccine#Excluding_pertussis" title="DPT vaccine">Td</a></td> <td>Tdap preferred (if not yet received) or Td </td></tr></tbody></table> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=16" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Tetanus_world_map-Deaths_per_million_persons-WHO2012.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f4/Tetanus_world_map-Deaths_per_million_persons-WHO2012.svg/330px-Tetanus_world_map-Deaths_per_million_persons-WHO2012.svg.png" decoding="async" width="290" height="128" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f4/Tetanus_world_map-Deaths_per_million_persons-WHO2012.svg/500px-Tetanus_world_map-Deaths_per_million_persons-WHO2012.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f4/Tetanus_world_map-Deaths_per_million_persons-WHO2012.svg/580px-Tetanus_world_map-Deaths_per_million_persons-WHO2012.svg.png 2x" data-file-width="940" data-file-height="415" /></a><figcaption>Tetanus deaths per million persons in 2012<style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col div-col-small" style="column-width: 10em;"><style data-mw-deduplicate="TemplateStyles:r981673959">.mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{}</style><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffff20; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 0–1</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffa020; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 1–2</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff9a20; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 2–3</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#f08015; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 4–8</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#e06815; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 9–13</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#d85010; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 14–28</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#d02010; color:white;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 29–151</div></div> </figcaption></figure> <div class="mw-heading mw-heading3"><h3 id="Mild_tetanus">Mild tetanus</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=17" title="Edit section: Mild tetanus"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Mild cases of tetanus can be treated with:<sup id="cite_ref-World_Health_Organization_48-0" class="reference"><a href="#cite_note-World_Health_Organization-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p> <ul><li><a href="/wiki/Tetanus_immunoglobulin" class="mw-redirect" title="Tetanus immunoglobulin">Tetanus immunoglobulin</a> (TIG),<sup id="cite_ref-CDC2012Pink_1-20" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> also called <i>tetanus antibodies</i> or <i>tetanus antitoxin.</i><sup id="cite_ref-britannica2013_46-1" class="reference"><a href="#cite_note-britannica2013-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> It can be given as <a href="/wiki/Intravenous_therapy" title="Intravenous therapy">intravenous therapy</a> or by <a href="/wiki/Intramuscular_injection" title="Intramuscular injection">intramuscular injection</a>.</li> <li>Antibiotic therapy to reduce toxin production. <a href="/wiki/Metronidazole" title="Metronidazole">Metronidazole</a> intravenous (IV) is a preferred treatment.<sup id="cite_ref-World_Health_Organization_48-1" class="reference"><a href="#cite_note-World_Health_Organization-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Benzodiazepines" class="mw-redirect" title="Benzodiazepines">Benzodiazepines</a> can be used to control muscle spasms. Options include <a href="/wiki/Diazepam" title="Diazepam">diazepam</a> and <a href="/wiki/Lorazepam" title="Lorazepam">lorazepam</a>, oral or IV.<sup id="cite_ref-World_Health_Organization_48-2" class="reference"><a href="#cite_note-World_Health_Organization-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Severe_tetanus">Severe tetanus</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=18" title="Edit section: Severe tetanus"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Severe cases will require admission to <a href="/wiki/Intensive_care" class="mw-redirect" title="Intensive care">intensive care</a>. In addition to the measures listed above for mild tetanus:<sup id="cite_ref-World_Health_Organization_48-3" class="reference"><a href="#cite_note-World_Health_Organization-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Human tetanus immunoglobulin injected <a href="/wiki/Intrathecal" class="mw-redirect" title="Intrathecal">intrathecally</a> (which increases clinical improvement from 4% to 35%).</li> <li><a href="/wiki/Tracheotomy" title="Tracheotomy">Tracheotomy</a> and <a href="/wiki/Mechanical_ventilation" title="Mechanical ventilation">mechanical ventilation</a> for 3 to 4 weeks. Tracheotomy is recommended for securing the airway, because the presence of an endotracheal tube is a stimulus for spasm.</li> <li><a href="/wiki/Magnesium_sulfate_(medical_use)" class="mw-redirect" title="Magnesium sulfate (medical use)">Magnesium sulfate</a>, as an intravenous infusion, to control spasm and autonomic dysfunction.</li> <li><a href="/wiki/Diazepam" title="Diazepam">Diazepam</a> as a continuous IV infusion.</li> <li>The <a href="/wiki/Autonomic_nervous_system" title="Autonomic nervous system">autonomic</a> effects of tetanus can be difficult to manage (alternating hyper- and <a href="/wiki/Hypotension" title="Hypotension">hypotension</a> <a href="/wiki/Hyperpyrexia" class="mw-redirect" title="Hyperpyrexia">hyperpyrexia</a>/<a href="/wiki/Hypothermia" title="Hypothermia">hypothermia</a>), and may require IV <a href="/wiki/Labetalol" title="Labetalol">labetalol</a>, magnesium, <a href="/wiki/Clonidine" title="Clonidine">clonidine</a>, or <a href="/wiki/Nifedipine" title="Nifedipine">nifedipine</a>.</li></ul> <p>Drugs, such as diazepam or other <a href="/wiki/Muscle_relaxant" title="Muscle relaxant">muscle relaxants</a>, can be given to control the muscle spasms. In extreme cases, it may be necessary to paralyze the person with <a href="/wiki/Curare" title="Curare">curare</a>-like drugs, and use a mechanical ventilator.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (June 2022)">citation needed</span></a></i>]</sup> </p><p>To survive a tetanus infection, the maintenance of an airway and proper <a href="/wiki/Nutrition" title="Nutrition">nutrition</a> are required. An intake of 3,500 to 4,000 calories (15,000 to 17,000 kJ) and at least 150 g of protein per day is often given in liquid form through a tube directly into the stomach (<a href="/wiki/Percutaneous_endoscopic_gastrostomy" title="Percutaneous endoscopic gastrostomy">percutaneous endoscopic gastrostomy</a>), or through a drip into a vein (<a href="/wiki/Parenteral_nutrition" title="Parenteral nutrition">parenteral nutrition</a>). This high-caloric diet maintenance is required because of the increased metabolic strain brought on by the increased muscle activity. Full recovery takes 4 to 6 weeks because the body must regenerate destroyed nerve <a href="/wiki/Axon" title="Axon">axon</a> terminals.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> </p><p>The antibiotic of choice is <a href="/wiki/Metronidazole" title="Metronidazole">metronidazole</a>. It can be given intravenously, by mouth, or by rectum.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-World_Health_Organization_48-4" class="reference"><a href="#cite_note-World_Health_Organization-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> Of likewise efficiency is <a href="/wiki/Penicillin" title="Penicillin">penicillin</a>, but some raise the concern of provoking spasms because it inhibits <a href="/wiki/Gamma-Aminobutyric_acid" class="mw-redirect" title="Gamma-Aminobutyric acid">GABA receptor</a>, which is already affected by tetanospasmin.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=19" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Tetanus_world_map_-_DALY_-_WHO2004.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/5b/Tetanus_world_map_-_DALY_-_WHO2004.svg/330px-Tetanus_world_map_-_DALY_-_WHO2004.svg.png" decoding="async" width="290" height="128" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/5b/Tetanus_world_map_-_DALY_-_WHO2004.svg/500px-Tetanus_world_map_-_DALY_-_WHO2004.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/5b/Tetanus_world_map_-_DALY_-_WHO2004.svg/580px-Tetanus_world_map_-_DALY_-_WHO2004.svg.png 2x" data-file-width="940" data-file-height="415" /></a><figcaption><a href="/wiki/Disability-adjusted_life_year" title="Disability-adjusted life year">Disability-adjusted life year</a> for tetanus per 100,000 inhabitants in 2004.<link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1184024115" /><div class="div-col div-col-small" style="column-width: 10em;"> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#b3b3b3; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> no data</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffff65; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> ≤10</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#fff200; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 10–25</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffdc00; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 25–50</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffc600; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 50–75</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffb000; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 75–100</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff9a00; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 100–125</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff8400; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 125–150</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff6e00; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 150–200</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff5800; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 200–250</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff4200; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 250–500</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff2c00; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 500–750</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#cb0000; color:white;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> ≥750</div> </div></figcaption></figure> <p>In 2013, it caused about 59,000 deaths—down from 356,000 in 1990.<sup id="cite_ref-GBD2014_7-1" class="reference"><a href="#cite_note-GBD2014-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Tetanus, notably the <a href="/wiki/Neonatal" class="mw-redirect" title="Neonatal">neonatal</a> form, remains a significant public health problem in non-industrialized countries, with 59,000 newborns dying worldwide in 2008 as a result of neonatal tetanus.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> In the United States, from 2000 through 2007, an average of 31 cases were reported per year.<sup id="cite_ref-CDC2012Pink_1-21" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Nearly all of the cases in the United States occur in unimmunized individuals, or individuals who have allowed their <a href="/wiki/Inoculation" title="Inoculation">inoculations</a> to lapse.<sup id="cite_ref-CDC2012Pink_1-22" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <ul class="gallery mw-gallery-traditional"> <li class="gallerybox" style="width: 235px"> <div class="thumb" style="width: 230px; height: 230px;"><span typeof="mw:File"><a href="/wiki/File:Tetanos.png" class="mw-file-description" title="Tetanus cases reported worldwide (1990–2004). Ranging from some (in dark red), to very few (in light yellow) (grey, no data)."><img alt="Tetanus cases reported worldwide (1990–2004). Ranging from some (in dark red), to very few (in light yellow) (grey, no data)." src="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Tetanos.png/250px-Tetanos.png" decoding="async" width="200" height="93" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Tetanos.png/330px-Tetanos.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/41/Tetanos.png/500px-Tetanos.png 2x" data-file-width="1357" data-file-height="628" /></a></span></div> <div class="gallerytext">Tetanus cases reported worldwide (1990–2004). Ranging from some (in dark red), to very few (in light yellow) (grey, no data).</div> </li> <li class="gallerybox" style="width: 235px"> <div class="thumb" style="width: 230px; height: 230px;"><span typeof="mw:File"><a href="/wiki/File:Tetanus-deaths-by-age-group.png" class="mw-file-description" title="Tetanus deaths between 1990 and 2017 by age group.[54]"><img alt="Tetanus deaths between 1990 and 2017 by age group" src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b9/Tetanus-deaths-by-age-group.png/200px-Tetanus-deaths-by-age-group.png" decoding="async" width="200" height="120" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b9/Tetanus-deaths-by-age-group.png/300px-Tetanus-deaths-by-age-group.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b9/Tetanus-deaths-by-age-group.png/400px-Tetanus-deaths-by-age-group.png 2x" data-file-width="3311" data-file-height="1988" /></a></span></div> <div class="gallerytext">Tetanus deaths between 1990 and 2017 by age group.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup></div> </li> </ul> <div class="mw-heading mw-heading2"><h2 id="In_animals">In animals</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=20" title="Edit section: In animals"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Tetanus is found primarily in goats and sheep. The following are clinical symptoms found in affected goats and sheep. Extended head and neck, tail rigors (tail becomes rigid and straight), abnormal gait (walking becomes stiff and abnormal), arched back, stiffness of the jaw muscles, lockjaw, twitching of eyes, drooping eyelids, difficulty swallowing, difficulty or inability to eat and drink, abdominal bloat, spasms (uncontrolled muscular contractions) before death. Death sometimes is due to asphyxiation, secondary to respiratory paralysis.<sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=21" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Tetanus was well known to ancient civilizations, who recognized the relationship between wounds and fatal muscle spasms.<sup id="cite_ref-PMC1073859_56-0" class="reference"><a href="#cite_note-PMC1073859-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> In 1884, <a href="/wiki/Arthur_Nicolaier" title="Arthur Nicolaier">Arthur Nicolaier</a> isolated the <a href="/wiki/Strychnine" title="Strychnine">strychnine</a>-like toxin of tetanus from free-living, anaerobic soil bacteria. The etiology of the disease was further elucidated in 1884 by Antonio Carle and Giorgio Rattone, two pathologists of the <a href="/wiki/University_of_Turin" title="University of Turin">University of Turin</a>, who demonstrated the transmissibility of tetanus for the first time. They produced tetanus in rabbits by injecting pus from a person with fatal tetanus into their sciatic nerves, and testing their reactions while tetanus was spreading.<sup id="cite_ref-CDC2012Pink_1-23" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>In 1891, <a href="/wiki/Clostridium_tetani" title="Clostridium tetani"><i>C. tetani</i></a> was isolated from a human victim by <a href="/wiki/Kitasato_Shibasabur%C5%8D" title="Kitasato Shibasaburō">Kitasato Shibasaburō</a>, who later showed that the organism could produce disease when injected into animals and that the toxin could be neutralized by specific <a href="/wiki/Antibodies" class="mw-redirect" title="Antibodies">antibodies</a>. In 1897, <a href="/wiki/Edmond_Nocard" title="Edmond Nocard">Edmond Nocard</a> showed that tetanus antitoxin induced <a href="/wiki/Passive_immunity" title="Passive immunity">passive immunity</a> in humans, and could be used for <a href="/wiki/Prophylaxis" class="mw-redirect" title="Prophylaxis">prophylaxis</a> and treatment. <a href="/wiki/Tetanus_vaccine" title="Tetanus vaccine">Tetanus toxoid vaccine</a> was developed by <a href="/w/index.php?title=P._Descombey&action=edit&redlink=1" class="new" title="P. Descombey (page does not exist)">P. Descombey</a> in 1924, and was widely used to prevent tetanus induced by battle wounds during <a href="/wiki/World_War_II" title="World War II">World War II</a>.<sup id="cite_ref-CDC2012Pink_1-24" class="reference"><a href="#cite_note-CDC2012Pink-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Etymology">Etymology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=22" title="Edit section: Etymology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The word tetanus comes from the <a href="/wiki/Ancient_Greek_language" class="mw-redirect" title="Ancient Greek language">Ancient Greek</a>: <span lang="grc">τέτανος</span>, <small><a href="/wiki/Romanization_of_Ancient_Greek" class="mw-redirect" title="Romanization of Ancient Greek">romanized</a>: </small><span title="Ancient Greek-language romanization"><i lang="grc-Latn">tetanos</i></span>, <small><a href="/wiki/Literal_translation" title="Literal translation">lit.</a> </small>'taut', which is further from the <a href="/wiki/Ancient_Greek_language" class="mw-redirect" title="Ancient Greek language">Ancient Greek</a>: <span lang="grc">τείνειν</span>, <small><a href="/wiki/Romanization_of_Ancient_Greek" class="mw-redirect" title="Romanization of Ancient Greek">romanized</a>: </small><span title="Ancient Greek-language romanization"><i lang="grc-Latn">teinein</i></span>, <small><a href="/wiki/Literal_translation" title="Literal translation">lit.</a> </small>'to stretch'.<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Research">Research</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=23" title="Edit section: Research"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There is insufficient evidence that tetanus can be treated or prevented by <a href="/wiki/Vitamin_C" title="Vitamin C">vitamin C</a>. This is at least partially due to the fact that the historical trials that were conducted in attempts to look for a possible connection between vitamin C and alleviating tetanus patients were of poor quality.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=24" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Renshaw_cell" title="Renshaw cell">Renshaw cell</a></li> <li><a href="/wiki/Tetanized_state" class="mw-redirect" title="Tetanized state">Tetanized state</a></li></ul> <div style="clear:both;" class=""></div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=25" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-CDC2012Pink-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-CDC2012Pink_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-11"><sup><i><b>l</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-12"><sup><i><b>m</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-13"><sup><i><b>n</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-14"><sup><i><b>o</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-15"><sup><i><b>p</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-16"><sup><i><b>q</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-17"><sup><i><b>r</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-18"><sup><i><b>s</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-19"><sup><i><b>t</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-20"><sup><i><b>u</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-21"><sup><i><b>v</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-22"><sup><i><b>w</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-23"><sup><i><b>x</b></i></sup></a> <a href="#cite_ref-CDC2012Pink_1-24"><sup><i><b>y</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFAtkinson2012" class="citation book cs1">Atkinson, William (May 2012). <a rel="nofollow" class="external text" href="https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html"><i>Tetanus Epidemiology and Prevention of Vaccine-Preventable Diseases</i></a> (12 ed.). Public Health Foundation. pp. <span class="nowrap">291–</span>300. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9780983263135" title="Special:BookSources/9780983263135"><bdi>9780983263135</bdi></a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20150213010501/http://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html">Archived</a> from the original on February 13, 2015<span class="reference-accessdate">. Retrieved <span class="nowrap">12 February</span> 2015</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Tetanus+Epidemiology+and+Prevention+of+Vaccine-Preventable+Diseases&rft.pages=%3Cspan+class%3D%22nowrap%22%3E291-%3C%2Fspan%3E300&rft.edition=12&rft.pub=Public+Health+Foundation&rft.date=2012-05&rft.isbn=9780983263135&rft.aulast=Atkinson&rft.aufirst=William&rft_id=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fpubs%2Fpinkbook%2Ftetanus.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATetanus" class="Z3988"></span> <span class="noviewer" typeof="mw:File"><span><img alt="Public Domain" src="//upload.wikimedia.org/wikipedia/en/thumb/6/62/PD-icon.svg/20px-PD-icon.svg.png" decoding="async" width="12" height="12" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/6/62/PD-icon.svg/40px-PD-icon.svg.png 2x" data-file-width="196" data-file-height="196" /></span></span> This article incorporates <a href="/wiki/Copyright_status_of_works_by_the_federal_government_of_the_United_States" title="Copyright status of works by the federal government of the United States">public domain material</a> from websites or documents of the <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">Centers for Disease Control and Prevention</a>.</span> </li> <li id="cite_note-CDC2013S-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-CDC2013S_2-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/tetanus/about/symptoms-complications.html">"Tetanus Symptoms and Complications"</a>. <i>cdc.gov</i>. 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Retrieved <span class="nowrap">12 February</span> 2015</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=cdc.gov&rft.atitle=Tetanus+Symptoms+and+Complications&rft.date=2013-01-09&rft_id=https%3A%2F%2Fwww.cdc.gov%2Ftetanus%2Fabout%2Fsymptoms-complications.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATetanus" class="Z3988"></span></span> </li> <li id="cite_note-CDC2013C-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-CDC2013C_3-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/tetanus/about/causes-transmission.html">"Tetanus Causes and Transmission"</a>. <i>www.cdc.gov</i>. 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Retrieved <span class="nowrap">12 February</span> 2015</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.cdc.gov&rft.atitle=Tetanus+Causes+and+Transmission&rft.date=2013-01-09&rft_id=https%3A%2F%2Fwww.cdc.gov%2Ftetanus%2Fabout%2Fcauses-transmission.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATetanus" class="Z3988"></span></span> </li> <li id="cite_note-CDC2013Doc-4"><span class="mw-cite-backlink">^ <a href="#cite_ref-CDC2013Doc_4-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-CDC2013Doc_4-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/tetanus/clinicians.html">"Tetanus For Clinicians"</a>. <i>cdc.gov</i>. 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CollinsDictionary.com. Collins English Dictionary - Complete & Unabridged 11th Edition. Retrieved October 01, 2012</span> </li> <li id="cite_note-58"><span class="mw-cite-backlink"><b><a href="#cite_ref-58">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFHemiläKoivula2013" class="citation journal cs1">Hemilä H, Koivula T (November 2013). "Vitamin C for preventing and treating tetanus". <i>The Cochrane Database of Systematic Reviews</i> (11): CD006665. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1002%2F14651858.CD006665.pub3">10.1002/14651858.CD006665.pub3</a>. <a href="/wiki/Hdl_(identifier)" class="mw-redirect" title="Hdl (identifier)">hdl</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://hdl.handle.net/10138%2F225863">10138/225863</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24226506">24226506</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Vitamin+C+for+preventing+and+treating+tetanus&rft.issue=11&rft.pages=CD006665&rft.date=2013-11&rft_id=info%3Ahdl%2F10138%2F225863&rft_id=info%3Apmid%2F24226506&rft_id=info%3Adoi%2F10.1002%2F14651858.CD006665.pub3&rft.aulast=Hemil%C3%A4&rft.aufirst=H&rft.au=Koivula%2C+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATetanus" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Tetanus&action=edit&section=26" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="toccolours" style="float: right; 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/></div><div role="navigation" class="navbox" aria-label="Navbox32" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q47790" class="extiw" title="d:Q47790">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/A33">A33</a>-<a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/A35">A35</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=037">037</a>, <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=771.3">771.3</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D013742">D013742</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb2829.htm">2829</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000615.htm">000615</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/emerg/574-overview">emerg/574</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /></div><div role="navigation" class="navbox" aria-labelledby="*_Bacillota_(low-G+C)_Infectious_diseases_*_Bacterial_diseases:_G+200" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Gram-positive_firmicutes_diseases" title="Template:Gram-positive firmicutes diseases"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Gram-positive_firmicutes_diseases" title="Template talk:Gram-positive firmicutes diseases"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Gram-positive_firmicutes_diseases" title="Special:EditPage/Template:Gram-positive firmicutes diseases"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="*_Bacillota_(low-G+C)_Infectious_diseases_*_Bacterial_diseases:_G+200" style="font-size:114%;margin:0 4em"> <ul><li><a href="/wiki/Bacillota" title="Bacillota">Bacillota</a> (low-<a href="/wiki/GC-content" title="GC-content">G+C</a>) <a href="/wiki/Infection" title="Infection">Infectious diseases</a></li> <li><a href="/wiki/Pathogenic_bacteria" title="Pathogenic bacteria">Bacterial diseases</a>: <a href="/wiki/Gram-positive_bacterial_infection" class="mw-redirect" title="Gram-positive bacterial infection">G+</a></li></ul> </div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Bacilli" title="Bacilli">Bacilli</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Lactobacillales" class="mw-redirect" title="Lactobacillales">Lactobacillales</a><br />(<a href="/wiki/Catalase" title="Catalase">Cat-</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Streptococcus" title="Streptococcus">Streptococcus</a></i></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alpha-hemolytic_streptococci" class="mw-redirect" title="Alpha-hemolytic streptococci">α</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Optochin" title="Optochin">optochin</a> susceptible</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Streptococcus_pneumoniae" title="Streptococcus pneumoniae">S. pneumoniae</a></i> <ul><li><a href="/wiki/Pneumococcal_infection" title="Pneumococcal infection">Pneumococcal infection</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">optochin resistant</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Viridans_streptococci" title="Viridans streptococci">Viridans streptococci</a>: <i><a href="/wiki/Streptococcus_mitis" title="Streptococcus mitis">S. mitis</a></i></li> <li><i><a href="/wiki/Streptococcus_mutans" title="Streptococcus mutans">S. mutans</a></i></li> <li><i><a href="/wiki/Streptococcus_oralis" title="Streptococcus oralis">S. oralis</a></i></li> <li><i><a href="/wiki/Streptococcus_sanguinis" title="Streptococcus sanguinis">S. sanguinis</a></i></li> <li><i><a href="/wiki/Streptococcus_sobrinus" title="Streptococcus sobrinus">S. sobrinus</a></i></li> <li><a href="/wiki/Streptococcus_anginosus_group" title="Streptococcus anginosus group"><i>S. anginosus</i> group</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Beta-hemolytic_streptococci" class="mw-redirect" title="Beta-hemolytic streptococci">β</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Group_A_streptococcal_infection" title="Group A streptococcal infection">A</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bacitracin" title="Bacitracin">bacitracin</a> susceptible: <i><a href="/wiki/Streptococcus_pyogenes" title="Streptococcus pyogenes">S. pyogenes</a></i> <ul><li><a href="/wiki/Group_A_streptococcal_infection" title="Group A streptococcal infection">Group A streptococcal infection</a></li> <li><a href="/wiki/Streptococcal_pharyngitis" title="Streptococcal pharyngitis">Streptococcal pharyngitis</a></li> <li><a href="/wiki/Scarlet_fever" title="Scarlet fever">Scarlet fever</a></li> <li><a href="/wiki/Erysipelas" title="Erysipelas">Erysipelas</a></li> <li><a href="/wiki/Rheumatic_fever" title="Rheumatic fever">Rheumatic fever</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Group_B_streptococcal_infection" title="Group B streptococcal infection">B</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>bacitracin resistant, <a href="/wiki/CAMP_test" title="CAMP test">CAMP test</a>+: <i><a href="/wiki/Streptococcus_agalactiae" title="Streptococcus agalactiae">S. agalactiae</a></i> <ul><li><a href="/wiki/Group_B_streptococcal_infection" title="Group B streptococcal infection">Group B streptococcal infection</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">ungrouped</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Streptococcus_iniae" title="Streptococcus iniae">Streptococcus iniae</a></i> <ul><li><a href="/wiki/Cutaneous_Streptococcus_iniae_infection" title="Cutaneous Streptococcus iniae infection">Cutaneous Streptococcus iniae infection</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hemolysis_(microbiology)#Gamma" title="Hemolysis (microbiology)">γ</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Streptococcus#Group_D_(enterococci)_*variable_in_hemolysis" title="Streptococcus">D</a></li> <li><a href="/wiki/Bile_esculin_agar" title="Bile esculin agar">BEA</a>+: <i><a href="/wiki/Streptococcus_bovis" title="Streptococcus bovis">Streptococcus bovis</a></i></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Enterococcus" title="Enterococcus">Enterococcus</a></i></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bile_esculin_agar" title="Bile esculin agar">BEA</a>+: <i><a href="/wiki/Enterococcus_faecalis" title="Enterococcus faecalis">Enterococcus faecalis</a></i> <ul><li><a href="/wiki/Urinary_tract_infection" title="Urinary tract infection">Urinary tract infection</a></li></ul></li> <li><i><a href="/wiki/Enterococcus_faecium" title="Enterococcus faecium">Enterococcus faecium</a></i></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Bacillales" title="Bacillales">Bacillales</a><br />(<a href="/wiki/Catalase" title="Catalase">Cat+</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Staphylococcal_infection" title="Staphylococcal infection">Staphylococcus</a></i></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Coagulase" title="Coagulase">Cg+</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Staphylococcus_aureus" title="Staphylococcus aureus">S. aureus</a></i> <ul><li><a href="/wiki/Staphylococcal_scalded_skin_syndrome" title="Staphylococcal scalded skin syndrome">Staphylococcal scalded skin syndrome</a></li> <li><a href="/wiki/Toxic_shock_syndrome" title="Toxic shock syndrome">Toxic shock syndrome</a></li> <li><a href="/wiki/Methicillin-resistant_Staphylococcus_aureus" title="Methicillin-resistant Staphylococcus aureus">MRSA</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Coagulase" title="Coagulase">Cg-</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Novobiocin" title="Novobiocin">novobiocin</a> susceptible</i> <ul><li><i><a href="/wiki/Staphylococcus_epidermidis" title="Staphylococcus epidermidis">S. epidermidis</a></i></li></ul></li> <li><i>novobiocin resistant</i> <ul><li><i><a href="/wiki/Staphylococcus_saprophyticus" title="Staphylococcus saprophyticus">S. saprophyticus</a></i></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Bacillus" title="Bacillus">Bacillus</a></i></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Bacillus_anthracis" title="Bacillus anthracis">Bacillus anthracis</a></i> <ul><li><a href="/wiki/Anthrax" title="Anthrax">Anthrax</a></li></ul></li> <li><i><a href="/wiki/Bacillus_cereus" title="Bacillus cereus">Bacillus cereus</a></i> <ul><li><a href="/wiki/Foodborne_illness" title="Foodborne illness">Food poisoning</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Listeria" title="Listeria">Listeria</a></i></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Listeria_monocytogenes" title="Listeria monocytogenes">Listeria monocytogenes</a></i> <ul><li><a href="/wiki/Listeriosis" title="Listeriosis">Listeriosis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Clostridia" title="Clostridia">Clostridia</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Clostridium" title="Clostridium">Clostridium</a></i> (<a href="/wiki/Endospore" title="Endospore">spore</a>-forming)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><i>motile:</i></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Clostridium_botulinum" title="Clostridium botulinum">Clostridium botulinum</a></i> <ul><li><a href="/wiki/Botulism" title="Botulism">Botulism</a></li></ul></li> <li><i><a href="/wiki/Clostridium_tetani" title="Clostridium tetani">Clostridium tetani</a></i> <ul><li><a class="mw-selflink selflink">Tetanus</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i>nonmotile:</i></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Clostridium_perfringens" title="Clostridium perfringens">Clostridium perfringens</a></i> <ul><li><a href="/wiki/Gas_gangrene" title="Gas gangrene">Gas gangrene</a></li> <li><a href="/wiki/Clostridial_necrotizing_enteritis" title="Clostridial necrotizing enteritis">Clostridial necrotizing enteritis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Clostridioides" title="Clostridioides">Clostridioides</a></i> (<a href="/wiki/Endospore" title="Endospore">spore</a>-forming)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Clostridioides_difficile" title="Clostridioides difficile">Clostridioides difficile</a></i> [<i>Clostridium difficile</i>] <ul><li><a href="/wiki/Pseudomembranous_colitis" class="mw-redirect" title="Pseudomembranous colitis">Pseudomembranous colitis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Finegoldia" title="Finegoldia">Finegoldia</a></i> (non-spore forming)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Finegoldia" title="Finegoldia">Finegoldia magna</a></i></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Mollicutes" title="Mollicutes">Mollicutes</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Mycoplasmataceae" title="Mycoplasmataceae">Mycoplasmataceae</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Ureaplasma_urealyticum" title="Ureaplasma urealyticum">Ureaplasma urealyticum</a></i> <ul><li><a href="/wiki/Ureaplasma_infection" class="mw-redirect" title="Ureaplasma infection">Ureaplasma infection</a></li></ul></li> <li><i><a href="/wiki/Mycoplasma_genitalium" title="Mycoplasma genitalium">Mycoplasma genitalium</a></i></li> <li><i><a 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