Beside roadside injuries, tetanus may occur from various wounds caused by cuts, especially while working in fields / gardens, or when a deep punctured wound occurs in the case of mechanics engaged in various factories / workshops, etc. Tetanus may also manifest itself in patients with bed sores, or wounds caused by splints, or in cases of burns, skin ulcers or, following tooth extraction. It may be due to gunshot wound as well. A simple pinprick, injury by nail, thorn may also cause this problem. Fishermen may also suffer from it when they get an injury while handling the fish-hook. Frost-bite can also prove dangerous in some cases.
Tetanus may appear when injections or intravenous drips are given without proper sterilization. It is usually seen when drug addicts do not use properly sterilized needles / syringes.
The disease is known to occur when the wound is a tiny one, which can hardly be seen and is completely forgotten / healed. In such cases, the patient did suffer from an injury sometimes or the other.
Sometimes tetanus breaks out even in the wards of hospitals. It happens when the various materials used are not quite sterilized. As already mentioned, tetanus spores are highly resistant in nature, and require very high temperature for sterilization / autoclaving. Boiling. for at least 4-5 hours is required to eliminate these spores. In operation cases, tetanus spores get free from the unsterilized material, eg cat-gut, gauze, cotton, etc., the wounds caused by the operation serve as the ports of entry for tetanus spores, and their further germination into vegetative forms, which are responsible for the secretion of the toxin.
A pregnant woman may also become the victim of tetanus by a wound caused during labor / child-birth. It usually occurs when the woman has not been properly vaccinated against tetanus during her period of pregnancy.
Newborn babies may become infected, as a result of tetanus, when the cut ends of their umbilical cords, or any other injuries, they have suffered during their birth, have not been properly treated, with the result that such wound / s get infected by tetanus spores.
Tetanus may also develop in cases of ear discharge (otitis media), when the tetanus spores which may be present in the discharge of the ear, gain entry into the body through perforation / s in the ear-drum of these patients. Such cases are called 'otogenic tetanus'. This is of great importance, because such cases usually remain ignored till they get tetanus. This calls for energetic treatment of the continuing disease of the ear, as well as urgent vaccination against tetanus usually, these cases have not been vaccinated for tetanus earlier. Cases of otogenic tetanus are not uncommon. The author discussed such cases in one of the issues of Current Medical Practice. The disease is more common among children, and the parents should have the requisite awareness about this disease.