There is a well written article on Live Science that I found interesting as I read it this morning. It seems that a young child living on a farm in Oregon had an accident where he got a significant laceration to his forehead. His parents, I guess the self sufficient kind, allegedly cleaned the wound, sewed him up and sent him on his merry way. I say allegedly because the wound was infected with Clostridium tetani. Now C. tetani is pretty much everywhere. It can be found in soil all around the world, in the gut tracts of all kinds of animals including Homo sapiens and is one hell of a pathogen.

The interesting thing about C. tetani is that it works a bit different than other pathogens and when a person becomes infected with it this particular microbe releases a toxin that causes severe complications including what we were always warned about as farm kids in the 1970’s, lock jaw. It is a pretty insidious infection that can be either localized or systemic. According to one of my old text books there are several portals of entry for C. tetani. Probably the two easiest portals would be through an open wound or through absorption of the toxin, tetanospasmin via the gut tract. Interestingly, the vaccine doesn’t actually help the immune system make antibodies but works to mitigate the toxin. Antibiotics such as metronidazole readily kills the bacteria.

What is interesting about this case is that lacerations to the head or neck region are more likely to result in the worst symptoms plus there is the concept of an inoculating dose which varies from pathogen to pathogen. I looked everywhere I could think of to actually find out what the dose is for C. tetani but it isn’t in any of my reference materials. What I can say is that as minor as a laceration can be proper care is essential.

The last time that I had a severe laceration that required medical intervention was when I was an undergrad at the time. Our sewer had become backed up and ever the frugal type I rented an auger to clean out the pipes. So was using a different machine than the ones I had experience with and when it hit a tree root it bound up quickly and then my hand got caught in the backlash. Needless to say the laceration was really deep and impregnated with raw sewage plus there was the possibility of a fracture. So I trudged my way to the minor emergency where we filled out all the paper work and carefully explained the situation. The very, very first thing they did was give me a tetanus shot. Then they spend what seemed like an hour thoroughly cleaning the wound and I mean thorough. Having a clean wound is just super important. This can’t be stressed enough. Then I got stitches and sent on my way to heal up without getting an infection. Oh, they did give me a prescription for antibiotics.

One of the things about a bacterial infection is that for an infection to occur there has to be 3 things that happen. The first thing is that you have to make contact with the pathogen. The second thing is that there has to be colonization. The third is that after colonization there has to be damage. In the vast majority of cases there is contact without colonization. There has to be a portal of entry such as an open wound where the bacteria can enter. Then once colonization has occurred in the vast majority of the cases our immune systems can keep the invaders localized or they can wipe them out completely. Only rarely at least in terms of how many times your body encounters pathogens do they succeed and cause disease. It is those times that are truly frightening.

This particular instance could have been completely avoided. It is said that 1 gram of soil contains billions of microbes, bacteria, protozoa and fungi, and quite a few will cause damage if given the chance. That is why we vaccinate for microbes like C. tetani. Worldwide, C. tetani is still a major killer even though we’ve had a vaccine for the toxin since 1938. The European Centre for Disease Prevention and Control estimates that C. tetani kills between 213,000 and 293,000 people worldwide annually. It primarily affects those who have no access to the vaccine but does rarely occur in places like the US or Europe. My textbook says that there is about 1 case for every 1 million people every year and that worldwide there is 1 million cases. It isn’t some kind of rare, nondescript thing. No one needs to needlessly suffer from not receiving the proper vaccinations. To say that I don’t understand the idea of not vaccinating your children so that they don’t have to suffer painful, horrible life shattering illnesses is understating it. What I truly don’t get is how so many people in the world tend to adopt and promote terrible ideas. It is truly baffling to me.