Tetanus is a serious and potentially life-threatening disease, which can affect a variety of animals. Cases in rabbits are extremely rare, but it is important to know what to be on the lookout for, and if your rabbit is diagnosed with it, what to expect.

©Stephen Hernandez-Divers & Maud Lafortune

Tetanus is caused by the bacterium, Clostridium tetani (C. tetani). The spores of C. tetani are widely found and distributed in soil, and often transiently present in the gastrointestinal tract of some animals.

Tetanus is contracted when the spores of the bacteria enter the body via an open wound. Wounds most likely to pick up tetanus are usually located on the feet or legs, since these areas are closer to the ground, and potentially more likely for contamination from spores in the soil. Surgical wounds on these areas may also be a route for the bacterium to enter the body.

Cases of tetanus are rare in all animals and especially so in rabbits, but they can occur.

The signs of tetanus will start to be seen anywhere from a few days to even several weeks from when the bacteria enter the body. The first signs usually target the most susceptible motor nerve canters associated with the neck and head, including spasms of the face and jaw muscles (commonly seen as lockjaw) and protruding 3rd eyelids. The tightened muscles tend to draw the facial features back creating a grimacing appearance. As the cells multiply, two types of toxins are produced. One of these tetanolysin (a hemolysin), is thought to be insignificant. But the other, tetanospasmin, which travels along the peripheral nerves and binds to specific gangliosides (a molecule situated on the surface of cells) of the motor nerve terminals, causing paralysis and the characteristic spasms of tetanus. Tetanus can be localized (within one area of the body) or generalized (affect the entire body or more than one area). Localized tetanus means only a focal group of muscles, such as those in a limb or the head, is affected, whereas with generalized tetanus, the entire body is affected. Other signs may include:

• Seizures, including staring or jerking motions, or spasms triggered by minor things such as a loud noise, light or touch.
• Difficulty opening the mouth.
• Difficulty swallowing or eating (dysphagia).
• Fever/high body temperature (pyrexia), often due to the constant contraction of muscles.
• Increased heart rate and blood pressure.

There is no specific test to diagnose tetanus. A diagnosis is obtained by taking a through clinical history, and ruling out other conditions which may require diagnostic tests, such as bloods, radiography, ultrasound or even advanced imaging, such as CT or MRI scanning. It is important you consider any signs that could have indicated your rabbit had a wound, even if you didn’t notice it at the time, as this is a helpful diagnostic indicator for tetanus.

Tetanus is a progressive disease, getting worse as toxins are produced and carried through the body. It is therefore important that treatment is started as soon as possible once a diagnosis has been made. The aim of treatment is to avoid further toxins being produced, to neutralize those already circulating, and to provide supportive care. Treatment for tetanus includes:

• Administering a tetanus antitoxin: there is not a rabbit specific antitoxin and the use for rabbits is off-license, which your vet will discuss with you. The benefits of this use far outweighs the risks, since without an antitoxin the chances of survival for your rabbit are extremely poor.
• Administering antibiotics: many antibiotics cannot be used in rabbits, and especially when given orally (into the mouth), since they disrupt and kill off the beneficial bacteria in the digestive system, as well as the harmful bacteria we want it to kill, so selection of a suitable antibiotic, not only for the treatment of tetanus, but that is safe to use in rabbits, is imperative. Typically, giving antibiotics intravenously (into the vein) not only works quicker, but is safer.
• Cleaning the wound: if any wounds have been found, then these must be cleaned and flushed to remove debris and excess infected tissue. Surgery may be needed to remove necrotic (dead) tissue as well as cleaning and potentially suturing the wound closed. This may require sedation or a general anesthetic, which is higher risk in a sick rabbit, so your vet will discuss the options with you.
• Supportive care: the supportive care your rabbit requires may include assisted feeding using a syringe or feeding tube, intravenous fluid therapy, pain medication, prokinetic medication to help keep the gastrointestinal tract moving, cleaning and grooming (especially of any urine or fecal soiling), keeping them warm but ensuring they do not overheat, keeping their environment quiet and dark to reduce stimulation (which may include placing cotton wool or something within the ears to reduce sounds and stimuli). Soft bedding will be required, with frequent turning if the rabbit is unable to do this themselves. Muscle relaxants may be required to help reduce the spasms. The supportive care may be needed for two or more weeks until the rabbit recovers.

Sadly, there is no guarantee your rabbit will recover from tetanus, especially if the disease had progressed extensively before treatment was started. Tetanus can be extremely serious, and treatment is often needed for a long time before any sign of improvement is seen. Sometimes euthanasia is the kindest option, since many rabbits may not cope with the intensive treatment and stress. It is also costly to maintain treatment for weeks so this may factor into your decisions.

If you notice a wound on your rabbit, it is important to contact your veterinary practice straight away for advice, even if it looks like a small and minor wound. Keep the rabbit in a clean area, and do not allow it to go outside until the wound is healed. If you notice any signs of tetanus, you must seek veterinary advice straight away. Early diagnosis and treatment offer a better outcome.