TETANUS
INTRODUCTION
• Tetanus-a Greek word-to stretch
• First described by Hippocrates and Susruta
• Tetanus an neurological disease characterized by an acute onset of
hypertonia, painful muscular contractions (usually of the muscles of
the jaw and neck),and generalized muscle spasms without other
apparent medical causes.
• Only vaccine preventable disease that is infectious but not contagious.
DEFINITION
• Tetanus is a acute bacterial disease caused by the neurotoxin
tetanospasmin elaborated by clostridium tetani, and characterized by
a prolonged contraction of skeletal muscle fibers
• It is also called lockjaw.
HISTORY OR INCIDENCE OF
TETANUS
• Tetanus was well known to ancient people who
recognized the relationship between wounds and
fatal muscle spasms.
• In 1884,Arthus Nicolaier isolated the strychnine
like toxin of tetanus from free-living ,anaerobic
soil bacteria.
• During 1884 Nicolaier produced tetanus in
animals by injecting them with samples of soil.
CAUSES OF TETANUS
• Bacteria called clostridium tetani cause tetanus. spores of the
bacteria can be found in dust, dirt and animal droppings.
• Spores are small reproductive bodies produced by certain organisms.
They are often very resistant to harsh environment conditions, like
high heat.
• A person can become infected when these spores enter the
bloodstream through a cut or deep wound.
• The bacteria spores then spread to the central nervous system and
produce a toxin called tetanospasmin. This toxin is a poison that
blocks the nerve signals from your spinal cord to your muscles.
EPIDEMIOLOGY
*Tetanus is an international health problem ,as
spores are ubiquitous. The disease occurs almost
exclusively in persons who are unvaccinated or
inadequately immunized.
*Tetanus occurs worldwide but is more common
in hot , damp climates with soil rich in organic
matter.
*More common in developing and under
developing countries.
*More prevalent in industrial establishment,
where agricultures workers are employed.
Tetanus neonatorum is common due to lack of
MCH.
INCUBATION PERIOD
• Usually incubation period ranges from 3-21 days but can range from
the day of injury to several months.
• Average incubation period is 10 days.
• Depends on character, location, and extent of wound.
MODE OF TRANSMISSION
• Infection is acquired by contamination of wounds with clostridium
tetani spores. A tiny breach in skin or mucosa(e.g.. Skin abrasion,
punctured wounds, burns, animal bites, unsterile surgery, aseptic
abortion, unsterile instruments to cut umbilical cord etc.) leads to
introduce of spores.
• The spores are widely distributed in the intestines and faces of many
non-human animals such as horses, cattle, dogs, cats, rats, sheep and
chickens.
• Tetanus is not spread from person to person.
CLINICAL FEATURES
*Pain and tingling at the site of wound.
*Opisthotonos position.
*Pain in neck, back, and abdomen.
* Risus sardonicus (mouth kept slightly
open).
*Spasm of pharyngeal muscles.
*Lock jaw (reflex trismus).
*Dysphasia.
*Acute asphyxia.
*Refusal of feeding and excessive crying.
*Other symptoms like fever, headache, etc.
DIAGNOSIS
There are currently no blood tests that can be used to diagnose
tetanus.
Clinical presentation of patient associated with tetanus are the
essential factors of diagnosis.
History of injury and possible contamination.
TREATMENT
Injection tetanus toxoid 0.5ml intramuscularly.
Passive immunization with human anti-tetanospasmin
immunoglobulin.
Local wound care:
o Incision And drainage of pus.
o Debridement (Removal of necrotic tissues and foreign bodies)
o Wound should be open.
Control of spasm:
o Injection diazepam 0.1-0.2mg/kg.
o Paralyze And Ventilate.
Antibiotics:
o Broad spectrum antibiotics to treat or prevent infection.
Supportive care:
o Isolation in a quit dark room.
o Maintain fluid, nutrition, and electrolytes.
o Oxygen inhalation if required.
COMPLICATIONS
Acute asphyxia
Aspiration pneumonia
Respiratory arrest
Vertebral fracture
Laceration of tongue, lips, buccal cavity.
CONTROL AND PREVENTION
Tetanus is a vaccine preventable disease.
Immunization of mother with 2 doses of TT during 2nd trimester of
pregnancy can prevent Neonatal tetanus.
Infants and children should be immunized by primary active
immunization with DPT at 6, 10, 14 weeks.
Immunize the vulnerable groups such as all
industrial, agricultural workers, armed forces etc.
Early treatment of wound /injury and give injection
tetanus toxoid.
Use of early antibiotics
3 clean during delivery;
Clean hand
Clean delivery surface
Clean cord care
Give proper health education about
tetanus such as preventive measures,
effects, etc.
Provide awareness that it can be
prevented by post-exposure prophylaxis.
Active immunization shall protect all over
them for 10 years that means adults
should receive a booster vaccine every ten
years.
PICTURES OF CHILDREN SUFFERING FROM
TETANUS