Tetanus

TETANUS
Presented by :-
Sushant Dobhal
HCN, SRHU

INTRODUCTION
• Its infectious disease caused by
contamination of wounds from the
bacteria Clostridium tetani, or the
spores they produce that live in the
soil, and animal feces.
• Greek words -“tetanos
and teinein”, meaning rigid and
stretched.

• Clostridium tetani produces 2 toxins,
 1.Tetanolysin (Cause red cell lysis)
 2.Tetanospasmin (muscle spasm/rigidity)
• Tetanus spores are found throughout the
environment, usually in soil, dust, and animal
waste.
• Tetanus is acquired through contact with the
environment; it is not transmitted from person to
person.

• As the infection progresses, muscle spasms in the
jaw develops, hence the common name, lockjaw.
• This is followed by difficulty swallowing &
general muscle stiffness & spasms in other parts
of the body.
• Infection can be prevented by proper
immunisation & by post-exposure prophylaxis.
• Incubation period varies from 1 day to several
months. , but is usually about eight days.

incidence
 Around a million cases occur worldwide each
year.
 If the patient does not receive treatment the
risk of life-threatening complications is
higher - Mortality rates reported vary from
40% to 78%.
 in 2013 it caused about 59,000 deaths

TETANUS
Tetanus is a
medical condition
characterised by
prolonged
contraction of
skeletal muscle
fibres.

•The bacteria that cause tetanus, Clostridium
tetani, are found in soil, dust and animal feces.
When they enter a deep flesh wound, spores of
the bacteria may produce a powerful toxin,
tetanospasmin, which actively impairs your motor
neurons, nerves that control your muscles. The
effect of the toxin on your motor neurons can
cause muscle stiffness and spasms — the major
signs of tetanus.
•They cause tetanus in both man & animal.
ETIOLOGY

Risk factors
 Tetanus cases have developed from the following types of
injuries:
 Puncture wounds — including from splinters, body piercings,
tattoos, injection drugs
 Gunshot wounds
 Compound fractures
 Crush injuries
 Burns
 Surgical wounds
 Injection drug use
 Ear infections
 Animal bites
 Infected foot ulcers
 Infected umbilical stumps in newborns born of inadequately
immunized mothers

 certain factors are necessary for tetanus
bacteria to proliferate in your body.These
include:
 Lack of immunization or inadequate
immunization — failure to receive timely
booster shots — against tetanus.
 A penetrating injury that results in tetanus
spores being introduced to the wound site.
 The presence of other infective bacteria.
 Injured tissue.
 A foreign body, such as a nail or splinter.
 Swelling around the injury.

1.Local tetanus
 Persistent spasm of musculature at site of
primary infection (injury site).
 Contractions persist for weeks before
subsiding.
 Its generally milder, 1% cases are fatal but may
precede the generalised tetanus.
 affects mostly the cranial nerves and facial
nerves.

2.Cephalic tetanus
 Primary site of infection is head injury or otitis
media.
 Associated with disfunction of 1 or more cranial
nerves, most commonly facial nerve.
 Poor prognosis.

3.Generalised tetanus
 Most common form(80% of cases).
 Presents with a descending pattern.
 1st sign is trismus(lockjaw) -due to spasm of
masseter muscles.
 Followed by stiffness of the neck, difficulty in
swallowing, rigidity of abdominal muscles.

4.Tetanus neonatorum
 It is the generalised tetanus
that occurs in newborn
infants.
 Occurs in infants of non-
immunised mothers.
 Occurs from infection of
un-healed umbilical stump
particularly when stump is
cut with non-sterile
instrument.
 Very poor prognosis

 This has a faster acting progression and the
incubation period is normally only four days.
This is a rare condition in developed
countries, but elsewhere is responsible for
around 15% of neonatal deaths.
 If the mother has been immunised against
tetanus then this can help to give the child
'passive immunity'.

CLINICAL FEATURES
• Febrile (feverish), irritability,
• heavy sweating
Risus sardonicus:
Contraction of the muscles
at the angle of mouth and
frontalis.
Characteristic sardonic
smile in tetanus, sustained
contraction of facial muscles.

 Trismus (Lock Jaw): Spasm of Masseter
muscles.
Opisthotonus:
Spasm of
extensor of the
neck, back and
legs to form a
backward
curvature.

Other symptoms…
 Bloody stools (feces)
 Diarrhea
 Fever
 Headache
 Sensitivity to touch
 Sore throat
 Sweating
 Tachycardia (rapid heartbeat).

PATHOGENESIS
C. tetani enters
body from wound.
Stays in sporulated form until
anaerobic conditions are presented
Germinates under anaerobic
conditions and begins to multiply
and produce tetnospasmin.
Tetnospasmin
spreads using blood
and lymphatic
system, and binds
to motor neurons
Travels along the
axons to the spinal
cord.
Binds to sites responsible for
inhibiting skeletal muscle
contraction.

 It blocks the release of inhibitory
neurotransmitters (glycine and gamma-amino
butyric acid) across the synaptic cleft, which is
required to check the nervous impulse.
 If nervous impulses cannot be checked by normal
inhibitory mechanisms, it leads to unopposed
muscular contraction and spasms that are
characteristic of tetanus.
TEATANUS TOXIN ACTION…….

complications
 Once tetanus toxin has bonded to your nerve
endings it is impossible to remove. Complete
recovery from a tetanus infection requires the
growth of new nerve endings and can take up to
several months.
 Broken bones.The severity of spasms may cause
the spine and other bones to break.
 Disability.Treatment for tetanus typically involves
the use of powerful sedatives to control muscle
spasms. Prolonged immobility due to the use of
these drugs can lead to permanent disability. In
infants, tetanus infections may cause lasting brain
damage, ranging from minor mental deficits to
cerebral palsy.

 Aspiration pneumonia - if secretions or contents of
the stomach are inhaled, which may sometimes
happen in patients with tetanus, a lower respiratory
tract infection can develop, leading to pneumonia.
 Laryngospasm - the larynx (voice box) goes into a
spasm which can last up to a minute and cause
breathing difficulties. In severe cases the patient
can suffocate.
 Pulmonary embolism - a blood vessel in the lung
can become blocked and affect breathing and
circulation.The patient will urgently need oxygen
therapy and anti-clotting medication.

 Tetanic seizures - if infection spreads to the
brain the patient can have epileptic-like fits
(seizures).
 Severe kidney failure (acute renal failure) -
severe muscle spasms can result in the
destruction of skeletal muscle which can cause
myoblobin - a muscle protein - leaking into the
urine.This can cause acute renal failure (severe
kidney failure).

 - symptoms may include: Asphyxia (suffocation)
 Heart attack
 Kidney failure
 Septicemia (blood poisoning).
 Prolonged muscular action causes sudden,
powerful, and painful contractions of muscle
groups. This is called tetany. These episodes
can cause fractures and muscle tears.

DIAGNOSIS
 Diagnosis made based on clinical presentation.
 Doctors diagnose tetanus based on a physical exam,
medical and immunization history, and the signs and
symptoms of muscle spasms, stiffness and pain.
Laboratory tests generally aren't helpful for
diagnosing tetanus.
 Specimen: Wound swab, exudate or tissue from the
wound.
 1.Direct smear & gram staining
 2.Culture
 3.Animal inoculation

management
 There's no cure for tetanus.Treatment
focuses on managing complications until the
effects of the tetanus toxin resolve. Fatality is
highest in individuals who haven't been
immunized and in older adults with
inadequate immunization.
 Cleaning the wound is essential to preventing
growth of tetanus spores.This involves
removing dirt, foreign objects and dead
tissue from the wound.

 Any patient with a tetanus prone wound should
receiveTIG (tetanus immunoglobulin) as soon as
possible, even if he/she has been vaccinated.
Tetanus immunoglobulin contains antibodies
that kill Clostridium tetani. It is injected into a
vein and provides immediate short-term
protection against tetanus.TIG is just short-term
and does not replace the long-term effects of
vaccination.
 antibiotics- doctors may prescribe penicillin and
metronidazole for tetanus treatment.These
antibiotics prevent the bacterium from
multiplying and producing the neurotoxin that
causes muscle spasms and stiffness. Patients
who are allergic to penicillin or metronidazole
may be given tetracycline instead.

 Anticonvulsants - these treat muscle spasms.
Examples include diazepam (Valium) and
phenobarbital.
 Muscle relaxants - these drugs help ease the
symptoms of muscle stiffness and spasms.
Examples include baclofen (Lioresal) and
dantrolene (Dantrium).
 Vaccine. Having tetanus once doesn't make
you immune to the bacteria afterward. So you'll
need to receive a tetanus vaccine in order to
prevent future tetanus infection.

 Neuromuscular blocking agents - these medications
block the signals from nerves to muscle fibers and are
useful in controlling muscle spasms. An example is
vacuronium, a neuromuscular blocking agent
sometimes used as a muscle relaxant in addition to
anesthesia during surgery.
 Surgery - If the doctor thinks the tetanus prone
wound is very large, he/she may surgically remove as
much of the damaged and infected muscle as possible
(debridement). Debridement is the act of removing
dead or contaminated tissue, or foreign material. In
the case of a tetanus prone wound the foreign
material may be dirt or manure.
 Nutrition - A patient with tetanus requires a high daily
calorie intake because of increased muscle activity.
Ventilator - Some patients may need ventilator
support to help with breathing if their vocal cords or
respiratory muscles are affected.

PREVENTION
 Tetanus carries a 35% mortality rate, making
prevention very important! The best course is
childhood immunizations, with consistent booster
doses, and prompt cleaning of wounds with
hydrogen peroxide.
 Tetanus is completely preventable by active tetanus
immunization.
 Immunization is thought to provide protection for
10 years.
 Begins in infancy with the DTP series of shots. The
DTP vaccine is a "3-in-1" vaccine that protects
against diphtheria, pertussis, and tetanus.

PREVENTION :-
1.TT-2 doses for pregnant women,
2.DPT at 6, 10, 14 weeks after birth,
3.DPT booster at 18 months
4.DT at 5yrs.
5.TT boosters at 10 & 16 yrs.

 Provide complete bed rest to the child.
 Keep the infant in dim lighted, quiet and well
ventilated room, as spasms can be precipitated
by bright light, noise or even touch.
 Minimiseexternal stimuli.
 Prompt suctioning and oxygen administration
is essential.
 Fluid and electrolyte balance should be
maintained.
 Due to spasm and increased mucle activity,
patients are exhausted and need extra calories,
so provide high calorie & protein diet to
patient.

 NG feed must b given in case of high fever
and tapid spunging too.
 Change patients position every 2 hourly to
prevent bed sores.
 General hygiene including bath,oral care, and
elimination should be maintained.
 Care of wound such as removal of necrosed
tissue, cleaning with hydrogen peroxide and
treatment with antibiotic ointment is done.
 Regularly monitor vital signs.

Bibliography
 http://coldflu.about.com/od/vaccines/p/tetan
us.htm
 http://google.com/tetanus
 http://en.wikipedia.org/wiki/tetanus
 http://www.mayoclinic.org/diseases-
conditions/tetanus/basics/
 http://www.webmd.com/a-to-z-
guides/tetanus-topic-overview

Tetanus

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