TETANUS
(LOCKJAW)
BY; DR YUSUF IMRAN
DEPT. OF PEDIATRICS
J.N MEDICAL COLLEGE
AMU-INDIA
ETIOLOGY
• TETANUS, HISTORICALLY CALLED LOCKJAW, IS AN ACUTE, SPASTIC
PARALYTIC ILLNESS CAUSED BY TETANUS TOXIN
• AGENT- C...
EPIDEMIOLOGY.
• TETANUS OCCURS WORLDWIDE AND IS ENDEMIC IN 90
DEVELOPING COUNTRIES
• MOST COMMON FORM, NEONATAL (UMBILICAL...
• MOST NON-NEONATAL CASES OF TETANUS ARE ASSO. WITH A
TRAUMATIC INJURY, FOR EXAMPLE-
1) A PENETRATING WOUND INFLICTED BY A...
PATHOGENESIS
SPORES GERMINATE, MULTIPLY, AND
PRODUCE TETANUS TOXIN IN THE INFECTED
INJURY SITE
TOXIN IS RELEASED WITH VEGE...
UNDERGOES RETROGRADE AXONAL TRANSPORT TO THE
CYTOPLASM OF THE ALPHA-MOTOR NEURON
TOXIN EXITS THE MOTOR NEURON IN THE SPINA...
CLINICAL MANIFESTATIONS
• THE INCUBATION PERIOD TYPICALLY IS 2-14 DAYS (USUALLY
ABOUT 8 DAYS)
• VARIOUS TYPES OF TETANUS A...
• OPISTHOTONOS-PATIENT MAY ASSUME AN ARCHED POSTURE
OF EXTREME HYPEREXTENSION OF THE BODY
• SARDONIC SMILE (RISUS SARDONIC...
• NEONATAL TETANUS (TETANUS NEONATORUM)- INFANTILE
FORM OF GENERALIZED TETANUS, TYPICALLY MANIFESTS
WITHIN 3-12 DAYS OF BI...
DIFFERENTIAL DIAGNOSIS (OF
LOCKJAW)
• PARAPHARYNGEAL, RETROPHARYNGEAL, OR DENTAL
ABSCESSES RESULTING IN TRISMUS
• RABIES M...
MANAGEMENT
• GENERAL - SURGICAL WOUND EXCISION AND DEBRIDEMENT IS OFTEN
NEEDED
• PATIENT SHOULD BE SEDATED AND PROTECTED F...
• SPECIFIC TREATMENT
• HUMAN TETANUS IMMUNOGLOBULIN(TIG ) IS GIVEN AS SOON
AS POSSIBLE TO NEUTRALIZE TOXIN BEFORE IT CAN B...
COMPLICATIONS
• ASPIRATION OF SECRETIONS AND PNEUMONIA
• SEIZURES MAY RESULT IN :
1. LACERATIONS OF THE MOUTH OR TONGUE,
2...
PREVENTION
• TETANUS IS AN ENTIRELY PREVENTABLE DISEASE; A SERUM
ANTIBODY TITER OF ≥0.01 U/ML IS CONSIDERED PROTECTIVE
• A...
Tetanus dr yusuf imran
Tetanus dr yusuf imran
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Tetanus dr yusuf imran

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Tetanus and neonatal tetanus. Its symptoms,diagnosis,prevention,vaccination and treatment.

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Tetanus dr yusuf imran

  1. 1. TETANUS (LOCKJAW) BY; DR YUSUF IMRAN DEPT. OF PEDIATRICS J.N MEDICAL COLLEGE AMU-INDIA
  2. 2. ETIOLOGY • TETANUS, HISTORICALLY CALLED LOCKJAW, IS AN ACUTE, SPASTIC PARALYTIC ILLNESS CAUSED BY TETANUS TOXIN • AGENT- CLOSTRIDIUM TETANI, A MOTILE, GRAM-POSITIVE, SPORE-FORMING, OBLIGATE ANAEROBE IS NOT A TISSUE-INVASIVE ORGANISM • TETANUS TOXIN (TETANOSPASMIN)- NEUROTOXIN PRODUCED BY IT CAUSES DISEASE MANIFESTATIONS • IT IS THE SECOND MOST POISONOUS SUBSTANCE KNOWN (AFTER BOTULINUM TOXIN ) • TETANOLYSIN- A HEMOLYTIC TOXIN ,POTENTIATE INFECTION BUT DOESNOT CONTRIBUTE TO DISEASE PROCESS
  3. 3. EPIDEMIOLOGY. • TETANUS OCCURS WORLDWIDE AND IS ENDEMIC IN 90 DEVELOPING COUNTRIES • MOST COMMON FORM, NEONATAL (UMBILICAL) TETANUS, KILLS APPROXIMATELY 500,000 INFANTS EACH YEAR (ABOUT 80% DEATHS INVOLVING 12 TROPICAL COUNTRIES) • AN ESTIMATED 15,000-30,000 UNIMMUNIZED WOMEN WORLDWIDE DIE EACH YEAR OF MATERNAL TETANUS THAT RESULTS FROM POSTPARTUM, POSTABORTAL, OR POSTSURGICAL WOUND INFECTION WITH C. TETANI
  4. 4. • MOST NON-NEONATAL CASES OF TETANUS ARE ASSO. WITH A TRAUMATIC INJURY, FOR EXAMPLE- 1) A PENETRATING WOUND INFLICTED BY A DIRTY OBJECT, SUCH AS A NAIL, SPLINTER, FRAGMENT OF GLASS 2) AFTER ILLICIT DRUG INJECTION, IN ADDICTS 3) UNCOMMON SETTINGS INCLUDE ANIMAL BITES, ABSCESSES (INCLUDING DENTAL ABSCESSES), EAR PIERCING, BURNS, COMPOUND FRACTURES, FROSTBITE, GANGRENE, INTESTINAL SURGERY, RITUAL SCARIFICATION, INFECTED INSECT BITES 4) THE USE OF CONTAMINATED SUTURE MATERIAL OR AFTER INTRAMUSCULAR INJECTION
  5. 5. PATHOGENESIS SPORES GERMINATE, MULTIPLY, AND PRODUCE TETANUS TOXIN IN THE INFECTED INJURY SITE TOXIN IS RELEASED WITH VEGETATIVE BACTERIAL CELL DEATH AND SUBSEQUENT LYSIS TETANUS TOXIN BINDS AT THE NEUROMUSCULAR JUNCTION AND ENTERS
  6. 6. UNDERGOES RETROGRADE AXONAL TRANSPORT TO THE CYTOPLASM OF THE ALPHA-MOTOR NEURON TOXIN EXITS THE MOTOR NEURON IN THE SPINAL CORD AND NEXT ENTERS ADJACENT SPINAL INHIBITORY INTERNEURONS BLOCKS THE NORMAL INHIBITION OF ANTAGONISTIC MUSCLES AFFECTED MUSCLES SUSTAIN MAXIMAL CONTRACTION RESULTING IN TETANUS
  7. 7. CLINICAL MANIFESTATIONS • THE INCUBATION PERIOD TYPICALLY IS 2-14 DAYS (USUALLY ABOUT 8 DAYS) • VARIOUS TYPES OF TETANUS ARE: • GENERALIZED TETANUS- TRISMUS (MASSETER MUSCLE SPASM, OR LOCKJAW) MAY BE THE PRESENTING SYMPTOM • HEADACHE, RESTLESSNESS, AND IRRITABILITY ARE EARLY SYMPTOMS • STIFFNESS, DIFFICULTY CHEWING, DYSPHAGIA, AND NECK MUSCLE SPASM FOLLOW LATER
  8. 8. • OPISTHOTONOS-PATIENT MAY ASSUME AN ARCHED POSTURE OF EXTREME HYPEREXTENSION OF THE BODY • SARDONIC SMILE (RISUS SARDONICUS) RESULTS FROM INTRACTABLE SPASM OF FACIAL AND BUCCAL MUSCLES • LARYNGEAL AND RESPIRATORY MUSCLE SPASM CAN LEAD TO AIRWAY OBSTRUCTION AND ASPHYXIATION • AS TETANUS TOXIN DOES NOT AFFECT SENSORY NERVES OR CORTICAL FUNCTION, THE PATIENT REMAINS CONSCIOUS, IN EXTREME PAIN, AND IN FEARFUL ANTICIPATION
  9. 9. • NEONATAL TETANUS (TETANUS NEONATORUM)- INFANTILE FORM OF GENERALIZED TETANUS, TYPICALLY MANIFESTS WITHIN 3-12 DAYS OF BIRTH AS PROGRESSIVE DIFFICULTY IN FEEDING • LOCALIZED TETANUS- RESULTS IN PAINFUL SPASMS OF THE MUSCLES ADJACENT TO THE WOUND SITE AND MAY PRECEDE GENERALIZED TETANUS • CEPHALIC TETANUS- RARE FORM OF LOCALIZED TETANUS INVOLVING THE BULBAR MUSCULATURE THAT OCCURS WITH WOUNDS OR FOREIGN BODIES IN THE HEAD, NOSTRILS, OR FACE(ASSO. WITH CHRONIC OTITIS MEDIA)
  10. 10. DIFFERENTIAL DIAGNOSIS (OF LOCKJAW) • PARAPHARYNGEAL, RETROPHARYNGEAL, OR DENTAL ABSCESSES RESULTING IN TRISMUS • RABIES MAY PRESENT AS TRISMUS WITH SEIZURES • STRYCHNINE POISONING MAY RESULT IN TONIC MUSCLE SPASMS • HYPOCALCEMIA MAY PRODUCE TETANY, CHARACT. BY LARYNGEAL AND CARPOPEDAL SPASMS • OCCASIONALLY, EPILEPTIC SEIZURES, NARCOTIC WITHDRAWAL, OR OTHER DRUG REACTIONS MAY SUGGEST TETANUS
  11. 11. MANAGEMENT • GENERAL - SURGICAL WOUND EXCISION AND DEBRIDEMENT IS OFTEN NEEDED • PATIENT SHOULD BE SEDATED AND PROTECTED FROM ALL UNNECESSARY SOUNDS, SIGHTS, AND TOUCH • CAREFUL NURSING ATTENTION TO MOUTH, SKIN, BLADDER, AND BOWEL FUNCTION IS NEEDED • MUSCLE RELAXANTS- DIAZEPAM PROVIDES BOTH RELAXATION AND SEIZURE CONTROL (INITIAL DOSE OF 0.1-0.2MG/KG Q 3- 6 HR) • MAGNESIUM SULFATE, OTHER BENZODIAZEPINES (E.G., MIDAZOLAM), CHLORPROMAZINE,DANTROLENE, AND BACLOFEN ARE ALSO USED
  12. 12. • SPECIFIC TREATMENT • HUMAN TETANUS IMMUNOGLOBULIN(TIG ) IS GIVEN AS SOON AS POSSIBLE TO NEUTRALIZE TOXIN BEFORE IT CAN BIND AT DISTANT MUSCLE GROUPS • A SINGLE INTRAMUSCULAR INJECTION OF 500 U OF TIG IS SUFFICIENT , BUT TOTAL DOSES AS HIGH AS 3,000-6,000 U ARE ALSO RECOMMENDED • ANTIBIOTIC- PENICILLIN G (100,000 U/KG/24 HR DIVIDED Q 4-6 HR IV FOR 10-14 DAYS) REMAINS THE ANTIBIOTIC OF CHOICE • METRONIDAZOLE ,ERYTHROMYCIN AND TETRACYCLINE ARE
  13. 13. COMPLICATIONS • ASPIRATION OF SECRETIONS AND PNEUMONIA • SEIZURES MAY RESULT IN : 1. LACERATIONS OF THE MOUTH OR TONGUE, 2. INTRAMUSCULAR HEMATOMAS OR RHABDOMYOLYSIS WITH MYOGLOBINURIA AND RENAL FAILURE 3. LONG BONE OR SPINAL FRACTURES • VENOUS THROMBOSIS, PULMONARY EMBOLISM, GASTRIC ULCERATION, PARALYTIC ILEUS, AND DECUBITUS ULCERATION ARE CONSTANT HAZARDS • MAINTAINING AIRWAY PATENCY OFTEN MANDATES ENDOTRACHEAL INTUBATION AND MECHANICAL VENTILATION
  14. 14. PREVENTION • TETANUS IS AN ENTIRELY PREVENTABLE DISEASE; A SERUM ANTIBODY TITER OF ≥0.01 U/ML IS CONSIDERED PROTECTIVE • ACTIVE IMMUNIZATION SHOULD BEGIN IN EARLY INFANCY WITH COMBINED DPT VACCINE AT 2, 4, AND 6 MO OF AGE, F/B A BOOSTER AT 15MTH AND 4-6 YR OF AGE (DT) & AT 10-YR INTERVALS THEREAFTER WITH (TD) TOXOIDS • IMMUNIZATION OF WOMEN WITH TETANUS TOXOID PREVENTS NEONATAL TETANUS

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