Fahad basheer
Tetanus is caused by CLOSTIDIUM TENATI

The organism produce a potent
NEUROTOXIN Known as TENATOSPASMIN.

Clostridium te...
PATHOGENESIS
The spores of
the organism
remain non
pathogenic in
soil or
contaminated
tissues until
conditions are
favorab...
PATHOGENESIS

Part 2

Tetanolysin

Tetanospasmin

Hemolytic toxin

Binds to NM junction at the site of injury and
undergoe...
CLINICAL FEATURES

TETANUS

GENERALIZED
TETANUS

NEONATAL
TETANUS

LOCALIZED
TETANUS
– GENERALIZED TETANUS Incubation period is 8 days (2-14 days),
Incubation period depends on site of injury from
CNS
Dis...
– GENERALIZED TETANUS SPECIAL FEATURES
 SENSORIUM IS PRESERVED.

 DIFFICULTY IN SWALLOWING
 AUTONOMIC DYSFUNCTIONS:
HYP...
– neonatal TETANUS  Results from unhygienic birth practices most commonly when umbilical cord is
contaminated at the time...
– localized TETANUS  PAIN CONFINED TO INJURED REGION CHARECTERIZED BY
RIGIDITY
 IT MAY LEAD TO GENERALIZED TETANUS LATER...
– TREATMENT AIMS OF TREATMENT

Airway maintenance

Prevention of further
toxin absorption

Relieving clinical
symptoms : s...
Aim 1

AIRWAY MANAGEMENT
• Intubation and mechanical
ventilation
• In severe cases , if the infant gets
frequent episodes ...
Aim 2
PREVENTION OF FURTHER TOXIN ABSORPTION
• Neutralization of free toxin is done by administrating human
tetanus immuno...
Aim 3
RELEIVING CLINICAL SYMPTOMS
• Spasms are precipitated by minimal stimuli therefore efforts
should be made to avoid n...
– prognosis  The prognosis in neonatal tetanus is worse if
1.onset of symptoms occurs within 1st week of life

2.interval...
-Prevention-

Part 1

 Prevention is by tetanus immunization.
 Using 2 doses of TT to immunize pregnant woman or
woman o...
-Prevention-

Part 2

TETANUS TOXIN
• TT is highly toxic so it is inactivated by formalin
to make TT and adsorbed on to al...
-Prevention-

Part 3

Past doses of
TT

Clean minor
wound

Clean minor
wound

All other
wound

All other
wound

UNKNOWN/
L...
-------------------------------------------Tetanus
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Tetanus paediatics

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this is my pediatric presentation for tetanus


I hav not included pics im sorry so uv find 1

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Tetanus paediatics

  1. 1. Fahad basheer
  2. 2. Tetanus is caused by CLOSTIDIUM TENATI The organism produce a potent NEUROTOXIN Known as TENATOSPASMIN. Clostridium tetani • Gram positive motile bacillus • Found in human and animal feces • Found commonly in areas where soil is cultivated, in warm climates and during summer months
  3. 3. PATHOGENESIS The spores of the organism remain non pathogenic in soil or contaminated tissues until conditions are favorable for transformation into vegetative form. Transformation occurs in the presence of locally decreased oxygen reduction potential Part 1 When transformed it produces 2 types of TOXINS 1.Tetanolysin 2.Tetanospasmin
  4. 4. PATHOGENESIS Part 2 Tetanolysin Tetanospasmin Hemolytic toxin Binds to NM junction at the site of injury and undergoes retrograde axonal transport to reach presynaptic nerve terminal where it prevents the inhibitory neurotransmitters GLYCINE AND GABA. Potentiates infection but does not cause disease process In normal states these neurotransmitters prevent release of Ach from excitatory neurons thus prevent muscle contraction.in the presence of toxins these inhibitory impulses are prevented leading to uncontrolled contraction of muscles,
  5. 5. CLINICAL FEATURES TETANUS GENERALIZED TETANUS NEONATAL TETANUS LOCALIZED TETANUS
  6. 6. – GENERALIZED TETANUS Incubation period is 8 days (2-14 days), Incubation period depends on site of injury from CNS Diseases occurs after an initial injury. Faster the onset of symptoms poor the prognosis. The nature of paralysis is in descending form : JAW muscles – Spasm of masseter leading to Trismus and LOCK JAW NECK BACK ABDOMINAL MUSCLES WHOLE BODY. COMPLICATES TO DEATH
  7. 7. – GENERALIZED TETANUS SPECIAL FEATURES  SENSORIUM IS PRESERVED.  DIFFICULTY IN SWALLOWING  AUTONOMIC DYSFUNCTIONS: HYPERTENSION,HYPOTENSION,DIAPHORESIS AND ARRYTHMIAS RECOVERY Recovery usually begins in 3 weeks and approximately takes 4 weeks Recovery occurs by sprouting new nerve terminals in the spinal cord and leading to relaxation of contracted muscles.
  8. 8. – neonatal TETANUS  Results from unhygienic birth practices most commonly when umbilical cord is contaminated at the time of cutting after delivery.  Symptoms usually appear by the 3RD DAY after birth.  Initial SYMPTOMS: Excessive unexplained crying followed by refusal of feeds and apathy  The baby develops progressive feeding difficulty (reflex spasm of massetter makes feeding painful) (pharyngeal muscles goes into spasm and cause dysphagia chocking) Spasm of larynx and respiratory muscles are induced by stimuli such as touch ,noise ,bright light, resulting in episodes of apnea and cyanosis. Constipation persists until spasms are relieved, becomes rigid ,develops paralysis , and may develop opisthotonic posturing(in extension) and experience painful spasm. Intercurrent infections, dehydration and acidosis complicate the clinical picture:
  9. 9. – localized TETANUS  PAIN CONFINED TO INJURED REGION CHARECTERIZED BY RIGIDITY  IT MAY LEAD TO GENERALIZED TETANUS LATER.  CEPAHALIC TETANUS IS A FORM OF LOCAL TETANUS WHICH OCCURS DUE TO INJURY OF BULBAR MUSCLES.
  10. 10. – TREATMENT AIMS OF TREATMENT Airway maintenance Prevention of further toxin absorption Relieving clinical symptoms : spasms, autonomic instability
  11. 11. Aim 1 AIRWAY MANAGEMENT • Intubation and mechanical ventilation • In severe cases , if the infant gets frequent episodes of laryngeal spasms, apneic attacks with cyanosis or central respiratory failure.
  12. 12. Aim 2 PREVENTION OF FURTHER TOXIN ABSORPTION • Neutralization of free toxin is done by administrating human tetanus immunoglobulin ;however the anti toxin cannot dislodge toxins in the nerve root. • The route of administration is intra muscular or intra thecal. • Dose:500 – 1000 IU • Supportive care: maintain adequate hydration, early detection of myoglobinuria , prevention of renal shutdown. • Oropharyngeal secretions should be sucked periodically. • Maintenance of oxygen is essential • Oral feeding should be stopped and IV line should be established for providing adequate fluids , calories , electrolytes and for administration of various drugs. • After 3 – 4 days of treatment milk feeding through nasogastric tube may be started.
  13. 13. Aim 3 RELEIVING CLINICAL SYMPTOMS • Spasms are precipitated by minimal stimuli therefore efforts should be made to avoid noxious stimuli including bright lights, pain , loud noises. • So ,Patient should be kept in dark quiet and isolated rooms. • I.M injections should be avoided. • Temperature should be maintained within normal limits. • Relief of symptoms is by using benzodiapenes. • DIAZEPAM prevents spasms by causing GABA mediated central inhibition.it promotes muscle relaxation. • Antibiotic therapy is needed to abolish bacteria bacteria from wound site. Commonly used: crystalline penicillin or metronidazole • ANS Instability treated by: alpha and beta blockers,i.v magnesium.
  14. 14. – prognosis  The prognosis in neonatal tetanus is worse if 1.onset of symptoms occurs within 1st week of life 2.interval between lockjaw on onset of spasms is less than 48 hours 3.high fever and tachyardia are present 4.spasms, especially of larynx resulting in apnea and are very severe and frequent.  All patient should receive a complete course of immunization with tetanus toxoid once recovered.
  15. 15. -Prevention- Part 1  Prevention is by tetanus immunization.  Using 2 doses of TT to immunize pregnant woman or woman of child bearing age is an important strategy to reduce the incidence of the disease , because IgG Abs are transferred across the placenta to fetus and protect the newborn.  The last dose of TT should be received at least 2 wks prior to delivery.this cause passive immunization to child.  Scince tetanus can occur at any age: primary immunization is essential for which 3 doses of DPT are given 1month apart  Boosters are given at 18 th month, 5,10 and 16 years of age,  For previously un immunized school children: 2 Doses of TT given 1 month are sufficient.  For previously immunized pregnant woman: 1 Dose of TT is sufficient if the 2 nd pregnancy within the next 5 years
  16. 16. -Prevention- Part 2 TETANUS TOXIN • TT is highly toxic so it is inactivated by formalin to make TT and adsorbed on to aluminum salts to enhance its immunogenicity. • TT vaccine contains 5 liters of toxoid • It is heat stable vaccine that remain potent for few weeks even at 37 degree Celsius • Tetanus is administered along with Diphtheria toxoid and pertussis killed vaccine as combination called DPT.
  17. 17. -Prevention- Part 3 Past doses of TT Clean minor wound Clean minor wound All other wound All other wound UNKNOWN/ Less than 3 doses TT TIG* TT TIG* Greater than/equal to 3 doses YES NO YES YES NO** NO NO*** NO * ** TETANUS IMMUNOGLOBULIN (250IU i/m) YES,IF GREATER THAN 10 YEARS SCINCE LAST DOSE *** YES,IF GREATER THAN 5 YEARS SCINCE LAST DOSE
  18. 18. -------------------------------------------Tetanus

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