this slide will know you about tetanus prophylaxis and tupes of immunity.

1. Dr. Shamsul Ahmad Yousufi (HO)
Department of G. Surgery.

3.  Introduction to tetanus
 Pathophysiology
 Clinical types
 Clinical features
 Management
 Tetanus prophylaxis
 Types of immunity

4.  Is an acute infectious disease caused by toxin
producing anaerobe clostridium tetani that
commonly found in soil, saliva, dust, and
manure.
 Produce a toxin that affect the brain and
nervous system, leading to spasm and
stiffness in the muscles.

5.  Apparently trivial injuries
 Animal bites
 Open fractures
 Burns
 Gangrene
 In neonates usually via infected umbilicus
 Abscess

6. 1
• C. Tetani enters the body through the contaminated wounds.
2
• Stays in spore form until anaerobic condition presented.
3
• Germinate under anaerobic conditions and begin to multiply and produce
tetanospasmin.
4
• Tetanospasmin spread and binds to motor neurons.
5
• Travels along the axons to the spinal cord.
6
• Binds to site responsible for inhibiting muscle contraction, and blocks the
release of inhibitory neurotransmitters

8. • Most common and severe form
affects all skeletal muscles.
Generalized
• Manifest with muscle spasm at or
near the infected wound.
Local
• Affect one or more muscles in face in one or
two days after a head injury or ear infection.
•Lockjaw occur that can easily progress
to generalized tetanus.
Cephalic
• Similar to generalized tetanus and
affects the neonates.
Neonatal

9.  Risus sardonicus: Contraction of the muscles
at the angle of mouth and frontalis.
 Trismus: also called lockjaw is the spasm of
Masseter muscles.
 Opisthotonus: spasm of extensor of the neck,
back and legs to form a backward curvature.
 Tetany: Prolonged muscular action causes
sudden, powerful, and painful contraction of
muscle groups.

10.  If respiratory muscles involved ---Apnea
 Drooling
 Excessive sweating
 Fever
 Hand or foot spasm
 Irritability
 Swallowing difficulty
 Uncontrolled urination or defecation.

11. Opisthotonus

12.  Risus sardonicus:

13.  Lockjaw or trismus.

14.  General measure
Goal is to eliminate the source of toxin.
Admit in a dark and quiet room in ICU.
Continuous careful observation and
cardiopulmonary monitoring.
minimize stimulation.
Protect airway.
 Wound management
wound should be cleaned and necrotic and
foreign material should be removed.

15. wound is then lightly bandaged to prevent
formation of local anaerobic environment.
 Control of spasm
Minimize the stimuli.
Anticonvulsants.
Sedatives
Muscle relaxants
 Neutralize the remaining unbound toxin
HTIG/ATS
Elimination of C. tetani
Penicillin G, Metronidazole.

16.  Tetanus prophylaxis depend on the nature
of the lesion and patient’s immunization
history it may include tetanus
immunoglobulin (TIG) and tetanus toxoid
(TT) containing vaccines.
 The emergency department patient
encounter provide an ideal opportunity to
screen the patient for adequate tetanus
immunization and provide it when
necessary.

17. Patient seen in emergency department with
clean, minor wounds are considered adequately
immunized if they have received primary
immunization and have had a booster shot within
the past 10 years.
And if a wound is dirty (which includes wound
contaminated with saliva, feces or dirt, and burn
injuries) then a booster within the 5 years is
necessary to ensure immunization. If the patient
has not received primary immunization or unsure
then passive immunity with TIG is provided.

18.  A wound sustained more than 6 hours before
surgical treatment
 Deeper than 1cm
 Soil, feces contamination
 Burns, missiles, crush, frostbites and animal
bites
 Devitalized tissues
 Puncture or penetrating wounds
 Infected cord in neonates
 Surgical incision contamination

20.  Tetanus is completely preventable disease by
active tetanus immunization.
 Tetanus vaccine is a component of Expanded
program on immunization(EPI).
 Begin in infancy with DTP series of shot.

21. Active immunization
1st dose at 6th week (DPT)
2nd dose at 10th week (DPT)
3rd dose at 14th week (DPT)
1st booster at 18th week(DPT)
2nd booster at 6th year (DT)
3rd booster at 10th year (TT)
Duration of active immunity is 5 years after primary
series . Dose is 0.5ml IM

22. Passive immunization
1. Tetanus immunoglobulin(TIG) It is used for
prophylaxis and therapy.
provide protection for 30 days
Prophylactic dose is 250 IU IM and
therapeutic dose is 1000 – 10000 IU IM.
2. Teatnus Antitoxin serum (ATS) Protection last for
7 - 15 days.
prophylactic dose is 1500 – 3000 IU IM therapeutic
dose is in neonate is 10000 IU S/C, IM, IV and in
children is 40000 – 60000 IU(half IM and half IV).

23.  Immunity is the ability of the body to protect
against all types of foreign bodies like
bacteria, virus, toxic substances that enters
the body.
 Immune response is the reaction of the body
against any foreign antigen.

24. 1.Innate immunity:
It is also called natural or native immunity, consist of
mechanism that exist before infection and are capable of rapid
responses to microbes.
 It comprise of 4 types of defense barriers
Anatomical barriers
Physiologic barriers.
Phagocytic barriers.
Inflammatory barriers.

26.  Acquired immunity
Also called adaptive immunity is the immunity that
is developed by the host in its body after exposure to
suitable antigen or after a transfer of anti bodies or
lymphocyte from an immune donor.
Characteristic of acquired immunity
Antigenic specificity
Diversity
Immunologic memory
Self/non self recognition

27.  1. Active immunity
it is induced by natural exposure to a
pathogen or by vaccination.
 2. Passive immunity
Achieved by transfer of immune products
such as antibody or sensitized T cells from
an immune individual to non immune one.