4. INTRODUCTION
𝗈 Tetanus – a greek word , Meaning – Rigid
𝗈 First described by Hippocrates & Susruta
Types of disease – infectious disease
Agent :- Clostridium tetani
Type of infection – Bacterial
Definition :- it is a neurological disease characterised by increased musles tone
And spasm caused by clostridium tetani.
5.
6. CAUSATIVE AGENT
𝗈 Caused by CLOSTRIDIUM
TETANI
𝗈 Anaerobic
𝗈 Motile
𝗈 Gram positive bacilli
𝗈 Oval, colourless, terminal
spores – tennis racket or
drumstick shape.
𝗈 It is found worldwide in soil,
in inanimate environment, in
animal faeces & occasionally
human faeces.
7. Clostridium tetani Gram Stain
NOTE:
Round terminal spores give a cell
“drumstick” or “tennis racket” appearance.
8. EPIDEMIOLOGY
Tetanus is an international health problem, as spores are
ubiquitous. The disease occurs almost exclusively
in persons who are unvaccinated or inadequately
immunized.
Host
Agent
Enviroment
9. Host Factors
●Age : It is the disease of active age (5-40 years), New born baby,
female during delivery or abortion
●Sex : Higher incidence in males than females
●Occupation : Agricultural workers are at higher risk
●Rural –Urban difference: Incidence of tetanus in urban areas is
much lower than in rural areas
●Immunity ; Lower immunity
●Environmental and social factors: Unhygienic custom
habits,Unhygienic delivery practices
11. Risk Factors
𝗈 Apparently trivial injuries
𝗈 Animal bites/human bites
𝗈 Open fractures
𝗈 Burns
𝗈 In neonates usually via infected umbilical
stumps .
Sport injuries .
Inadquate immunization.
12. TETANUS PRONE WOUND
𝗈 A wound sustained more than 6 hr before surgical treatment.
𝗈 A wound sustained at any interval after injury which is puncture type or
shows much devitalised tissue or is septic or is contaminated with soil
or manure.
•Spores that gain entry can persist in normal tissue for months to years under
anaerobic conditions.
•When the oxygen levels in the surrounding tissue is sufficiently low, the implanted C.
tetani spore then germinates into a new, active vegetative cell that grows and
multiplies and most importantly produces tetanus toxin - tetanospasmin and
tetanolysin.
•Tetanolysin is not believed to be of any significance in the clinical course of tetanus.
•Tetanospasmin is a neurotoxin and causes the clinical manifestations of tetanus.
13. Mechanism of Action of Tetanus Toxin
11. tetani enters
body from through
wound.
22. Stays in sporulated
form until anaerobic
conditions are
presented.
3. Germinates under
anaerobic conditions and
begins to multiply and produce
tetnospasmin.
4. Tetnospasmin spreads
using blood and lymphatic
system, and binds to motor
neurons.
5. Travels along
the axons to the
spinal cord.
6. Binds to sites responsible for
inhibiting skeletal muscle
contraction.
14. Local maifestation
•Contraction of spasm of those muscle that is closed to site of injury or
infection .
Fever
Generalized manifestation
•Lock jaw
•Facial spasm
•Stiff neck
•Difficulty in swallowing
•Opisthatonus
•Fever
•Death
15. Trismus (Lock Jaw): Spasm of Masseter muscles.
Opisthotonus: Spasm of extensor of the neck, back and legs to form
a backward curvature.
RISUS SARDONICUS
16. TYPES OF TETANUS
Local
Generalized
Maternal tetanus
Cephalic
Traumatic
Maternal tetanus
•Tetanus occurring during pregnancy or within 6 weeks after any type of pregnancy termination, is
one of the most easily preventable causes of maternal mortality.
•It includes postpartum or puerperal tetanus
(i)postpartum or puerperal tetanus, usually resulting from septic procedures during delivery,
(ii)postabortal tetanus, following septic maneuvers during induced abortion
(iii)Tetanus during pregnancy, generally resulting from inoculation through a nongenital portal of
entry
17. NEONATAL TETANUS
𝗈 Tetanus neonatorum (8th day disease)
𝗈 Usually fatal if untreated
𝗈 Children born to inadequately immunized mothers, after
unsterile treatment of umbilical stump
𝗈 During first 2 weeks of life.
𝗈Poor feeding ,rigidity and spasms
𝗈 It is easily preventable by 2 tetanus toxoid injections and ‘5 cleans’
while conducting deliveries.
18. LOCAL TETANUS
𝗈 Uncommon form
𝗈 Manifestations are restricted to muscles near the wound.
𝗈 Cramping and twisting in skeletal muscles surrounding the wound
– local rigidity
𝗈 Prognosis – excellent
CEPHALIC TETANUS
𝗈 A rare form of local tetanus
𝗈 Follows head injury /ear infection
𝗈 Involves one /more facial cranial nerves
𝗈 Trismus and localised paralysis ,usually facial nerve, often unilateral.
𝗈 Involvement of cranial nerves VI,III, IV, and XII may also occur either alone or in combination
with others
𝗈 Incubation period : few days
𝗈 Mortality : high
19. DIAGNOSIS
* History collection :- to collect about the occupation exposure ,immunization schedule or any
bite such as
dog animal .
* Physical examination : by assessing the injured site and classical symptoms of lack jaw in
tetanus condition.
• Tetnas antibody test .
• Lumbar puncture : CSF increased due to increased WBC count .
• Electro myelography : To asses the muscular activity .
• Spatula test :
It is main test
A soft tipped instrument is given to patient to check pharyngeal area .
Assessed the patient response .
If patient try to remove spatula negative result .
* Blood culture : WBC increased .
20. Complications :-
1- Breathing difficulties .
2-Spinal and long bone fracture .
3- Nosocomial infection due to long
hospitalization .
Management
• There ‘s no cure for tetanus . Treatment focus 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 object and
dead tissue from the wound ..
21. RINCIPLE O F TREATMENTP
-
2.Prevention of further toxin production
-Wound debridement & antibiotics
3.Antibiotics / Penicillion
4.Control of spasm
-Anticonvulsants, Sedatives, Muscle relaxants etc.
5.Management of autonomic dysfunction
-MGSO4, Betablockers etc.
6.Supportive care
-Physiotherapy, Nutrition, Thromboembolism prophylaxis
ABC etc…
24. MONOVALENT VAC C I N E S
𝗈Purified tetanus toxoid ( adsorbed ) supplanted the plain toxoid – higher & long lasting
immunity response
𝗈Primary course of immunization – 3 doses
𝗈Each 0.5 ml , injected into arm given at intervals of 0,1,6 months
𝗈
25. PASSIVE IMMUNIZATION
PREVENTION OF NEONATAL TETANUS
Clean delivery practices
𝗈 3 cleans : clean hands, clean delivery surface, clean cord care
𝗈 Tetanus toxoid protects both mother & child
𝗈 Unimmunized pregnant women : 2 doses tetanus toxoid (16th-36thweek)
• 1st dose as early as possible during pregnancy
• 2nd dose – at least a month later /3 weeks before delivery
𝗈 Immunized pregnant women : a booster is sufficient
𝗈 No need of booster in every consecutive pregnancy
𝗈 To newborn of unimmunized mother, 500U HTIG within 6 hours of birth.
•Temporay proctection :- human tetans immunoglobulin /ATS.
•
26. Nursing Management
• Provide complete bed rest to the child .
• Keep the infant in dim lighted ,quite and well ventilated room , as spasms can be
precipitated by bright light , noise or even touch.
• Minimize external stimuli .
• Prompt suctioning and oxygen administration is essential .
• Fluid and electrolyte balance should be maintained .
• Due to spasm and increased mucle activity , patient are exhausted and need extra
calories ,so provide high calories & protein diet to patient .
• NG feed must b given in case of high fever and tapid sponging too .
• Change patient positions 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.
27. •Educate patient about etiology transmission and effects of tetanus .
•Explain that tetanus is a infectious disease and that taking immunization
is most effective way preventing and Trannsmission of tetanus .
