tetanus

1. TETANUS
Tetanus is a very serious disorder with very high mortality rate even with treatment. The disease
is caused by “Clostrium tetani”, an anaerobic spore forming bacillus.
MORPHOLOGY
1. It is a gram positive, slender bacillus, measuring (4-8um*0.5um)
2. It has spherical terminal spores, giving bacillus the charestic drumstick appearance
3. It is non capsulated & motile with peritrichate flagella

2. POSSIBLE ROUTES OF INFECTIONS
1. Umbilical cord: in neonates, seen in communities that practice cowdung
application on the umbilical stump
2. Wound: as an complication of road traffic accident
3. Minor injuries with rusted nails, piercing of ear lobes, tattoing
4. Endogenous infection after septic abortions or surgical operations on
gastrointestinal tract
5. Tetanus due to infection acquired in the operation threatre
Thus tetanus is an wound infection “ NO WOUND, NO TETANUS”

3. TOXINS
a. Tetanospasmin (neurotoxin): it has affinity towards nervous tissue. It reaches the central
nervous system along the axons of motor nerve trunks
b. Tetanolysin (haemolysin)
The toxins act in the following ways:-
1. It inhibit the release of cholinesterase
2. It act at the spinal level and cause reflex contraction of muscles due to minor stimuli
3. The toxins which is fixed to the nervous tissue cannot be neutralized
SIGN & SYMPTOMS
Tetanus often begins with mild spasms in the jaw muscles (lockjaw). The spasms can also affect
the chest, neck, back, abdominal muscles,and bottom. Sometimes the spasms affect muscles
that help with breathing, which can lead to breathing problems.
Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups.
This is called tetany. These episodes can cause fractures and muscle tears. Other symptoms
include drooling, excessive sweating, fever, hand or foot spasms, irritability, swallowing
difficulty, uncontrolled urination or defecation.

5. SPECIAL TYPES OF TETANUS
1. Tetanus neonatrum
2. Local tetanus
3. Cephalic tetanus
4. Bulbar tetanus
5. Latent tetanus
6. Postoperative tetanus
7. Otitis tetanus
DIAGNOSIS
The "spatula test" is a clinical test for tetanus that involves touching the posterior pharyngeal
wall with a sterile, soft-tipped instrument and observing the effect. A positive test result is the
involuntary contraction of the jaw (biting down on the "spatula") and a negative test result
would normally be a gag reflex attempting to expel the foreign object.

7. TREATMENT OF ESTABLISHED TETANUS
1. GENERAL MANAGEMENT
2. SPECIFIC MANAGEMENT
GENERAL MANAGEMENT
a. Admission & isolation
b. Wound care: drainage of pus
c. Injection tetanus toxoid: 0.5ml to be given IM
d. Human anti tenanus globulin given in the dose 3000-4000 units
e. Injection crystalline penicillin 10 labels unit every 6 hours is the drug of choice against
clostridium tetani, given for a period of 7-10 days
f. Metronidazole 500 mg IV, 8th hourly for 10 days
SPECIFIC MANAGEMENT
 MILD CASES: there is only tonic rigidity without spasm or dysphagia. Patients are managed
by heavy sedation, benzodiazepine & morphine act centrally to minimize the effects of
tetanospasmin. Chlorpromazine being a receptor blocker can decrease sympathetic activity

8.  SERIOUSLY ILL CASES
1. They have dysphagia & reflex spasms
2. A nosogastric tube is introduced for feeding purpose & to administer drugs
3. Tracheostomy, if breating difficulty arises
 DANGEROUSLY ILL CASES
1. This group includes patient with major cyanotic convulsions
2. In addition to sedatives, patients are paralysed with muscle relaxants and
positive pressure ventilation is given till they recover
PROPHYLAXIS
1. Infants & children are immunized with tetanus toxoid, diphtheria, pertussis vaccine (DPT)
three doses at 6, 10, 14 weeks of age
A booster dose is given at 18 months and school going time 5 yrs, & once in 5 years
2. Tetanus neonatrum can be prevented by immunization of the mother with two tetanus toxoid
injection half ml IM given in the 3rd trimester of pregnancy
3. Tetanus can be prevented by giving tetanus antitoxin, 250 units

10. THANK YOU

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