Te t a n usDaquioag, Deborah C. Dizon, Jose Enrico C. Primary Health Care AAPD2F
What is Tetanus?• An infectious disease caused by contamination of wounds from the bacteria Clostridium tetani, or the spores they produce that live in the soil, and animal feces• Greek words - “tetanosand teinein”, meaning rigid and stretched, which describe the condition of the muscles affected by the toxin, tetanospasmin, produced by Clostridium tetani
Causes• Tetanus occurs when a wound becomes contaminated with Clostridium tetani bacterial spores.• Infection follows when spores become activated and develop into gram-positive bacteria that multiply and produce a very powerful toxin (tetanospasmin) that affects the muscles.
Causes• Tetanus spores are found throughout the environment, usually in soil, dust, and animal waste.• Tetanus is acquired through contact with the environment; it is not transmitted from person to person.
Causes• The usual locations for the bacteria to enter the body: – Puncture wounds (such as those caused by rusty nails, splinters, or insect bites.) – Burns, any break in the skin, and IV drug access sites are also potential entryways for the bacteria.
Signs and Symptoms• Tetanus often begins with mild spasms in the jaw muscles (lockjaw). It can also affect the chest, neck, back, and abdominal muscles. Back muscle spasms often cause arching, called opisthotonos.• 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.
Signs and Symptoms• Other symptoms include:• Drooling• Excessive sweating• Fever• Hand or foot spasms• Irritability• Swallowing difficulty• Uncontrolled urination or defecation
Prevention• Tetanus is completely preventable by active tetanus immunization.• Immunization is thought to provide protection for 10 years.• Begins in infancy with the DTaP series of shots. The DTaP vaccine is a "3-in-1" vaccine that protects against diphtheria, pertussis, and tetanus. It is a safer version of an older vaccine known as DTP
Prevention• Td vaccine or Tdap vaccine is used to maintain immunity in those age 11 and older. Tdap vaccine should be given once, prior to age 65, as a substitute for Td for those who have not had Tdap. Td boosters are recommended every 10 years starting at age 19.• Older teenagers and adults who have sustained injuries, especially puncture-type wounds, should receive booster immunization for tetanus if more than 10 years have passed since the last booster.
Treatment• Medical treatment has two aims: – Limit growth and eventually kill the infecting C. tetani and thus eliminate toxin production; – to neutralize any toxin that is formed. If the toxin has already affected the patient
Treatment• Antibiotics (for example, metronidazole[Flagyl, Flagyl 375, Flagyl ER], penicillin G or doxycycline [Adoxa, Alodox, Avidoxy, Doryx, Monod ox, Oracea, Oraxyl, Periostat, Vibramycin, Vibramycin Calcium, Vibramycin Monohydrate, Vibra-Tabs]) to kill the bacteria, tetanus booster shot, if necessary, and occasionally, antitoxin (termed tetanus immune globulin or TIG) to neutralize the toxin
Treatment• Wound cleansing to remove any obvious bacteria collections (abscesses) or foreign bodies; if the patient is exhibiting any toxin-related problems, TIG (tetanus immune globulin) is usually administered first and wound care is delayed for a few hours while the TIG neutralizes toxin because infected wounds, when manipulated, may release more toxin.
Treatment• Supportive measures• Pain medicine as needed• Sedatives such as diazepam (Valium) to control muscle spasms and muscle relaxants• Ventilator support to help with breathing in the event of spasms of the vocal cords or the respiratory muscles• IV rehydration because, as muscles spasm constantly, increased metabolic demands are placed on the body