Tetanus is caused by a neurotoxin produced by Clostridium tetani bacteria that enters the body through wounds or burns. It causes muscle spasms by blocking motor neuron synapses in the central nervous system. Symptoms range from lockjaw to generalized painful muscle spasms. Treatment involves wound care, antibiotics, medications to control spasms, and supportive care like ventilation for severe cases. Prevention centers on immunization and proper wound management.

1. TETANUS
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2. DEFINATION
Tetanus is caused by a powerful
neurotoxin (tetanospasmin)
produced by strains of “Clostridium
tetani” when introduced into the
tissues that blocks the inhibitory
“synapses on motor neurons in
CNS”, resulting in unrestrained reflex
spasm.
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3. PATHOLOGY
 The toxin travels up local motor axons from the site of infection 
causing local tetanus and spreads through the blood stream  to
reach many axons and hence the CNS.
 Cranial nerves are usually affected because they are shorter 
hence the common initial presentation is lock-jaw.
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4. PREDISPOSING FACTORS
 Punctured or war wounds.
 Otitis media.
 Unsterile surgery including use of infected cat gut and swabs,
criminal abortions, ritual circumcision, and ear piercing.
 Bowel surgery and infarction of bowel.
 Burns.
 Animal bites and stings.
 Firework injuries.
 Intra-uterine death.
 Unsterile division of umbilical cord.
 Compound fractures.
 Miscellaneous – Chronic skin ulcers, plaster sores, gangrenous limbs,
eye infections, human bites, dental extractions.
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5. CLINICAL FEATURES
 Incubation period – usually 6 to 10 days, rarely
several months.
 Clinical Features
1. Prodromal symptoms – Nonspecific such as malaise,
fever, sweating, headache and irritability.
2. Presenting symptoms – Trismus (lock jaw) and
dysphagia (often described as sore throat) due to
painful rigidity of masseters and muscles of deglutition.
Pain and stiffness in the neck and back.
3. Symptoms of established disease – Rigidity, muscle
spasms, symptoms due to sympathetic overactivity
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6. CLINICAL VARIANTS
 LOCAL TETANUS  INJURY OF LIMB
 ASCENDING FORM  LOCAL SPASM
 CEPHALIC TETANUS  HEAD & NECK INJURY &
INFECTIONS OF EYE & ORBIT  7TH CN AFFECTED
 SPLANCHNIC TETANUS  ABDOMINAL / THORACIC
WOUND  MAINLY POST OPERATIVE
 NEONATAL TETANUS  DUE TO UMBILICAL STUMP
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7. SEVERITY OF TETANUS GRADING
 GRADE- 1 (MILD) Mild & moderate lock jaw, generalized
spasticity, no spasms / respiratory difficulty
 GRADE-2 (MODERATE)  Well marked rigidity, brief spasm, mild
dysphagia, tachypnoea
 GRADE-3 (SEVERE) Severe trismus, generalized spasticity,
prolonged spasms often spontaneous, tachypnoea (> 40/min),
apnoeic spells, marked dysphagia, tachycardia
 GRADE-4 (VERY SEVERE)  severe hypertension and
tachycardia alternating with relative hypotension and
bradycardia, or severe persistent hypertension or hypotension.
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8. DIAGNOSIS
 Is confirmed by microbiology. A tissue sample
(preferably) or a swab of the wound site is taken for
Gram-staining and anaerobic culture.
 Cultures of C. tetani are tested for toxin production
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9. MANAGEMENT
 Neutralization of unbound toxin – Hyperimmune human anti-
tetanus immunoglobulin
 Reduction of further toxin production –
 (a) Care of the wound – Removal of foreign material and debridement
of non-viable tissue of entry wound.
 (b) Antibiotic – Benzyl penicillin / erythromycin
 Control of rigidity & tetanic seizures
 (a) Avoidance of provocative stimuli –such as noise, unnecessary
movement, and keeping injections to minimum.
 (b) Sedative drugs – Diazepam, chlorpromazine, morphine sulphate
 (c) Tracheostomy  not controlled with conservative sedative
regimen
 (d) Induced paralysis with ventilatory support – Neuroparalytic agents
pancuronium
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10.  Nursing support –
 (a) ICU – Moderate and severe cases should be nursed
in ICU.
 (b) Nutrition – Continuous drip feeding via nasogastric
or nasojejunal tube.
 General measures and physiotherapy – to prevent
bed sores and complications of prolonged
unconsciousness.
 Low molecular weight heparin  to prevent deep vein
thrombosis.
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11.  Management according to severity of tetanus –
 Mild: Sedatives + Muscle relaxants
 Moderate: Sedatives + Muscle relaxants +
tracheostomy
 Severe: Sedatives + tracheostomy + neuromuscular
paralytic agents + ventilatory support
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12. PREVENTION
1. Immunization –
 (a) Active immunization – with 1 mL tetanus toxoid
to be repeated after 3 months,
 For prevention of tetanus neonatorum and
puerperal tetanus the pregnant woman must be
vaccinated against tetanus unless she has received
a booster dose within the previous 5 years.
 (b) Passive immunization – with toxoid,
immunoglobulin for all clean and minor wounds,
and toxoid immunoglobulin plus antibiotic or
metronidazole for infected wounds
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13. Destruction of spores
 e.g. in operation theatres by filtered ventilation and
by use of antiseptics on floors and walls
 Autoclaving of surgical instruments and dressings.
 Iodine for skin decontamination.
Treatment of wounds
 Thorough cleaning, removal of foreign material and
debridement of necrotic tissue.
 Use of antimicrobials.
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14. THANK
YOU
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