This document discusses tetanus (lockjaw), caused by Clostridium tetani bacteria. It can enter the body through wounds or the umbilical cord in neonates. The bacteria produce toxins that cause painful muscle spasms. Symptoms include jaw stiffness, neck rigidity, swallowing difficulties, and spasms triggered by stimuli. Treatment involves wound care, antibiotics, tetanus immunoglobulin, sedation and respiratory support. Homeopathic remedies that may help include Nux Vomica, Ledum, Aconite, Hypericum and Ignatia. Prevention relies on tetanus vaccination of mothers during pregnancy and infants through childhood.

1. Dr.Prafulla C.Patil.
Shri. Chamunadamata Homoeopathic
Medical College and Hospital,Jalgaon.
TETANUS

2. Tetanus, also called lockjaw, is a serious
infection caused by Clostridium Tetani characterized
by muscle spasm.

3. AETIOPATHOGENESIS :
 Clostridium tetani,
 An anaerobic spore-forming bacillus with terminal
spore which has a drumstick-like appearance.

4. POSSIBLE ROUTES OF
INFECTION:
 Umbilical cord, in neonates, seen in communities which
practise cowdung application on the umbilical stump.
 Wound, as a complication of road traffic accidents where
other aerobic organisms reduce oxygen tension in the
wound, thereby facilitating growth of anaerobic
Clostridium tetani .
 Minor injuries with rusted nails, piercing of the ear lobes,
tattooing, injections, etc.
 Endogenous infection after septic abortion or surgical
operations on gastrointestinal tract.
 Tetanus due to infection acquired in the operation theatre.
 Thus, tetanus is a wound infection. “No wound, no
tetanus.”

5. PATHOPHYSIOLOGY:

6. PATHOPHYSIOLOGY:
 The organisms multiply and produce powerful
exotoxins which produce the disease. The toxins
produced by the organisms are:
1) Tetanospasmin (neurotoxin) :causes the clinical
manifestation of tetanus.
2) Tetanolysin (haemolysin):-The function of
tetanolysin is not known.

7. PATHOPHYSIOLOGY:

8. PATHOPHYSIOLOGY:
 The toxin which is fixed to the nervous tissue cannot
be neutralised. However, the circulating toxin can be
neutralised. Incubation period may vary from a few
days to months or years. Hence, it is not important.
The interval between first symptom ( dysphagia and
stiffness of jaw) to a reflex spasm is called the period
of onset. If this is less than 48 hours, the prognosis is
poor and if more than 48 hours, prognosis is better.

9. FAVOURABLE CONDITION FOR
DEVELOPMENT OF TETANUS:
 No immunisation
 Foreign body
 Injury
 Improper sterilisation
 Devitalised tissues
 Anaerobic conditions.

10. SPECIAL TYPES OF TETANUS:
 1. Tetanus neonatorum: It occurs due to contamination of
umbilical cord in children born to nonimrnunised mothers.
It manifests usually around 6-8 days of birth and is called
eighth day disease. It carries almost l00% mortality.
 2. Local tetanus: In this, contraction of muscles occurs in
the neighbourhood of the wound.
 3. Cephalic tetanus: Usually occurs after wound of head
and face. Cranial nerves such as facial nerve and
oculomotor nerve can get paralysed. It carries poor
prognosis.
 4. Bulbar tetanus: It is a condition wherein muscles of
deglutition and respiration are involved. It is fatal.

11.  5. Latent tetanus: It develops after a few months to year:
following a wound which might have been forgotten.
 6. Puerperal tetanus: It occurs as a complication of
abortior or puerperal sepsis.
 7. Postoperative tetanus: Occurs due to improper
sterilisationof instruments and carries 100% mortality. This
type 0f tetanus should not occur, in a modern operation
theatre.
 8. Otitis tetanus: It is due to chronic suppurative otitis
media. In these cases, the wound is a tear in the tympanic
membrane. It can occur in any age group, but commonly
occurs in children and young adults.

12. CLINICAL FEATURE:
 Spasms and stiffness in your jaw muscles (trismus)
 Stiffness of your neck muscles
 Difficulty swallowing
 Stiffness of your abdominal muscles
 Painful body spasms lasting for several minutes,
typically triggered by minor occurrences, such as a
draft, loud noise, physical touch or light.

15. TREATMENT:
 General management:
 Specific management.
 I. General management
 • Admission and isolation1 in a quiet room
 • Wound care which includes drainage of pus, excision
of necrotic tissue removal of foreign body and proper
dressing. Exudate or pus can demonstrate gram-positive
rods.
 • lnj. tetanus toxoid 0.5 ml to be given IM.
 • Antitetanus serum (ATS) 50,000 units intramuscular
 (IM) and 50,000 units intravenous (IV).

16.  • Instead of ATS, human antitetanus globulin is
better and safe.
 • Inj. Crystalline penicillin 10 lakh units every 6
hours
 • Metronidazole 500 mg IV 8th hourly for 10 days.

17.  II. Specific management
 A. Mild cases
 • There is only tonic rigidity without spasm or dysphagia.These patients are
managed by heavy sedation using a combination of drugs so as to avoid spasm
or convulsions.
 An example of the method of treatment followed in our hospital is given in
 • Benzodiazepines and morphine
 • Chlorpromazine
 • Injection diazepam 10 mg,
 B. Seriously ill cases
 • They have dysphagia and reflex spasms.
 • A nasogastric tube is introduced for feeding purposes and
 to administer the drugs.
 • Tracheostomy, if breathing difficulty arises.

18.  C. Dangerously ill cases
 This group includes patients with major cyanotic
convulsions.
 In addition to continuing sedatives, these patients are
paralysed with muscle relaxants (neuromuscular
blocking agents) and mechanically ventilated till they
recover. One cannot predict the duration of the need
for ventilatory support. During this period, supportive
therapy such as adequate nutrition, care of the urinary
bladder and bowel, frequent change of position to
avoid bedsore, have to be given.

19. PROPHYLAXIS:
I. Tetanus neonatorum can be prevented by immunisation of the mother with
two tetanus toxoid injections, half ml IM given in the second trimester of
pregnancy.
 2. Infants and children are immunised with tetanus toxoid, diphtheria and
pertussis vaccine (DPT) three doses at 6,l 0, I 4 weeks of age. This is called
triple antigen. A booster dose is given at 18 months and school going time (5
years), and once in five years 0.5 ml of tetanus toxoid is given to achieve active
immunity.
 3. Immunised individual who receives a provocative injury is administered a
booster dose if he has not been given it in the previous 5 years.
 4. Tetanus can be prevented by giving tetanus antitoxin in the following
situations:
 • Wounds of head, face and penetrating wounds
 • Wounds with contused and devitalised tissues
 • War wounds and road traffic accidents
 In such patients, a dose of 250 units of human antitetanusglobulin will give
adequate protection.

20. CAUSES OF DEATH:
 1. Aspiration of pharyngeal contents into the lungs
resulting in aspiration pneumonia.
 2. Laryngeal spasm and respiratory arrest resulting in
cardiac arrest.
 3. Autonomic disturbances resulting in cardia
arrhythmias
 4. In some patients, pacemaker insertion may help if
there is refractory bradycardia.

21. HOMOEOPATHIC MANAGEMENT:
 Ledum pal – tetanus with twitching of muscles near the wound;
indicate din punctured wounds produced by sharp pointed
instruments.
 Aconite – Tetanus, with fever, numbness and tingling from
exposure to cold or traumation. The face changes color. A state
of fear, anxiety; anguish of mind and body. Physical and mental
restlessness, fright, is the most characteristic manifestation
of Aconite. Acute, sudden, and violent invasion, with fever, call
for it. Does not want to be touched. Sudden and great sinking of
strength. Complaints and tension. Fears death but believes that
he will soon die; predicts the day. Fears the future, a crowd,
crossing the street. Restlessness, tossing about. Tendency to start.
Imagination acute, clairvoyance. Pains are intolerable; they drive
him crazy.

22.  Nux Vomica –
The leading homeopathic remedy for tetanus. It has tetanic
convulsions with opisthotonos, distortion of eyes and face,
with dyspnoea excited by any external impression.
Strychnia, the alkaloid of Nux-vomica, produces a perfect
picture of tetanus, with its convulsion of muscles renewed
by the slightest external impression, its “risus sardonicus,”
its respiratory spasm, with blue `cyanosed face and clear
mind. The value of Strychnia in tetanus is recognized by
Trousseau and Stille, and it is a striking example of
Homoeopathy as sometimes practiced by allopaths.
Ignatia suits emotional trismus or opisthotonos

23.  Hypericum –Trismus from injury to nerves; it is
considered prophylactic in cases of wounds of palms
or soles. Especially useful in spinal injuries. It has a
growing clinical record in this disease.
 Some other homoeopathic remedies:
-strammonium
- cuprum
-passiflora
-physostigma