Tetanus is caused by Clostridium tetani bacteria and is characterized by painful muscle spasms. It is spread through contamination of wounds, especially those exposed to dirt or manure. The document discusses the microbiology, types, pathogenesis, prophylaxis with tetanus toxoid immunization, and management of tetanus which involves wound debridement, antibiotics, antitoxin administration, and supportive care. Prognosis depends on immune status and wound severity, with mortality rates as high as 50-60% without treatment.

1. Discuss Tetanus And Tetanus
Prophylaxis
By
Dr Salihi Abdulmalik
National Orthopaedic Hospital, Dala
16th February 2018

2.  Introduction
 Microbiology
 Types
 Pathogenesis
 Prophylaxis
 Management
 Prognosis
 Differential diagnosis
 Complications

3.  ‘Tetanos’, meaning “taut” or “rigid”
 An acute infection that is characterized by spasms of
skeletal muscles ,rigidity and convulsion due to exotoxins
released by Clostridium tetani
 Important cause of death worldwide
 High mortality rate
15% in best of centers
50-60%
 1 million deaths worldwide 1992 (WHO)
 300 cases/year in South Africa

4. First described by Hippocrates
Etiology discovered in 1884 by Carle and Rattone
ATS used for treatment and prophylaxis during
World War I
TT first widely used during World War II

5.  Clostridium tetani is an anaerobic gram-positive, spore
forming bacteria
 Spores found in soil, dust, animal faeces, may persist for
months to years
 Clostridium tetani produces 2 forms of exotoxins
Tetanospamin (lethal dose 2.5ng/kg)
Tetanolysin

6.  Generalized
 Localized
 Cephalic
 Neonatal

8.  Active immunization
 More effective
 Takes 2 to 3 months to become operational
 Passive immunization
 Less effective
 Immediately operational
 Can precipitate anaphylaxis

9.  Traditionally
0.5ml of toxoid stat, 6 weeks, 6 month and every 10 years
 Rapid method using alum-precipitated toxoid
1st, 4th and 7th day following injury to develop active immunity at 28th
day
 DPT (3 primary doses at 6, 10 and 14 weeks, 2 booster doses
at 15 months and 5 years)
 Pregnant women (stat, 1/12, 6/12, 1 yr or next pregnancy, 1
yr or next pregnancy
 Efficacy of 100%

10.  Human immunoglobulin
250 – 500IU stat
Protection for 4-6weeks
No serum sickness
 Equine immunoglobulin
1500 IU sat
Protection for 7-10 days
Test dose to prevent serum sickness
 Bovine immunoglobulin

11.  Fully immunized
 Had conventional doses, a booster dose every 10 years
with last dose being less than 5 years
 Partially immunized
 Completed toxoid with last booster dose greater 5 but less
than 10years
Unimmunized
 No immunization
 Can’t remember
 Last booster dose greater than 10 years

12.  Fully immunized + clean wound
 Nothing
 Fully immunized + dirty wound
 Debridement + antibiotics
 Partially immunized + clean wound
 Complete immunization
 Partially immunized + dirty wound
 Give TT and complete booster after + debridement +
antibiotics

13.  Unimmunized + clean wound
Give TT + and to complete immunization
 Unimmunized + dirty wound
Give TT and ATS
To complete TT dose
Wound debridement
Antibiotics

14.  Patient in shock
 Allergic reaction
To TT?, consider ATS
 In setting of moderate to severe acute illness
Differ vaccination

15.  Clinical emergency
 Multidisciplinary
Surgeons
Physicians
Anaesthesiologist
Nurses
 Best managed in ICU

16.  History of wound contamination
 Dysphagia, dysphonia
 Headache, delirium, sleeplessness
 Hesitancy in micturition, constipation
 Convulsion
 Can be triggered by touch, noise, light, movement

17.  Tetanus prone wounds
◦ Wound sustained in farm land
◦ Gunshot wound
◦ Wound contaminated with saliva (human or animal)
◦ Wound contaminated with faeces (human or animal)
◦ Wounds sustained in lakes or ponds

18.  Anxiousness, sweating
 Fixed and staring eyes
 Trismus
 Risus sardonicus
 Nuchal rigidity
 Spasm and rigidity of all muscles
 Opisthotonus/Orthotonus/
Emprosthotonus
 Fever, tachycardia
 Open injury
 Diagnosis is clinical

19.  Incubation period 6-10 days
 Onset period 3 days to 3 weeks
 Muscle rigidity and spasm 1st week
 Autonomic disturbance starts several days after spasm and
persist for 1-2 weeks
 Spasm reduces after 2-3 weeks

20.  Goals
 Neutralize toxins
 ATS
 Human Ig 500IU o.d X 6 days
 Equine Ig 15000 IU o.d X 10-12 days (after test dose)
 Prevent further toxin production by removing source of infection
 Antibiotics; Penicillin, Metronidazole, Erythromycin
 Wound debridement
 Controlling muscle spasms
 anticonvulsants
 Maintaining airway
 General supportive therapy

21.  Isolation
 Avoid noise, light
 IVF
 TPN
 Urethral catheterization
 NGT
 Regular suction of throat
 Oxygen
 Prevention of pressure sore

22.  Mild cases
 Tonic rigidity, spasms
 Sedation
 Seriously ill
 Tonic rigidity,spasms, swallowing difficulty, respiratory
infection
 Sedation, NG tube, IPPV
 Dangerously ill
 Major cyanotic convulsive attacks, respiratory failure

23.  Laryngospasm
 Fractures
 Hypertension
 Nosocomial infections
 Pulmonary embolism
 Aspiration
 Death

24.  High mortality
 Incubation period
 Onset period, if less than 48hours death is very likely
 Immune status of the patient
 Degree of wound contamination
 Entry point proximity to the brain
 Frequency of spasms
 Autonomic complication
 Neonate

25.  Trismus – dental, oral, tonsillar sepsis
 Strychnine poisoning
 Meningitis
 Convulsive disorder
 Torticolis
 Rabies

26.  A medical emergency
 Diagnosis is clinical
 Management is multidisciplinary and best done in ICU
 A very high mortality, hence the need for early diagnosis
and prompt treatment
 Tetanus prophylaxis has greatly reduced the incidence of
tetanus

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of Surgery, University of Ghana Medical School: Repro India Ltd;
2015.p.17-20
 Sriram Bhat M, SRB’S Manual of Surgey, 4th ed., Department of
Surgery Kasturba Medical College Mangalore, Karnataka, India.
P49-52
 T. M. Cook, R.T Protheroe and J.M. Handel, Review Article, Tetanus:
a review of the literature, British Journal of Anaesthesia 87 (3):
p477-87 (2000)
 American Academy of Paediatric tetanus in pickering L,ed Red book
2003 26th edition 611-16