Tetanus is caused by Clostridium tetani bacteria, which produces a neurotoxin called tetanospasmin. The bacteria typically enters the body through wounds contaminated with soil or animal feces containing C. tetani spores. The toxin causes painful muscle spasms and rigidity, starting with lockjaw and risus sardonicus. Treatment involves controlling spasms with medications, administering tetanus immunoglobulin and antibiotics to neutralize toxin and prevent further growth of bacteria. Prevention relies on active immunization and prompt wound care.

1. Tetanus
By: Dr. Saurav Poudel
2016.10.22

2. • Tetanus is due to toxin secreting clostridium
tetani. Clostridium tetani is a box-car
shaped, anaerobic bacterium, it is Gram-
positive and its appearance on a gram
stain resembles tennis rackets or
drumsticks. C. tetani is found as spores in soil
or in the gastrointestinal tract of animals. C.
tetani produces a potent biological toxin,
tetanospasmin and tetanolysin.

3. • Tetanolysin serves no known benefit to C.
tetani. Tetanospasmin is a neurotoxin that
causes the clinical manifestations of tetanus.
Tetanus toxin is generated in living bacteria,
and is released when the bacteria lyse, such as
during spore germination or vegetative
growth.

4. Clostridium Tetani

5. Mode Of Transmission
• Infection is acquired by contamination of wounds
with tetanus spores.The range of injuries and
accidents which may lead to tetanus comprise
pin prick,skin abrasion,punctured
wound,burns,human bites,animal
bites,stings,compound fracture and use of
unsterile instrument to cut umbilical cord etc.
• Incubation Period : 5 days to 15 weeks,
with the average :- 8-12 days.

6. Clinical Features
• Prodromal state :
-dysphagia
- pain in the neck,back and abdomen
-pain and tingling at the site of wound.

7. • Stage of tonic rigidity :
- Trismus (lock-jaw):spasm of massester
muscles.
- Muscle spasticity
- Risus sardonicus :contraction of the muscle at
the angle of mouth and frontalis.
- Opisthotonus : spasm of muscles of back and
neck.

8. • State of clonic spasm:
-laryngeal and pharyngeal spasm
-spasm of respiratory muscle-acute asphyxia
• Others –
-patient is awake and alert throughout the
illness.Sensory examination is
normal,temperature is normal or slightly
elevated.

9. Risus Sardonicus

10. Opisthotonus

11. Trismus

12. • Death results from
aspiration,hypoxia,respiratory failure,cardiac
arrest or exhaustion.Poor prognostic
indicators include short incubation
period,short onset of time and extremes of
age.

13. • Cephalic tetanus is uncommon but invariably
fatal.It usually occurs when the portal of entry
of C.tetani is the middle ear. Cranial nerve
abnormalities particularly of 7th,9th are usual.
• Neonatal tetanus is usually due to infection of
the umbilical stump.Failure to thrive,poor
sucking,grimacing & irritability are followed
by the rapid development of intense rigidity
and spasms.

14. Differential Diagnosis
-meningitis
-encephalitis
-tetany
-epilepsy
-strychnine poisoning

15. Investigation
• Diagnosis is clinical
• Isolation of organisms from site of inoculation
• Essential of diagnosis:
①History of wound & possible contamination
②Jaw stiffness followed by spasm of jaw muscles
③Stiffness of the neck and other
muscles,dysphagia,irritable hyperreflexia
④Finally painful covulsion precipitated by minimal
stimuli.

16. Treatment
a.Control of spasm :
-inj. Diazepam 0.1-0.2mg/kg if not control,
paralyze with muscle relaxant and ventilate.
b.Neutralization of toxin:
-tetanus immunoglobulin 3000-6000 units IM
single dose or 500 unit for neonate.
-tetanus antitoxin after sensitivity test:50000 to
100000 units 1/2 i.m & 1/2 i.v.

17. c.To eradicate vegetative form by antibiotics
-Benzyl penicillin 600mg 6 hrly i.v for 10 days or
-metronidazole 400-800 mg 8 hrly for 7 days
-in penicillin sensitive case:Erythromycin
d.Local wound care:
-closed wound should be opened.
-all dead tissue should be removed
-wash by hydrogen peroxide

18. e.Supporative Care:
-isolation in a quite dark room
-maintenance of fluid,nutrition and electrolytes
-oxygen inhalation.

19. Prevention of Tetanus
• Active immunization: 3 doses of DPT
• Use of early antibiotics
• Early treatment of wound
• Three cleans during delivery:
*clean hand
*clean delivery surface
*clean cord care

20. Complication of Tetanus
• Acute asphyxia
• Aspiration pmeumonia
• Respiratory arrest
• Cardiac failure
• Urinary retention
• Vertebra fracture
• Laceration of tongue,lips,buccal mucosa.

21. THANK YOU
From- Dr. $aurav Poudel.
(saurav7utd@hotmail.com) if any query!!