2. Tetanus is an acute disease induced by the
endotoxin of Clostridium tetani. It is clinically
characterized by muscular rigidity which persists
through out illness punctuated by painful
paroxysmal spasms of the voluntary muscles.
Especially the masseters (trismus or lock
jaw),the facial muscles (risus sardonicus), the
muscles of the back and neck (opisthotonus)
and those of the lower limbs and abdomen.
3. What is Tetanus?
The word tetanus is derived from Greek words
-“tetanos and teinein”, meaning rigid and
stretched, which describe the condition of the
muscles affected by the toxin,
tetanospasmin, produced by Clostridium
tetani .
4. Agent factors
Clostridium tetani is a gram positive, anaerobic, spore
bearing organism, the spores are terminal and give
the organism a drum stick appearance.
Spores germinate under anaerobic conditions and
produce a potent exotoxin tetanospasmin.
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 a trivial pin prick, skin
abrasion, puncture wounds, burns, human bites,
animal bites and sting, unsterile surgery, unsterile
division of umbilical cord, compound fractures
etc….
•
6. Incubation Period
• It is defined as the time from injury to the first
symptom.
The incubation period is usually 6 to 10 days.
However, it may be as short as one day or as long
as several months.
Long incubation is probably explained by the
spores lying dormant in the wounds. Incubation is
also prolonged by prophylaxis
•
•
•
9. Pathogenesis
1. C. tetani enters
body through
wound.
2. Stays in sporulated form
until anaerobic conditions
develop.
10. 3. Germinates under
anaerobic conditions and
begins to multiply and
produce tetnospasmin.
4. Tetnospasmin spreads using
blood and lymphatic system,
and binds to motor neurons.
5. Travels along the axons
to the spinal cord.
6. Binds to sites responsible
for inhibiting skeletal
muscle
contraction.
11. Clinical features
Risus sardonicus: Contraction of the muscles at the angle of
mouth and frontalis
Trismus (Lock Jaw): Spasm of Masseter muscles.
Opisthotonus: Spasm of extensor of the neck, back and legs
to form a backward curvature.
Muscle spasticity
▪ Prolonged muscular action causes sudden,
powerful, and painful contractions of muscle
groups. This is called tetany. These episodes can
cause fractures and muscle tears.
If respiratory muscles are involved, apnoea may
occur.
12.
13. Other symptoms include:
Drooling Excessive sweating
Fever
Hand or foot spasms Irritability
Swallowing difficulty
Uncontrolled urination or defecation
14. Diagnosis
▪ There are currently no blood tests that can be
used to diagnose tetanus. Diagnosis is done
clinically.
15. Principle of Treatment
• 1.Neutralization of unbound toxin with Human
tetanus immunoglobulin
2.Prevention of further toxin production by
•
-Wound debridement
-Antibiotics (Metronidazole)
16. ▪ 3. Control of spasm
- Nursing in quiet environment
- avoid unnecessary stimuli
- Protecting the airway
▪ 4. Supportive care
- Adequate hydration
- Nutrition
- Treatment of secondary infection
- prevention of bed sores.
17. Prevention
Tetanus is completely preventable
by active tetanus immunization.
Immunization is thought to provide
protection for 10 years.
Begins in infancy with the DTP
series of shots. The DTP vaccine is
a "3-in-1" vaccine that protects
against diphtheria, pertussis, and
tetanus.
18. Prevention
▪ Can be achieved by active immunization by tetanus
toxoid (5 doses – 0 day, 1 month, 6 month, 1 year, 1
year).
▪ 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.
▪ Clinical tetanus does not produce immunity to further
attacks. Therefore, even after recovery, patients must
receive a full course of tetanus toxoid.
19. Case Presentation
▪ Name of the patient: Khushi
▪ Father’s name: Maruthi
▪ Age: 3 yrs.
▪ Sex: Male
▪ Address: Bidar Dist., Karnataka.
20. Chief complaints
▪ Unable to open mouth since 4 days.
▪ Stiffing of left side of the neck since 2 days.
▪ Spasm of both hands and both leg muscles since
2 days.
21. History of present illness
▪ Patient was asymptomatic 20 days back, then he
got injury on his left leg. He was given first aid.
▪ But 4 days back, the parents noticed that the child
was feeling difficulty in swallowing followed by
difficulty in opening mouth and stiffening of
muscles of left side of the neck.
▪ Then he was taken to Bidar institute of medical
sciences in Bidar, from where he was referred to Sir
Ronald Ross institute for tropical and communicable
diseases, Hyderabad.
22. Past medical history
▪ Patient had normally achieved his
developmental milestones.
▪ No H/O koch’s disease
▪ No H/O similar conditions
23. Family History
▪ Both the parents are healthy and alive.
He has two sisters, one elder and one younger,
and both are healthy and alive.
24. Differential Diagnosis
• Strychnine poisoning is the only condition that truly
mimics tetanus. However, a number of conditions
(eg, dental or other local infections, hysteria,
neoplasms, and encephalitis) may cause trismus,
and these must be differentiated these conditions
from tetanus
