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Tetanus prophylaxis and types of immunitynewnewv
- 1. Dr. Shamsul Ahmad Yousufi (HO) Department of G. Surgery.
- 3. Introduction to tetanus Pathophysiology Clinical types Clinical features Management Tetanus prophylaxis Types of immunity
- 4. Is an acute infectious disease caused by toxin producing anaerobe clostridium tetani that commonly found in soil, saliva, dust, and manure. Produce a toxin that affect the brain and nervous system, leading to spasm and stiffness in the muscles.
- 5. Apparently trivial injuries Animal bites Open fractures Burns Gangrene In neonates usually via infected umbilicus Abscess
- 6. 1 • C. Tetani enters the body through the contaminated wounds. 2 • Stays in spore form until anaerobic condition presented. 3 • Germinate under anaerobic conditions and begin to multiply and produce tetanospasmin. 4 • Tetanospasmin spread and binds to motor neurons. 5 • Travels along the axons to the spinal cord. 6 • Binds to site responsible for inhibiting muscle contraction, and blocks the release of inhibitory neurotransmitters
- 8. • Most common and severe form affects all skeletal muscles. Generalized • Manifest with muscle spasm at or near the infected wound. Local • Affect one or more muscles in face in one or two days after a head injury or ear infection. •Lockjaw occur that can easily progress to generalized tetanus. Cephalic • Similar to generalized tetanus and affects the neonates. Neonatal
- 9. Risus sardonicus: Contraction of the muscles at the angle of mouth and frontalis. Trismus: also called lockjaw is the spasm of Masseter muscles. Opisthotonus: spasm of extensor of the neck, back and legs to form a backward curvature. Tetany: Prolonged muscular action causes sudden, powerful, and painful contraction of muscle groups.
- 10. If respiratory muscles involved ---Apnea Drooling Excessive sweating Fever Hand or foot spasm Irritability Swallowing difficulty Uncontrolled urination or defecation.
- 11. Opisthotonus
- 13. Lockjaw or trismus.
- 14. General measure Goal is to eliminate the source of toxin. Admit in a dark and quiet room in ICU. Continuous careful observation and cardiopulmonary monitoring. minimize stimulation. Protect airway. Wound management wound should be cleaned and necrotic and foreign material should be removed.
- 15. wound is then lightly bandaged to prevent formation of local anaerobic environment. Control of spasm Minimize the stimuli. Anticonvulsants. Sedatives Muscle relaxants Neutralize the remaining unbound toxin HTIG/ATS Elimination of C. tetani Penicillin G, Metronidazole.
- 16. Tetanus prophylaxis depend on the nature of the lesion and patient’s immunization history it may include tetanus immunoglobulin (TIG) and tetanus toxoid (TT) containing vaccines. The emergency department patient encounter provide an ideal opportunity to screen the patient for adequate tetanus immunization and provide it when necessary.
- 17. Patient seen in emergency department with clean, minor wounds are considered adequately immunized if they have received primary immunization and have had a booster shot within the past 10 years. And if a wound is dirty (which includes wound contaminated with saliva, feces or dirt, and burn injuries) then a booster within the 5 years is necessary to ensure immunization. If the patient has not received primary immunization or unsure then passive immunity with TIG is provided.
- 18. A wound sustained more than 6 hours before surgical treatment Deeper than 1cm Soil, feces contamination Burns, missiles, crush, frostbites and animal bites Devitalized tissues Puncture or penetrating wounds Infected cord in neonates Surgical incision contamination
- 20. Tetanus is completely preventable disease by active tetanus immunization. Tetanus vaccine is a component of Expanded program on immunization(EPI). Begin in infancy with DTP series of shot.
- 21. Active immunization 1st dose at 6th week (DPT) 2nd dose at 10th week (DPT) 3rd dose at 14th week (DPT) 1st booster at 18th week(DPT) 2nd booster at 6th year (DT) 3rd booster at 10th year (TT) Duration of active immunity is 5 years after primary series . Dose is 0.5ml IM
- 22. Passive immunization 1. Tetanus immunoglobulin(TIG) It is used for prophylaxis and therapy. provide protection for 30 days Prophylactic dose is 250 IU IM and therapeutic dose is 1000 – 10000 IU IM. 2. Teatnus Antitoxin serum (ATS) Protection last for 7 - 15 days. prophylactic dose is 1500 – 3000 IU IM therapeutic dose is in neonate is 10000 IU S/C, IM, IV and in children is 40000 – 60000 IU(half IM and half IV).
- 23. Immunity is the ability of the body to protect against all types of foreign bodies like bacteria, virus, toxic substances that enters the body. Immune response is the reaction of the body against any foreign antigen.
- 24. 1.Innate immunity: It is also called natural or native immunity, consist of mechanism that exist before infection and are capable of rapid responses to microbes. It comprise of 4 types of defense barriers Anatomical barriers Physiologic barriers. Phagocytic barriers. Inflammatory barriers.
- 26. Acquired immunity Also called adaptive immunity is the immunity that is developed by the host in its body after exposure to suitable antigen or after a transfer of anti bodies or lymphocyte from an immune donor. Characteristic of acquired immunity Antigenic specificity Diversity Immunologic memory Self/non self recognition
- 27. 1. Active immunity it is induced by natural exposure to a pathogen or by vaccination. 2. Passive immunity Achieved by transfer of immune products such as antibody or sensitized T cells from an immune individual to non immune one.