Surgery Lecture On: Dr. Ehsanur Reza

Surgery Lecture on
Dr. Ehsanur Reza

MBBS, FCPS
Assistant Professor
Surgery Unit III
MMCH
WTetanushat is Tetanus?
An infectious disease caused by

contamination of wounds from the
bacteria Clostridium tetani, or the
spores they produce that live in the soil,
and animal feces
Greek words -tetanosandteinein,

meaning rigid and stretched, which
describe the condition of the muscles
affected by the toxin, tetanospasmin,
produced by Clostridium tetani
Sporulated Vegetative
Causes
Tetanus spores are found throughout the environment,
usually in soil, dust, and animal waste.
Tetanus is acquired through contact with the

environment; it is not transmitted from person to person.
The usual locations for the bacteria to enter the body:
Causes
Puncture wounds (such as those
caused by rusty nails,splinters,
orinsect bites.)
Burns, any break in the skin, and
IV drug access sites are also
potential entryways for the
bacteria.
Route of Entry
Apparently trivial injuries
Animal bites/human bites
Open fractures
Burns
Gangrene
In neonates usually via
infected umbilical stumps
Abscess
epidemiology
Tetanus is an international health problem, as spores are
ubiquitous. The disease occurs almost exclusively in persons
who are unvaccinated or inadequately immunized.
Tetanus occurs worldwide but is more common in hot,
damp climates with soil rich in organic matter.
More common in developing and under developing
countries.
More prevalent in industrial establishment, where
agricultures workers are employed.
Tetanus neonatorum is common due to lack of MCH care.
Incubation Period
Varies from 1 day to

several months. It is
defined as the time from
injury to the first
symptom.
Period of onset
It is the time from first

symptoms to the reflex
spasm.
An incubation period of 4
days or less
or
pathogenesis
1. C. tetani enters body 2. Stays in sporulated
form until anaerobic
from through wound.
conditions are presented.
3. Germinates under 4. Tetnospasmin spreads using

anaerobic conditions and blood and lymphatic system,
begins to multiply and and binds to motor neurons.
produce tetnospasmin.
6. Binds to sites responsible for

5. Travels along the axons
inhibiting skeletal muscle
to the spinal cord. contraction.
Initially binds to peripheral
nerve terminals
Transported within the axon and
across synaptic junctions until it
reaches the central nervous
system.
Becomes rapidly fixed to
gangliosides at the presynaptic
inhibitory motor nerve endings,
then taken up into the axon by
endocytosis.
How the toxin acts?
Blocks the release of inhibitory
neurotransmitters (glycine and gamma-
amino butyric acid) across the synaptic
cleft, which is required to check the nervous
impulse.
If nervous impulses cannot be checked by
normal inhibitory mechanisms, it leads to
unopposed muscular contraction and
spasms that are characteristic of tetanus.
Tetanus prone wound
A wound sustained more than

6 hr before surgical
treatment.
A wound sustained at any
interval after injury which
is puncture type or shows
much devitalised tissue or
is septic or is
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 muscle is involved

Signs and Symptoms
Other symptoms include:
Drooling
Excessive sweating
Fever
Hand or foot spasms
Irritability
Swallowing difficulty
Uncontrolled urination or defecation
Diagnosis
There are currently no blood tests that
can be used to diagnose tetanus.
Diagnosis is done clinically.
Differential Diagnosis
Masseter muscle spasm due to dental abscess
Dystonic reaction to phenothiazine
Rabies
Hysteria
Principle of Treatment
1. Neutralization of
unbound toxin with Human
tetanus immunoglobulin
2. Prevention of further
toxin production by
-Wound debridement
-Antibiotics
(Metronidazole)
3. Control of spasm
- Nursing in quiet
environment
- avoid unnecessary
stimuli
- Protecting the airway
4. Supportive care
- Adequate hydration
- Nutrition
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.
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.
Thank You

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Surgery Lecture on

Dr. Ehsanur Reza

An infectious disease caused by

Greek words -tetanosandteinein,

Tetanus is acquired through contact with the

Varies from 1 day to

It is the time from first

3. Germinates under 4. Tetnospasmin spreads using

6. Binds to sites responsible for

A wound sustained more than

Risus sardonicus: Contraction of the

If respiratory muscle is involved

Tetanus is completely preventable by

Immunization is thought to provide

Begins in infancy with the DTP series

Can be achieved by active immunization by

Clinical tetanus does not produce

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