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    Tetanus: Presenter:Walter K Facilitator: DR - Damani

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    Nina
    Tetanus is caused by Clostridium tetani bacteria and is characterized by painful muscle spasms. It is common in inadequately vaccinated individuals, especially those with wounds exposed to contaminated soil. The bacteria produces toxins that cause muscle rigidity by inhibiting inhibitory neurotransmitters. Treatment involves wound debridement, antibiotics, tetanus immune globulin, diazepam for spasms, and supportive care. Prevention is through routine vaccination, with boosters needed every 10 years, and prophylactic vaccination and immune globulin for wounds in unvaccinated individuals.

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    Tetanus: Presenter:Walter K Facilitator: DR - Damani

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    Nina
    23 views21 pages
    Tetanus is caused by Clostridium tetani bacteria and is characterized by painful muscle spasms. It is common in inadequately vaccinated individuals, especially those with wounds exposed to contaminated soil. The bacteria produces toxins that cause muscle rigidity by inhibiting inhibitory neurotransmitters. Treatment involves wound debridement, antibiotics, tetanus immune globulin, diazepam for spasms, and supportive care. Prevention is through routine vaccination, with boosters needed every 10 years, and prophylactic vaccination and immune globulin for wounds in unvaccinated individuals.

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    TETANUS

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    Tetanus is caused by Clostridium tetani bacteria and is characterized by painful muscle spasms. It is common in inadequately vaccinated individuals, especially those with wounds exposed to contaminated soil. The bacteria produces toxins that cause muscle rigidity by inhibiting inhibitory neurotransmitters. Treatment involves wound debridement, antibiotics, tetanus immune globulin, diazepam for spasms, and supportive care. Prevention is through routine vaccination, with boosters needed every 10 years, and prophylactic vaccination and immune globulin for wounds in unvaccinated individuals.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    23 views21 pages

    Tetanus: Presenter:Walter K Facilitator: DR - Damani

    Uploaded by

    Nina
    Tetanus is caused by Clostridium tetani bacteria and is characterized by painful muscle spasms. It is common in inadequately vaccinated individuals, especially those with wounds exposed to contaminated soil. The bacteria produces toxins that cause muscle rigidity by inhibiting inhibitory neurotransmitters. Treatment involves wound debridement, antibiotics, tetanus immune globulin, diazepam for spasms, and supportive care. Prevention is through routine vaccination, with boosters needed every 10 years, and prophylactic vaccination and immune globulin for wounds in unvaccinated individuals.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 21

    TETANUS

    PRESENTER:WALTER K
    FACILITATOR: DR.DAMANI
    OUTLINE
    • DEFINITION
    • EPIDEMIOLOGY
    • AETIOLGY
    • PATHOPHYSIOLOGY
    • CLINICAL FEATURES
    • DIANGOSIS
    • MANAGEMENT
    • PREVENATION
    DEFINITION
    TETANUS
    • acute onset of hypertonia or
    painful muscular contractions (usually of the muscles of the jaw and
    neck) and generalized muscle spasms without other apparent medical
    cause.
    Neonatal
    • Defined by the World Health Organization
    (WHO) as “an illness occurring in a child who has the normal ability to
    suck and cry in the first 2 days of life but who loses this ability between
    days 3 and 28 of life and becomes rigid and has spasms.
    Maternal tetanus
    • is defined by the WHO as tetanus occurring during pregnancy or within 6 weeks after the conclusion of
    pregnancy(whether with birth, miscarriage, or abortion).
    EPIDEMIOLOG
    • Rare in developed countries
    • Common in incompletely immunized or unimmunized indivduals
    • >60 at high risk;↓ antibodies levels over time
    Predisposing factors
    • In adequate vaccination
    • Wounds:
    • Penetrating; stepping on nail, IM injection, tatoo,
    • Abrasion
    • Dental :extraction,root cannal therapy,
    • Devitalized tissue
    • Foreign body
    • Neonates:
    • Infection of the umbilical stump
    • Unvaccinated mothers
    • Ear piercing
    • cirmucission
    • Obstetrics: septic abortions
    AETIOLOGY
    • caused by clostridium tetani;anaerobic gram-positive spore-froming
    rod.
    • Present in gut of mammals and widely soil
    PATHOPHYSIOLOGY
    • Inoculation
    • Vegetative ;produce exotoxins :1)metalloprotease tetanospasmin; 2)
    tetanolysin
    • Tetanospasmin:150kD-100kD(heavy chain) &50kD (light Chain)
    • 100kD; internalization and uptake
    • 50kD; cleaves vesicle associated membrane protein(VAMP)2.(synaptobrevin)
    • Retrograde fast axonal transportation
    • Translocation
    • Inhibition of release of inhibitory neurotransmitters
    CLINICAL FEATURES
    • Incubation period approx. 8 days but ranges from 3 to 21 days
    • Types of types clinically
    • Generalized tetanus
    • Localized tetanus
    • Cephalic tetanus
    • Neonatal tetanus
    • Generalised tetanus
    • Most common
    • Localised tetanus
    • Unusual form
    • involving extremity with contaminated wound
    • Excellent prognosis
    • Cephalic tetanus
    • Uncommon
    • 1-2 days
    • Poor prognosis
    • Usually occurs after head trauma
    • Cranial nerve palsies-CN VII
    • Neonatal tetanus /tetanus neonatorum
    • 3-10 days
    • Generalised
    • 70% mortality rate
    • Irritability
    • Poor feeding
    • Rigidity
    • Facial grimance
    • Severe spasms to touch
    • Trismus :in ability to open the mouth secondary tomasster muscle
    spasms
    • Risus sardonicus:grin like posture of hypertonic facial expression
    • Opisthotonus; arching of the body with hyperextension
    DIAGNOSIS
    • History:
    • Symptoms: onset, duration,
    • Predisposing;
    • Examination;
    • Neck stiffness
    • Posture
    • Investigations
    DIFFERENTIAL DIAGNOSIS
    • Drug induced dystonias
    • Trismus due to dental infection
    • Strychnine poisoning due to injection of rat poison
    MANAGEMENT
    Goals of management
    1. Halting toxin production
    2. Neutralizing unbound toxin
    3. Airway management
    4. Control of spasms
    5. Management of dysautonomia
    6. General supportive management
    Halting toxin production
    • Wound management :
    • Debridement; removes spores and necrotic tissue

    • Antibiotics therapy
    • Metronidazole 500mg IV 6 or 8 hourly
    • Penicillin G 2-4u IV 4 or 6 hourly for 7 to 10 days
    Neutralizing unbound toxin
    • Passive immunization;
    • Human tetanus immune globulin(HTIG) 3000-6000units IM (part of dose around the
    wound
    • Equine antitoxin ;intradermal test 0.1ml(1:10 dilution

    • Active immunization
    • Different site from that of TIG
    Control of spasms
    • Diazepam
    • 10-30mg IV PRN 1 to 4hourly.max dose 500mg /day
    • LORAZEPAM
    • Midazolam
    • Magnesium sulphate
    • Pancuronium
    • Baclofen 1000 mega 3 weeks
    General supportive management
    • Airway management
    • Nutrition
    PREVENTION
    • Vaccination
    • Children
    • DTaP- at 2,4,6 months
    • Mothers
    • Males

    • Prophylasis; following injury


    • Tetanus toxoid
    • TIG
    references
    • Harrison’s principles of internal medicine
    • Lippinicott’s reviews: microbiology 2nd edition
    • Medscape
    • Upto date.com

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