Tetanus

TETANUS
Mrs chirinda
DEFINITION
• Is a serious neurological disease

characterized by intermittent painful tonic
spasms of voluntary muscles and
convulsions.
DISEASE DISTRIBUTION
• Occurs world wide.

• Prevalent in farming underdeveloped areas
where there is constant contact with the
excreta of animals and immunisation is
inadequate.
CAUSATIVE ORGANISM
• Anaerobic bacillus Clostridium tetani
RESERVIOR
• Animals, humans, and rusty surfaces, soil
• MODE OF TRANSMISSION Infection generally
occurs through wound contamination and
often involves a cut or deep puncture wound.
• Direct: gains access to the body through a
wound contaminated with soil and dust
with the clostridium tetani
• In babies: through the umbilical stump with
contaminated manure
INCUBATION PERIOD
• 10 days – 3 weeks
PATHOPHYSIOLOGY
• After gaining entry into the body clostridium

tetani starts to multiply.
• It secretes a virulent exotoxin called
tetanospasmin which is transported via
blood or the lymph to the anterior horn
cells and sympathetic ganglia where it binds
with the nerve cells.
• Here it blocks the inhibiting signals on the
anterior horn cells and causes motor activity
without any effect on the sensory nerves,
cerebral cortex or cerebellum.
• The toxin can not be neutralised once it has
bound to the nerve cells, it starts affecting the
head, and neck muscles, followed by the muscles
of the torso and limbs.
• As the infection progresses, muscle spasms
develop in the jaw (thus the name "lockjaw)
SIGNS AND SYMPTOMS
• SYSTEMIC TETANUS (GENERALISED TETANUS)
• It is the most commonest type of tetanus, representing
about 80% of cases.
• It usually presents with a descending pattern.
• Progressive stiffness of the voluntary muscles.
• First to be affected are the masseter and neck muscles
and within 24 – 48 hours the stiffness spreads to the rest
of the body.
• 1st sign and symptom is (trismus) locked jaw,
dysphagia, restlessness and resus sardonicus
(contraction of the facial muscles with lifted
eyebrows and a grimace).
• This is followed by stiffness of the neck,
difficulty in swallowing, and descend further
to cause rigidity of pectoral and calf muscles.
• Other symptoms include elevated
temperature, sweating, elevated
blood pressure, and episodic rapid heart rate
• Severe opisthotonos (Spasms that occur
frequently and last for several minutes with
the body shaped into a characteristic shape .)
follows caused by the spasms of the neck
and back muscles causing fractures of the
vertebra.
• Spasms continue for up to 4 weeks, and
complete recovery may take months.
• The spasms are irregular at first but become
regular, last longer and are extremely
painful.
• Respiratory muscle involvement leads to
laryngospasm causing accumulation of
secretions in the tracheobronchial tree
which can lead to asphyxiation.
• Sphincters can cause retention of urine and
constipation.
• Patient is usually fully conscious and suffers
severe pain during a spasm.
• Coma or death occurs as a result of
exhaustion, cardiac failure or asphyxia.
LOCAL TETANUS
• It is an uncommon form of the disease, in

which patients have persistent contraction
restricted to wound area and spasms are of
the affected muscles of a single limb.
• The contractions may persist for many
weeks before gradually subsiding.
• Local tetanus is generally milder; only about
1% of cases are fatal, but it may precede the
onset of generalized tetanus.
NEONATAL TETANUS
• It is a form of generalized tetanus that

occurs in newborns.
• Infants who have not acquired passive
immunity because the mother has never
been immunized are at risk.
• It usually occurs through infection of the
unhealed umbilical stump, particularly when
the stump is cut with a non-sterile instrument.
• Neonatal tetanus is common in many
developing countries and is responsible for
about 14% (215,000) of all neonatal deaths,
but is very rare in developed countries.
[7]
SIGNS AND SYMPTOMS
• Difficulty in sucking, masseter muscles go

into spasm, dysphagia, trismus (locked jaw),
opisthotonos.
• Crying with a horse choking sound leading
to cyanosis and exhaustion.
CEPHALIC TETANUS
It is a rare form of the disease, occasionally

occurring with otitis media (ear infections) in
which C. tetani is present in the flora of the
middle ear, or following injuries to the head.
There is involvement of the cranial nerves,
especially in the facial area.
DIAGNOSIS
• History of injury, clinical picture

• Isolation of clostridium tetani from the
wound (MCS)
TREATMENT
• Patient needs intensive care treatment as an emergency
for respiratory and cardiac support.
• MEDICAL TREATMENT
• Debridement of the wound
• Tetanus anti serum
• Sedatives and muscle relaxants to control muscle spasms by
sedation eg midazolam 0,3 -0,5mg/kg body/wt continuous
infusion and muscle relaxation is with Atraculium
• Secondary infection is prevented by
antibiotics such as penicillin.
• Physiotherapy
NURSING CARE
• Patient is nursed in a darkened room where

all auditive, visual, tactile and other stimuli
can be reduced.
• Tracheostomy care if tracheostomy is
performed
• NG feeds to eliminate aspiration
• IV drugs
• Catheter and care of it.
• Enema and flatus tube to prevent
abdominal distention
• When recovered patient to be fully
immunised.
PREVENTIVE MEASURES
• Health education on immunisation with tetanus
toxoid to babies from 6 weeks.
• Booster doses every 10 years
• Prophylaxis to farm workers, armed forces, health
workers, police, young people attending camps.
• Pregnant women and breast feeding mothers
who have never been immunised.
• In children under the age of seven, the tetanus
vaccine is often administered as a combined
vaccine, DPT/DTaP vaccine, which also includes
vaccines against diphtheria and pertussis.
• For adults and children over seven, the Td vaccine
(tetanus and diphtheria) or Tdap (tetanus,
diphtheria, and acellular pertussis) is commonly
used.[11]
TETANUS SCHEDULE FOR
PREGNANT MOTHERS
• 1st dose at ANC booking
• 2nd dose after 28 days (1 month apart)
• 3rd dose after 6 months
• 4th dose after 1 year
• 5th dose after 5 years
COMPLICATIONS
• Pneumonia
• Atelectasis (lung collapse)
• Emphysema (abnormal accumulation of air in the
pleural space)
• Pneumothorax
• Fracture vertebra
• Tongue injuries
• Torn ligaments
• PROGNOSIS
• High mortality rate in systemic infection
• Local tetanus prognosis is good
• High mortality in neonatarum

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TETANUS

• Is a serious neurological disease

• Occurs world wide.

• After gaining entry into the body clostridium

• It is an uncommon form of the disease, in

• It is a form of generalized tetanus that

• Difficulty in sucking, masseter muscles go

It is a rare form of the disease, occasionally

• History of injury, clinical picture

• Patient is nursed in a darkened room where

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