Tetanus

Infectious disease caused by Clostridium

tetani which produces potent exotoxin with
prominent systemic neuromuscular efforts

manifested
by generalized spasmodic
contractions of the skeletal musculator
Mode of Transmission:
Transmission is primarily by
contaminated wounds, Tissue
injury( surgery, burns,deep
puncture wounds, crush wounds,
Otitis media ,dental infection,
animal bites, abortion, and
pregnancy
Incubation Period:
8 DAYS ( 3-21 DAYS)
 Clostridium tetani
Clostridium tetaniis
ananaerobic
pathogenicbacterium
thatisprimarilyfound
insoilandanimal
intestinaltracts.

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Resistance of the C. tetani
.Survives boiling up
to 3 hours
They can not
survive autoclaving
at 249.8 F (121 C)
for 20 minutes.
The spores are also
relatively resistant
to phenol and other
chemical agents.
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Tetanus Toxin oriented
disease
C. tetaniusuallyentersahostthrougha
woundtotheskinandthenitreplicates.
Onceaninfectionisestablished

C. tetaniproducestwoexotoxins,
(1)tetanolysinand
(2)tetanospasmin.

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Nature of Toxins
Tetanospasmin is a neurotoxin
and causes the clinical
manifestations of tetanus.

Tetanolysis is responsible for

destruction of RBC

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Tetanospasmin
Thetoxinistakenupintowithin
thenerveaxonandtransported
acrosssynapticjunctions,untilit
reachesthecentralnervous
system

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 Pathogenicty
Thesporesgerminate
inreducedoxygen
potentialdevitalized
tissues,presenceof
foreignbodies

Motorneuronsabsorb

SpreadIntraaxonally
toCNS
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 Mechanism of Action
of Tetanus Toxin

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How Toxin acts
Thetoxin,byblockingthereleaseof
inhibitors,keepstheinvolved
musclesinastate of contraction and
leads to spastic paralysis,a
conditionwhereopposingflexorand
extensormusclessimultaneously
contract.Deathisusuallyfrom
respiratoryfailure.

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Clinical manifestations
Theclinicalmanifestationsof
tetanusarecausedwhen
tetanustoxinblocksinhibitory
impulses,byinterferingwiththe
releaseofneurotransmitters,
Thisleadstounopposedmuscle
contractionandspasm.

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9/18/17 Dr.T.V.RaoMD@Rao's 12
Microbiology
Opisthotonus

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 Photo Courtesy of U.S. Centers for Disease
9/18/17 14
Control and Prevention
Tetanus characteristic features

risus sardonicus (a
rigidsmile)

trismus(commonly
knownas"lock-jaw"),
and
opisthotonus(rigid,
archedback).

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Risus Sardonicus in Tetanus Patient

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Treatment
Treatmentinvolvesdebridement,the
antibioticmetronidazole*active
immunizationwithtetanustoxoid,and
passiveimmunizationwithtetanus
immuneglobulin.
Preventionisthroughactiveimmunization
withtetanustoxoid**.Thetoxoid
stimulatesthebodytomakeneutralizing
antibodiesagainstthebindingcomponent
ofthetetanustoxin.Oncetheantibody
bindstothetoxin,thetoxincannolonger
bindtothereceptorsonthehostcell
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membrane
 Prevention
Tetanus carries a 35% mortality rate, making prevention very important!
The best course is childhood immunizations, with consistent booster doses,
and prompt cleaning of wounds with hydrogen peroxide.

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Prophylaxis
Surgicalattention
Antibiotics
Immunization
Antibiotics<4hours
Erythromycin5000mgBid
Pencillin
Localtreatmentwithbacitracin,and
neomycin
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Passive Immunization
Antitoxin(tetanus immune globulin)shouldbe
administeredimmediately.Thiswillinactivate
toxinsintheblood.
Woundsshouldbedebridedtoremovedead
tissueorforeignbodies.
AntibioticsshouldbegiventoinhibitgrowthofC.
tetani.
Atetanustoxoidboosterimmunizationshouldbe
giventopatientswhohavenotreceivedone
withinthelast5years.
Ifspasmsoccur,antispasmodicdrugsshouldbe
usedandrespirationmaintainedbyabreathing
apparatusifnecessary.
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Active Immunization
1st dose - 6th week
2nd dose - 10th week
3rd dose - 14th week
1st booster - 18th month
2nd booster - 6th year
3rd booster - 10th year

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Passive Immunization

1. ATS(equine) Ig- 1500 IU/s.c

after sensitivity test
(or)
2. ATS(human) Ig- 250-500 IU,
no anaphylactic shock, very
safe and costly.

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Treatment of Tetanus
patients

Hospitalization
Tracheotomy
Pencillin,Metronidazole
Giveactiveimmunization.

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 Triple Antigen vaccine
TripleAntigenvaccine
isacombinationof
Diphtheria,Tetanus,
andPertussis.The
vaccinestimulatesthe
productionof
antibodiesto
immunizethebody
againstthecausative
agentsofthethree
diseaseslistedabove
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Prevention is Better than
Cure

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Avenues for entrance

Rugged traumatic wounds

and burns

Umbilical stump

unrecognized wounds

Dental extraction
Complications:

1. Respiratory
a) Hypostatic pneumonia

b) Hypoxia due to laryngospasm

c) Atelectasis

d) Pneumothorax
2. Due to trauma
a) Laceration of the tongue
b) Intramuscular laceration
c) Fracture of the ribs

3.Septicemia

4.Encephalopathy
5. Good Nursing Care

a)avoidanceofexternal
stimulation
b)preventionfromfurtherinjury
c)maintainpatentairway
d)maintainfluidandelectrolyte
e)IVlineformedication
6. Efficient wound care

7. Avoid contractures and

pressure sores

8.Close monitoring of vital signs

and muscle tone

9. Psychological & spiritual care