Tetanus

TETANUS
Prepared by:
SAgun PAudel
Health Assistant
Student of BPH @ LA GRANDEE International college, Simalchour
Pokhara, Nepal
Presented with:
Rajeev Nepal

5/11/2012 Disease Presentation- TETANUS 1

Definition:
Tetanus is a acute bacterial disease caused by the
neurotoxin tetanospasmin elaborated by
Clostridium tetani. and characterized by a
prolonged contraction of skeletal muscle fibers.

It is also called lockjaw.


Causative organism:

 Clostridium tetani is a Gram-positive, obligate
anaerobic, spore bearing and flagellate organism.
 produce a potent exotoxin called tetanospasmin.
spores are resistant to heat and most antiseptics.


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.

Global burden:
 Tetanus, particularly the neonatal form a significant
public health problem in non-industrialized countries.

 The World Health Organization estimates that
59,000 newborns worldwide died in 2008 as a result
of neonatal tetanus.


In Nepal :
 In late 2005,Nepal demonstrated through surveys that it
had reached the WHO criterion for having eliminated
neonatal tetanus, i.e. NT cases occurred at a rate of less
than 1 per 1000 live births in every district.
Strategies:
 clean delivery

 routine immunization

 supplemental immunization campaigns

 surveillance


Some facts;

 Initiation of EPI in 1979 [3 districts]
 1989 in 75 districts
 DPT and TT vaccines from 1981.
years TT+2 COVERAGE
1993–1995 33%

1996–2000 45%
1999 65%


INCUBATION PERIOD:

 Usually incubation period ranges from 3-21 days but
can range from the day of injury to several months.

 Average incubation period is 10 days.

 Depends on character, location, and extent of
wound.


Mode of transmission:
 Infection is acquired by contamination of wounds with
Clostridium tetani spores. a tiny breach in skin or mucosa
(e.g.. Skin abrasion, punctured wounds, burns, animal
bites, unsterile surgery, aseptic abortion, unsterile
instruments to cut umbilical cord etc.) leads to introduce
of spores.
 the spores are widely distributed in the intestines and
faeces of many non-human animals such as horses,
sheep, cattle, dogs, cats, rats, guinea pigs, and chickens.
 Tetanus is not spread from person to person.


Pathogenesis:

 Tetanus begins when spores of Clostridium tetani enter
damaged tissue.

The spores transform into rod-shaped bacteria and produce
the neurotoxin tetanospasmin (also known as tetanus
toxin).

This toxin is inactive inside the bacteria, but when the
bacteria die, toxin is released and activated by proteases.

Finally it interferes with neurotransmission at spinal synapses
of inhibitory neurons.
This results to uncontrolled spasms and reflexes.

Clinical features:
 Pain and tingling at the site of wound.
 Pain in neck, back and abdomen.
 Opisthotonos position.
 Risus sardonicus (Mouth kept slightly
open)
 Spasm of pharyngeal muscles.
 Lock jaw (reflex trismus).
 Dysphasia.
 Acute asphyxia.
 Refusal of feeding and excessive
crying.
 Other symptoms like fever, headache,
etc

Diagnosis:

 There are currently no blood tests that can be
used to diagnose tetanus.

 clinical presentation of patient associated with
tetanus are the essential factors of diagnosis.

 history of injury and possible contamination.


Treatment:
 Injection tetanus toxoid 0.5ml intramuscularly.

 Passive immunization with human anti - tetanospasmin
immunoglobulin.

 Local wound care:
o Incision & drainage of pus.
o Debridement (Removal of necrotic tissues & foreign
bodies)
o Wound should be open.


Treatment:
 Control of spasm:
o Injection diazepam 0.1-0.2mg/ kg.
o Paralyze & ventilate.

 Antibiotics:
o Broad spectrum antibiotics to treat or prevent
infection.

 Supportive care:
o Isolation in a quit dark room.
o Maintain fluid, nutrition, and electrolytes.
o Oxygen inhalation if required.


Complications:

 Acute asphyxia
 Aspiration pneumonia
 Respiratory arrest
 Vertebral fracture
 Laceration of tongue, lips, buccal cavity.


Control and Prevention:
 Tetanus is a vaccine preventable
disease.

 Immunization of mother with 2
doses of TT during 2nd trimester of
pregnancy can prevent Neonatal
tetanus.

 Infants & children should be
immunized by primary active
immunization with DPT at 6, 10,14
weeks.


Control and prevention:
 immunize the vulnerable groups such as all industrial,
agricultural workers, armed forces etc.

 Early treatment of wound/ injury and give injection tetanus
toxoid.

 Use of early antibiotics.
 3 clean during delivery;
Clean hand
Clean delivery surface
Clean cord care.

Control and prevention:
• Give proper health education about tetanus such as
preventive measures, effects, etc.
•Provide awareness that it can be prevented by post-
exposure prophylaxis.
•Active immunization shall protect all over them for 10
years that means adults should receive a booster
vaccine every ten years.


PICTURES OF CHILDREN SUFFERING FROM
TETANUS:


Children and adult man;


Picture of Suffering dog;


REFERENCES :
 www.google.com
 www.wekepedia.org
 A book of preventive and social medicine by K. park
 A test book of clinical medicine for health science by
Dr. tilak pathak.
 Oxford journal of public health vol:31


THANK YOU………


Tetanus

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