TETANUS
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What is Tetanus?
• Tetanus is an illness characterized by an
acute onset of hypertonia, painful muscular
contractions (usually of the muscles of the
jaw and neck), and generalized muscle
spasms without other apparent medical
causes.
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Caused by Clostridium Tetani
Gram positive
Spore-forming
Anaerobic bacilli
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Causative agent
• Clostridium tetani
Left. Stained pus from a mixed anaerobic infection. At
least three different clostridia are apparent.
Right. Electron micrograph of vegetative Clostridium
tetani
cells.
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Morphology & Physiology
• Relatively large, Gram-positive, rod-
shaped bacteria
• Spore-forming, anaerobic.
• Found in soil, especially heavily-
manured soils, and in the intestinal
tracts and feces of various animals.
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[Link] spores are found
•everywhere
Spores of C. tetani are found in soils
throughout the world
Spores are very resistant to harsh
conditions
• heat
• radiation
• chemicals
• drying
•
• Spores can survive for a long time
in environment---100yrs possibly!
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Methods of transmission
• C. tetani can live for years as spores in animal feces
and soil. As soon as it enters the human body
through a major or minor wound and the
conditions are anaerobic, the spores germinate and
release the toxins.
• Tetanus may follow burns, deep puncture
wounds, ear or dental infections, animal bites,
abortion.
• Only the growing bacteria can produce the toxin.
• It is the only vaccine-preventable disease that is
infectious but not contagious from person to
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[Link] - Entry of spores
• Entry of C. tetani into the body
usually involves implantation of
spores into a wound
• After gaining entry, C. tetani
spores can persist in the body for
months, waiting for the proper low
oxygen growth conditions to
develop [Link] MD
•
[Link] produces toxigenic Disease
• C. tetani spores enter the body, they are again
in an oxygen-free environment where they can
germinate. The spores usually enter the body
through a deep puncture wound or cut, but
animal bites or even a splinter also can allow
spore entry. The bacteria then produce tetanus
toxins, which circulate in the body. One of the
toxins blocks nerve impulses that allow muscles
to relax. This toxin is responsible for causing
generalized tetanus, the most common form of
the disease.
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Virulence & Pathogenicity
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Toxic manifestations
• As growing cells of C. tetani produce
tetanospasmin at the wound site, the
toxin starts to migrate along nerves
into the Central Nervous System
where it blocks the release of inhibitory
neurotransmitters
• As a consequence of too much
“activator transmitters”, muscles are
Overstimulated to repeatedly
contract—called spastic paralysis
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How the toxin acts
Blocksthe release of inhibitory
neurotransmitters (glycine and
gamma- amino butyric acid) across the
synaptic cleft, which is required to
check the nervous impulse.
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Symptoms
• Tetanic seizures (painful,
powerful
bursts of muscle contraction)
• if the muscle spasms affect the larynx or chest
wall, they may cause asphyxiation
• stiffness of jaw (also called lockjaw)
• stiffness of abdominal and back muscles
• contraction of facial muscles
• fast pulse
• fever
• sweating [Link] 13
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Patient Manifests with
• A person suffering from tetanus undergoes
convulsive muscle contractions of the jaw--
called LOCKJAW
• The contractions by the muscles of the back
and extremities may become so violent and
strong that bone fractures may occur
• The affected individual is conscious
throughout the illness, but cannot stop these
contractions
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Trismus
The back muscles are
more powerful, thus
creating the arc
backward
Baby has neonatal
tetanus with
complete rigidity
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Types of tetanus:
local, cephalic, generalized, neonatal
• Incubation period: 3-21 days, average 8 days.
Uncommon types:
• Local tetanus: persistent muscle contractions in the
same anatomic area as the injury, which will however
subside after many weeks; very rarely fatal; milder
than generalized tetanus, although it could precede it.
• Cephalic tetanus: occurs with ear infections or
following injuries of the head; facial muscles contractions.
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Most common types:
Generalized tetanus
- descending pattern: lockjaw stiffness of neck
difficulty swallowing rigidity of abdominal and
back muscles.
- Spasms continue for 3-4 weeks, and recovery can last
for months
- Death occurs when spasms interfere with respiration.
Neonatal tetanus:
- Form of generalized tetanus that occurs in newborn
infants born without protective passive immunity because
the mother is not immune.
- Usually occurs through infection of the unhealed umbilical
stump, particularly when the stump is cut with an
unsterile instrument.
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Methods of diagnosis
• Based on the patient’s account and
physical findings that are
characteristic of the disease.
• Diagnostic studies generally are of
little value, as cultures of the
wound site are negative for C.
tetani two- thirds of the time.
–When the culture is positive, it
confirms the diagnosis of tetanus
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Diagnosis
• Tests that may be performed include
the
following:
–Culture of the wound site (may be
negative even if tetanus is
present)
–Tetanus antibody test
–Other tests may be used to rule
out meningitis, rabies, poisoning,
or other diseases with similar
symptoms. [Link]
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Clinical treatment
• If treatment is not sought early, the disease is
often fatal.
• The bacteria are killed with antibiotics,
such as penicillin or tetracycline; further
toxin production is thus prevented.
• The toxin is neutralized with shots of
tetanus
immune globulin.
• Other drugs may be given to provide
sedation,
relax the muscles and relieve pain.
• Due to the extreme potency of the toxin,
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Method of prevention - Immunization
• A person recovering from tetanus should begin
active immunization with tetanus toxoid (Td) during
convalescence.
• The tetanus toxoid is a formalin-inactivated
toxin, with an efficiency of approx. 100%.
• The DTaPe includes tetanus, diphtheria and
pertussis toxoids; it is routinely given in the US
during childhood. After 7 years of age, only Td
needs to be administered.
• Because the antitoxin levels decrease over time,
booster immunization [Link]
shots are needed every 22
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Other supporting measures?
• Remove and destroy the source of the toxin
through surgical exploration and cleaning of the
wound (debridement).
• Bed rest with a nonstimulating environment (dim
light, reduced noise, and stable temperature) may
be recommended.
• Sedation may be necessary to keep the
affected person calm.
• Respiratory support with oxygen, endotracheal
tube,
and mechanical ventilation may be necessary.
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b.
Specific Treatment
Wound should be debrided widely.
c. Maintain an adequate airway.
d. Employ sedation (as indicated) or muscle. relaxant.
e. Active immunization. should be initiated
concurrently with therapy.
[Link] of environmental spores:
- esp. in operating theatres.
- Special air-flow equipment and filtered ventilation.
- Reduce airborne particles. Surgical instruments
and dressing sterilization (use of autoclaves).
Disinfect.
e.g. formaldehyde. [Link]
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Tetanus Toxoid
• Formalin-inactivated tetanus toxin
• Schedule Three or four doses +
booster
Booster every 10 years
• Efficac Approximately
y 100%
• Duration Approximately 10 years
• Should be administered with diphtheria toxoid
as
DTaP, DT, Td, or Tdap
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Routine DTaP Primary
Vaccination Schedule
Dose
Primary 1 2 months
Primary 2 4 months 4 wks
Primary 3 6 months 4 wks
Primary 4 15-18 months 6 mos
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Active & Passive Immunization
• In non immunized persons
• 1500 IU of ATS / 250-500 units of
Human Ig in one arm & 0.5 ml of
adsorbed tetanus toxoid into other
arm /gluteal region
• 6 wks later, 0.5 ml of tetanus toxoid
• 1 yr later , 0.5 ml of tetanus toxoid
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Children Who Receive DT
• The number of doses of DT
needed to complete the series
depends on the child’s age at the
first dose:
–if first dose given at <12 months
of age, 4 doses are recommended
–if first dose given at ≥12 months, 3
doses complete the primary series
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Prognosis in Infected
• Prognosis is dependent on incubation period, time
from spore inoculation to first symptom, and time
from first symptom to first tetanic spasm.
• In general, shorter intervals indicate more
severe tetanus and a poorer prognosis.
• Patients usually survive tetanus and return to
their pre disease state of health.
• Recovery is slow and usually occurs over 2-4
months.
• Clinical tetanus does not produce a state of
immunity; therefore, patients who survive the
disease require active immunization with
tetanus toxoid to prevent a recurrence.
Care in the Hospital to eliminate
[Link] spores
.Destruction of environmental spores:
- Specially in operating theatres.
- Special air-flow equipment and
filtered ventilation. - Reduce
airborne particles. Surgical
instruments and dressing sterilization
(use of autoclaves). Disinfect. e.g.
formaldehyde.
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Tetanus is a Vaccine Preventable
Disease-
Do vaccinate without fail
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