TETANUS
COMMUNITY MEDICINE
GROUP 3
SUBTOPICS:
•INTRODUCTION
•CAUSATIVE AGENT
• EPIDEMIOLOGY
•TRANSMISSION, HOST FACTORS, ROUTE OF ENTRY
•CLINICAL FEATURES
•TYPES OF TETANUS
•DIAGNOSIS
•DIFFERENTIAL DIAGNOSIS
•TREATMENT
•PREVENTION – ACTIVE & PASSIVE IMMUNIZATION
INTRODUCTION
• Tetanus an neurological disease 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. The mortality tends to be
very high, varying from 40 to 80 per cent.
CAUSATIVE AGENT
¢ Caused by CLOSTRIDIUM TETANI Round terminal spores give
¢ Anaerobic cells a “drumstick” or
¢ Motile
“tennis racket” appearance.
¢ Gram positive bacilli
¢ Oval, colourless, terminal spores – tennis racket or drumstick shape.
¢ It is found worldwide in soil, in inanimate environment, in animal faeces &
occasionally human faeces.
EPIDEMIOLOGY
• Tetanus is an international health problem, as spores are
ubiquitous. The disease occurs almost exclusively in persons who
are unvaccinated or inadequately immunized.
• Entirely preventable disease by immunization
• 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 agricultural
workers are employed.
• Tetanus neonatorum is common due to lack of MCH CARE
INDIA:
• Tetanus is important endemic infection in India.
• Prior to the national immunization programme estimated 3.5 LAKH
children were dying annually. 70,000 cases continue to occur largely in
the states – Orissa, Bihar, MP, Aasam, Rajasthan, UP ,where TT
immunization coverage is less than national coverage(70%) .
TRANSMISSION
HOST FACTORS
•Age : It is the disease of active age (5-40 years), New born baby, female during delivery or abortion.
• Sex : Higher incidence in males than females.
•Occupation : Agricultural workers are at higher risk.
•Rural –Urban difference: Incidence of tetanus in urban areas is much lower than in rural areas.
•Immunity : Herd immunity does not protect the individual.
• Environmental and social factors: Unhygienic custom habits, Unhygienic delivery practices.
ROUTE OF ENTRY
• Apparently trivial injuries
• Animal bites/human bites
• Open fractures
• Burns
• Gangrene
• In neonates usually via infected umbilical stumps
• Abscess
• Parenteral drug abuse
MECHANISM OF ACTION
1. C. tetani enters body from through 4. Tetnospasmin spreads using blood
wound. and lymphatic system, and binds to
motorneurons
2.Stays in sporulated form until anaerobic 5.Travels along the axons to the spinal
conditions are presented. cord
6.Binds to site responsible for
1. 3.Germinates under anaerobic conditions and
begins to multiply and produce tetnospasmin.
inhibiting skeletal muscle contraction
CLINICAL FEATURES
IP : Time from injury to the first symptom.The median incubation period is 7
days, and, for most cases (73%), incubation ranges from 3-21 days.
Period of onset : It is the time from first symptoms to the reflex spasm.
In general the further the injury site is from the central nervous system, the
longer the incubation period.
The shorter the incubation period, the higher the chance of death.
• Triad of muscle rigidity, spasms & autonomic dysfunction.
• Early symptoms are neck stiffness, sore throat and poor mouth opening.
• Patients with generalized tetanus present with trismus (ie, lockjaw) in 75% of cases.
• Other presenting complaints include stiffness, neck rigidity, dysphagia, restlessness, and
reflex spasms. Spasms usually continue for 3-4 weeks.
• Subsequently, muscle rigidity becomes the major manifestation. Rigid Abdomen.
•
•
Trismus (Lock Jaw): Spasm of Masseter muscles.
•Opisthotonus: Spasm of extensor of the neck, back and legs to form a backward
curvature.
•Muscle spasticity
•Muscle rigidity spreads in a descending pattern from the jaw and facial muscles over
the next 24-48 hours to the extensor muscles of the limbs – stiff proximal limb muscles &
relatively sparing hand & feet.
OPISTHOTONUS IN TETANUS
PATIENT
SEQUENCE OF EVENTS
1.Lock Jaw
2. Stiff Neck
3. Difficulty Swallowing
4. Muscle Rigidity
5. Spasms
DIAGNOSIS
• Diagnosis is done clinically based on the presence of trismus, dysphagia, generalized
muscular rigidity, and/or spasm.
• Laboratory studies may demonstrate a moderate peripheral leukocytosis.
• An assay for antitoxin levels is not readily available. However, a level of 0.01 IU/mL or
greater in serum is generally considered protective, making the diagnosis of tetanus less
likely.
• Cerebrospinal fluid (CSF) study findings are usually within normal limits.
DIFFERENTIAL DIAGNOSIS
1. Drug induced Dystonic Reactions e.g. Phenothiazines
2.Strychnine poisoning
3. Neuroleptic Malignant Syndrome, Serotonin syndrome
4. Trismus d/t Peritonsillar Abscess/Dental infection
5. Stiff person syndrome
PRINCIPLES OF TREATMENT
•Neutralization of unbound toxin
-HTIG/ATS
• Prevention of further toxin production
-Wound debridement & antibiotics
•Antibiotics Penicillin G aqueous : (10-12 MU IV )
•Control of spasm
-Anticonvulsants, Sedatives, Muscle relaxants etc.
•Management of autonomic dysfunction
-MGSO4, Betablockers etc.
•Supportive care
-Physiotherapy, Nutrition, Thromboembolism prophylaxis ABC etc…
CONTROL OF SPASM
• Drugs used to treat muscle
spasm, rigidity, and tetanic
seizures include sedative-
hypnotic agents, general
anesthetics, centrally acting
muscle relaxants, and
neuromuscular blocking agents.
•Anticonvulsants
PREVENTION
•
Tetanus is completely preventable by active tetanus immunization.
Immunization is thought to provide protection for 10 years.
Begins in infancy with the DTP series of shots. The DTP
vaccine is a "3-in-1" vaccine that protects against diphtheria,
pertussis, and tetanus.
ACTIVE IMMUNIZATION
• 1st Dose - 6th Week (DPT)
• 2ndDose - 10th Week (DPT)
• 3rd Dose - 14th Week (DPT)
• 1st Booster - 18th month (DPT)
• 2ndBooster - 6th year (DT)
• 3rd Booster - 10th year (TT)
PASSIVE IMMUNIZATION
• It stimulates formation of antibodies to it , hence a person who has once
received ATS tends to rapidly eliminate subsequent doses
• Temp protection – human tetanus immunoglobulin /ATS
• Human Tetanus Hyperimmunoglobulin :250-500 IU
• THANK YOU
