Tetanus

1. TETANUS Prepared by: SAgun PAudel Health Assistant Student of BPH @ LA GRANDEE International college, Simalchour Pokhara, Nepal Presented with: Rajeev Nepal 5/12/2012 1 Disease Presentation- TETANUS

2. 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 . 5/12/2012 2 Disease Presentation- TETANUS

3. 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. 5/12/2012 3 Disease Presentation- TETANUS

4. 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. 5/12/2012 4 Disease Presentation- TETANUS

5. 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 . 5/12/2012 5 Disease Presentation- TETANUS

6. 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 5/12/2012 6 Disease Presentation- TETANUS

7. Some f a cts; 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% 5/12/2012 7 Disease Presentation- TETANUS

8. 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. 5/12/2012 8 Disease Presentation- TETANUS

9. 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. 5/12/2012 9 Disease Presentation- TETANUS

10. 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. 5/12/2012 10 Disease Presentation- TETANUS

11. 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 5/12/2012 11 Disease Presentation- TETANUS

12. 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. 5/12/2012 12 Disease Presentation- TETANUS

13. Treatment: Injection tetanus toxoid 0.5ml intramuscularly. Passive immunization with human anti - tetanospasmin immunoglobulin . Local wound care: Incision & drainage of pus. Debridement (Removal of necrotic tissues & foreign bodies) Wound should be open. 5/12/2012 13 Disease Presentation- TETANUS

14. Treatment: Control of spasm : Injection diazepam 0.1-0.2mg/ kg. Paralyze & ventilate. Antibiotics: Broad spectrum antibiotics to treat or prevent infection. Supportive care: Isolation in a quit dark room. Maintain fluid, nutrition, and electrolytes. Oxygen inhalation if required. 5/12/2012 14 Disease Presentation- TETANUS

15. Complications: Acute asphyxia Aspiration pneumonia Respiratory arrest Vertebral fracture Laceration of tongue, lips, buccal cavity . 5/12/2012 15 Disease Presentation- TETANUS

16. Control and Prevention: Tetanus is a vaccine preventable disease. Immunization of mother with 2 doses of TT during 2 nd trimester of pregnancy can prevent Neonatal tetanus. Infants & children should be immunized by primary active immunization with DPT at 6, 10,14 weeks. 5/12/2012 16 Disease Presentation- TETANUS

17. 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. 5/12/2012 17 Disease Presentation- TETANUS

18. 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. 5/12/2012 18 Disease Presentation- TETANUS

19. PICTURES OF CHILDREN SUFFERING FROM TETANUS: 5/12/2012 19 Disease Presentation- TETANUS

20. Children and adult man; 5/12/2012 20 Disease Presentation- TETANUS

21. Picture of Suffering dog; 5/12/2012 21 Disease Presentation- TETANUS

22. REFERENCES : www.g o ogle.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 5/12/2012 22 Disease Presentation- TETANUS

23. T H A N K Y O U ……… 5/12/2012 23 Disease Presentation- TETANUS

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