TETANUS Department of Physiotherapy, SHUATS, Prayagraj

Department of Physiotherapy, SHUATS, Prayagraj

1. TETANUS ( Community Medicine ) Submitted By – Bind Abhilasha ID N0 -21BPHY019 BPT – 3 rd Year Submitted To – Mrs. Surabhi Srivastava Assistant Professor Department of Physiotherap y Shuats

2. Tetanus CONTENT INTRODUCTION CAUSATIVE AGENT EPIDEMIOLOGY TRANSMISSION,HOST FACTORS MECHANISM OF ACTION OF TOXIN CLINICAL FEATURES TYPES OF TETANUS DIAGNOSIS TREATMENT COMPLICATION PREVENTION – ACTIVE & PASSIVE IMMUNIZATION

3. INTRODUCTION Tetanus – a Greek word –to stretch. 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

4. CAUSATIVE AGENT A serious bacterial infection that causes painful muscle spams and can lead to death. It is caused by bacterial infection called clostridium tetani. It is commonly found in soil, saliva, dust and manure. The bacteria generally enter through a break in the skin ,such as a cut or puncture wound caused by a contaminated object.

5. EPIDEMIOLOGY Tetanus is a gram –positive ,anaerobic, spore- bearing organism. 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 agricultural workers are employed. (AGENT) ( HOST ) (ENVIRONMENT )

6. TRANSMISSION Infection is acquired by contaminated of wound with tetanus spores. The range of injuries and accidents which may lead to tetanus:- A trivial pin prick Puncture wounds Animal bites Injection Chronic skin ulcer Unsterile division of umbilical cord Dental extraction

7. HOST FACTOR AGE :- It is the disease of active age (5- 40 years),new born baby , Female during delivery or abortion. SEX :- Higher incidences in males than females . Occupation :- Agriculture workers at higher risk . Rural-Urban difference :- Incidence of tetanus in urban areas is much lower than in rural area. Immunity :- Herd immunity does not protect the individual . Environmental and social factors :- Unhygienic custom habits ,Unhygienic delivery practices.

8. MECHANISM OF ACTION OF TETANUS TOXIN

9. CLINICAL FEATURES Pain and tingling at the site of wound. Pain in neck , back and abdomen. Risus sardonicus (Mouth kept slightly open). Spasm of Pharyngeal muscles. Lock Jaw (Reflex trismus ). Refusal of feeding and excessive crying. Other Symptoms like fever, headache , etc .

10. TYPES OF TETANUS TRAUMATIC :- Trauma is a major and important causes of tetanus may result from most trivial or even unnoticed wounds. OTOGENIC :- Ear may be rare portal of entry of foreign bodies such as infected pencils , matches and beads . OPTHALMOPLEGIC :- It is a variant that develops after penetrating eye injuries and results in CN III palsies and ptosis.

11. MATERNAL TETANUS Tetanus occurring during pregnancy or within 7 weeks after any type of pregnancy termination ,is one of the most easily preventable cause of maternal mortality. It includes postpartum or puerperal tetanus Postpartum or puerperal tetanus , usually resulting from septic procedures during delivery. Postabortal tetanus ,following septic maneuvers during induced abortion. Tetanus during Pregnancy , generally resulting from inoculation through a nongenital portal of entry.

12. NEONATAL TETANUS Tetanus neonatorum (8 th day disease ). Usually fatal if untreated Children born to inadequately immunized mothers,after unsterile treatment of umbilical stump. During first 2 weeks of life. Poor feeding,rigidity and spasms. It is easily preventable by 2 tetanus toxoid injections and 5 cleans while conducting deliveries.

13. 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. It is done clinically based on the presence of trismus , dysphagia ,generalized muscular rigidity or spasm. History of injury and possible contamination.

14. TREATMENT Injection tetanus toxoid 0.5 ml intramuscularly. Passive immunization with human anti – tetanospasmin immunoglobulin. LOCAL WOUND CARE Incision & drainage of pus. Debridement ( Removal of necrotic tissues and foreign bodies). Wound should be open . CONTROL OF SPASM Injection diazepam 0.1- 0.2 mg. Paralyze and ventilate.

15. TREATMENT ANTIBIOTICS Broad spectrum antibotics to treat or prevent infection . SUPPORTIVE CARE Isolation in a quit dark room. Maintain fluid , nutrition ,and electrolytes. Oxygen inhalation if required.

16. COMPLICATION Acute asphyxia Aspiration pneumonia Respiration arrest Vertebral fracture Laceration of tongue ,lips, buccal cavity .

17. 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 Diptheria ,Pertussis and Tetanus. ACTIVE IMMUNIZATION 1 ST Dose - 6 th week (DPT) 2 nd Dose -10 th week (DPT) 3 rd Dose -14 th week (DPT) 1 st Booster – 18 th month (DPT) 2 nd Booster -6 th year (DT) 3 rd Booster – 10 th year (TT)

18. MONOVALENT VACCINES Purified tetanus toxoid (adsorbed) supplanted the plain toxoid – higher and long lasting immunity response . Primary course of immunization – 3 Dose. Each 0.5 ml , injected into arm given at intervals of 0,1,6 months. The longer the interval between two doses , better is the immune response BOOSTER DOSES :- After 1yr Older teenager and adults who have sustained injuries , especially puncture-type wounds , should receive booster.

19. PASSIVE IMMUNIZATION Temporary protection against tetanus can be provided by by an injection of human tetanus hyperimmunoglobulin The dose for all ages is 250 IU. Produce protective antibody level for atleast 4- 6 weeks . High risk of serum sickness. Longer passive protection compared to horse ATS 7- 10 days. It stimulates formation of antibodies to it , hence a person who has once received ATS tends to rapidly eliminate subsequent doses.

20. ACTIVE AND PASSIVE IMMUNIZATION In non immunized persons. A patient is given 1500 IU of ATS/250- 500 units of human Ig in one arm and 0.5 ml of adsorbed tetanus toxide into other arm/gluteal region. 6 weeks later ,0.5 ml of tetanus toxid. 1yr later ,0.5 ml of tetanus toxoid. The purpose of antitoxin is for immediate temporary protection and the purpose of toxoid is for long-lasting protection.

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