TETANUS

 Aka “Dhanustankar” & Lock Jaw

 Tetanus is a serious bacterial disease caused by a toxin that leads to stiffness of your jaw
muscles and other muscles. Tetanus can cause severe muscle spasms, make breathing difficult
and, ultimately, threaten your life. Spores of the tetanus bacteria, Clostridium tetani, usually are
found in the soil, but can occur virtually anywhere. If deposited in a wound, the bacteria can
produce a toxin that interferes with the nerves controlling your muscles. Treatment for tetanus
is available, but the process is lengthy and not uniformly effective. Tetanus may be fatal despite
treatment. The best defense against tetanus is preventing it by getting a tetanus shot and by
properly caring for wounds. It is characterized by painful muscular rigidity primarily involving
Masseter and neck muscles.

CAUSATIVE AGENT/ETIOLOGY: Clostridium tetani, tetanus bacillus

(Anaerobic, Gram positive, Spore forming bacillus)

MODE OF TRANSMISSION: Contamination and Contact, Birth, usually occurs through contamination of
the unhealed stump of the umbilical cord
INCUBATION PERIOD: 5-10 days; 3 Days to 3 Weeks (Average 8 Days)
TYPES OF TETANUS

 Generalized tetatus - severe form affecting the body's muscles.

 Localized tetanus - milder form affecting only a local muscle group.
 Cephalic tetanus - rare form caught from head injury or ear infection.
 Neonatal tetanus
 Physiological tetanus - generalized muscle spasms
PREDISPOSING FACTORS
 Age: Neonates, All Ages
 Rural Areas
 Rainy Season
 Burn, crush injury
 Unclean Birth and Surrounding
 Chronic Supurative Otitis Media
 Unimmunized Mother

4 Requirements for Disease:

 Presence of Bacteria / Spores
 Tissue Injury, Wound
 Favorable Wound Condition for Bacterial Growth
 Susceptible Host

CLINICAL MANIFESTATIONS
 Difficulty in Sucking
 Excessive Cry
 Irritability
 Nuchal rigidity
 Progressive Stiffness- Neck and Jaw
 Trismus (Difficulty in Opening Mouth)
 Risus Sardonicus (Grinning face)
 Opisthotonus Position
 Board like rigidity- Abdomen, Limbs
 Difficulty in Swallowing
 Increased Responses to Stimuli- Visual, Auditory, Tactile
 Pooling of Secretion- Oral Cavity
 Respiratory Arrest
  Pneumonia
 Constipation
 Others: Pain, Anxious Face, Anxiety, Increased Pulse and Sweating.
Mortality
 Neonate : 60% - 70%,
 Children : 30% - 45%

DIAGNOSTIC PROCEDURES
 Doctors diagnose tetanus based on a physical exam and the signs and symptoms of muscle
spasms, stiffness and pain. Laboratory tests generally aren't helpful for diagnosing tetanus.

ANATOMY & PHYSIOLOGY

In human anatomy, the masseter is one of the muscles of mastication. In the animal
kingdom, it is particularly powerful in herbivores to facilitate chewing of plant matter. The
masseter is a thick, somewhat quadrilateral muscle, consisting of two parts, superficial and
deep. The fibers of the two portions are continuous at their insertion. The masseter muscle
is sometimes the target of plastic jaw reduction surgery.

Superficial: The superficial portion, the larger, arises by a thick, tendinous aponeurosis from
the zygomatic process of the maxilla, and from the anterior two-thirds of the lower border of
the zygomatic arch. Its fibers pass downward and backward, to be inserted into the angle
and lower half of the lateral surface of the ramus mandible.
 Deep: The deep portion is much smaller, and more muscular in texture. It arises from the
posterior 3rd of the lower border and from the whole of the medial surface of the zygomatic
arch. Its fibers pass downward and forward, to be inserted into the upper half of the ramus
and the lateral surface of the coronoid process of the mandible. The deep portion of the
muscle is partly concealed, in front, by the superficial portion; behind, it is covered by the
parotid gland.

Innervation: Along with the other three muscles of mastication (temporalis, medial
pterygoid and lateral pterygoid), the masseter is innervated by the mandibular division of
the trigeminal nerve.

COMPLICATIONS
 pneumonia
 instability in the autonomic nervous system
 constriction of airways
 Asphyxia
 Exhaustion
 Death
PROGNOSIS
 Localized tetanus can be mild or progress to generalized tetanus which is dangerous and can
be fatal.
TREATMENT
1. HTIG (Human tetanus Immunoglobulin): 3000-6000 units/IM
2. ATS (Anti tetanus Serum): 5000-10000 units/ ½ IV ½ IM
3. Antibiotics: Inj. Penicillin G 200000/kg in 4 divided Doses for 2 weeks
4. Sedation: Inj. Diazapam 0.1 – 0.2 mg/kg/ 4 hourly
Inj. Medazolam 1mg/ kg
5. Neuromuscular Blocking Agents:
Inj. Pancuronium Bromide
6. Supportive Care:
 Isolation, Avoid Stimulation
 Vital monitoring( Respiratory Rate, SPO2)
 Oral Suctioning
 Keep Nil Per Oral, Feed after 5 days
  Place Nasogastri tube,
 Hydration

PREVENTION & CONTROL

 Immunize mother - Tetanus toxoid – to avoid contamination by organism
 Prevent multiplication/pathogenicity thru:
1. Active immunization (DPT)
2. Passive immunization (anti toxin)
- ATS/HTIG
 Antibiotic prophylactic therapy
 Safe delivery
 Cord Care

NURSING RESPONSIBILITIES/INTERVENTIONS
 Provide proper cord care for the neonate
 Proper wound care & systemic care
 Maintain adequate airway
 Give TIG, antimicrobials & tetanus toxoid according to immune status of the patient
 Monitor vital signs especially respirations
 Ensure proper hydration of the patient