TETANUS

Diambil dari materi DR.I.SELVARAJ

I.R.M.S
B.SC.,M.B.B.S.,(M.D)., D.P.H.,D.I.H.,PGCH&FW/NIHFW,New
Delhi

Sr.D.M.O/S.RAILWAY (On study leave)

Indian Railway Medical service

C. tetani: key characteristics

Large, spore-forming, motile, obligate anaerobic bacillus (see
below).
Ferments: proteins or amino acids.
Produces: acetic acid, fatty acids, NH3, CO2, H2, and a strong
exotoxin.
Tetanospasmin, a powerful neurotoxin.

TETANUS
Tetanus is an acute,often fatal,disease

caused by an exotoxin produced by the

bacterium Clostridium tetani.
Prevented by immunization with tetanus
toxoid.
It is characterized by generalized rigidity and
convulsive spasms of skeletal muscles.
The muscle stiffness usually involves the jaw
(lockjaw) and neck and then becomes
generalized.

SYMPTOMS & SIGNS

An
acute,
potentially
deadly,
systemic
infection
characterized by painful involuntary contraction of skeletal
muscles.
Other symptoms include
Febrile (feverish), irritability, heavy sweating
A stiff neck, a tight jaw (lockjaw)
Facial muscle spasms (risus sardonicus) and difficulty

swallowing

TETANUS SYMPTOMS &

SIGNS

Photo Courtesy of U.S. Centers for Disease

Control and Prevention

Courtesy: Google image on tetanus

CEPHALIC TETANUS : A Rare Form of Localized Teta

Courtesy : Google image on tetanus)

Newborn
showing risus
sardonicus and
generalized
spasticity

Courtesy : Google Image on tetanus

Occurrence: Tetanus occurs worldwide but is most frequently

encountered in densely populated regions in hot,damp climates
with soil rich in organic matter.
Reservoir:Organisms are found primarily in the soil and
intestinal tracts of animals and humans.
Mode of Transmission:Transmission is primarily by
contaminated wounds,Tissue injury( surgery,burns,deep
puncture wounds,crush wounds,Otitis media ,dental
infection,animal bites, abortion,and pregnancy).
Communicability
Tetanus is not contagious from person to person.It is the only
vaccine-preventable disease that is infectious but not contagious.
Temporal pattern:Peak in winter and summer season
Incubation Period: 8 DAYS ( 3-21 DAYS)

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
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

Diagnosis Of Tetanus
Clinically it is confirmed by
noticing the following features:
1.
2.
3.

4.

Risus sardonicus or fixed sneer.

Lock jaw.
Opisthotonus (extension of lower
extremities, flexion of upper extremities
and arching of the back. The examiners
hand can be passed under the back of the
patient when he lies on the bed in supine
position.)
Neck rigidity

Type of Tetanus
Traumatic tetanus
Puerperal tetanus
Otogenic tetanus
Idiopathic tetanus
Tetanus Neonatorum

Local tetanus is an uncommon form of the disease,in which patients have

persistent contraction of muscles in the same anatomic area as the injury.
Local tetanus may precede the onset of generalized
tetanus but is generally milder.Only about 1%of cases are
fatal.
Cephalic
tetanus
is
a
rare
form
of
the
disease,occasionally occurring with otitis media (ear
infections)in which C.tetani is present in the flora of the
middle ear,or following injuries to the head.There is
involvement of the cranial nerves,especially in the facial
area.
The most common type (about 80%)of reported tetanus is
generalized tetanus .The disease usually presents with a
descending pattern.

Three Objectives of
Management of Tetanus
1. To provide supportive care until the

tetanospasmin that is fixed in tissue has

been metabolized
2. To neutralize circulating toxin
3. To remove the source of tetanospasmin.

The rating scale for the severity and the prognosis of tetanus is described below.
Score 1 point for each of the following:
Incubation period less than 7 days
Period of onset less than 48 hours
Acquired from burns, surgical wounds, compound fractures, or septic
abortion
Narcotic addiction
Generalized tetanus
Temperature greater than 104F (40C)
Tachycardia greater than 120 beats per minute (>150 beats per min in
neonates)
Total score indicates the severity and the prognosis as follows:
Score of 0-1 indicates mild severity with less than a 10% mortality
rate.
Score of 2-3 indicates moderate severity with a 10-20% mortality rate.
Score of 4 indicates severe tetanus with a 20-40% mortality rate.
Score of 5-6 indicates very severe tetanus with greater than a 50%
mortality rate. (http://www.emedicine.com/ped/topic3038.htm)
Phillips, Dakar,. Udwadia Score

PREVENTION

Spores are extremely stable,although

immersion in boiling water for 15 minutes
kills most spores. Exposure to saturated
steam under 15 lbs.of pressure for 15-20
minutes at 121c is highly effective against
spores . Sterilization by dry heat is slower
than by moist heat (1 -3 hrs at 160 C),but
it is also effective against spores. Ethylene
oxide sterilization is also sporocidal .

Fumigation
Sterilization of operation theatre
500 ml of formaline, 200gms of

Pot.permanganate/30 cu.meters of space

All windows and doors are closed except
one
Fissures between the panels of the doors
and windows are closed with adhesive tape
After 12 hours the doors and windows are
opened and the theatre is aired for 24
hours before decommissioning it

Active Immunization
Passive Immunization
Active and passive

Immunization
Antibiotics

TETANUS TOXOID
Tetanus toxoid was developed by Descombey in

1924,
Tetanus toxoid immunizations were used
extensively in the armed services during World War
II.
Tetanus toxoid consists of a formaldehyde-treated
toxin.
There are two types of toxoid available adsorbed
(aluminum salt precipitated)toxoid and fluid toxoid.
Although the rates of seroconversion are about
equal,the adsorbed toxoid is preferred because the
antitoxin response reaches higher titers and is
longer lasting than that following the fluid toxoid.

Active Immunization
1st dose
2nd dose
3rd dose
1st booster
2nd booster
3rd booster

6th week
10th week
14th week
18th month
6th year
10th year

Passive Immunization
1. ATS(equine) Ig- 1500

IU/s.c after sensitivity test

(or)
2. ATS(human) Ig- 250-500
IU, no anaphylactic shock,
very safe and costly.

Persons Seven Years of Age or Older Who

Have Not Been Immunized

Immunization requires at least three doses of

Td.
1st dose should be administered on the First
visit
2nd dose 4 8 weeks after the first dose of Td
and 3rd dose after 6 months of the second
Td.
A booster dose of Td should be repeated
every 10 years throughout life

TREATMENT
Antitoxin (tetanus immune globulin) should be

administered immediately. This will inactivate toxins

in the blood.
Wounds should be debrided to remove dead tissue or
foreign bodies.
Antibiotics should be given to inhibit growth of C.
tetani.
A tetanus toxoid booster immunization should be
given to patients who have not received one within
the last 5 years.
If spasms occur, antispasmodic drugs should be used
and respiration maintained by a breathing apparatus
if necessary.

REFERENCE
http://www.medindia.net/health_statistics/diseases/

tetanusTetanus J J Farrara b, L M Yenc, T Cookd, N

Fairweathere, N Binhc, J Parrya b, C M Parrya b
http://www.who.int/immunization_monitoring/diseas
es/Tetanus_map_cases.jpg
Txt book of preventive and social medicine 18 th
edition by K.PARK
Text book of community medicine by T. Bhaskar Rao
Management and Prevention of Tetanus
Richard F.Edlich,MD PhD,?Lisa G..Hill,?Chandra
A..Mahler, ary Jude Cox,MD,?Daniel G..Becker
MD,?Jed H..Horowitz,MD 4 Larry S.Nichter MD MS,4
Marcus L.Martin,MD 5 &William C.Lineweaver MD6
. www.rxlist.com/cgi/generic/tettoxpi.htm - 22k
. Mansons Tropical diseases 21 st edition

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