TETANUS

What is tetanus?
• -1st discovered by Hippocrates
• -serious infectious disease of the nervous system
not contagious

• -AKA “lockjaw”=(muscle stiffness usually involves the jaw)

• -always serious disease
Clostridium tetani
• Causative agent
• Anearobic gram-positive, spore forming bacteria.
• Spores may found in soil,& animal feces.
• Organism is sensitive to heat, and cannot survive in the
presence of oxygen.
• produces two exotoxins, tetanolysin and
tetanospasmin.
Predisposing factors
• Newborns whose method of delivery and umbilical cord
are not septic.
• Following surgeries; infected wounds.
• Women are poorer risk than men, so they are the very
young and the very old.
Tetanus clinical features
• Incubation period: 8 days (range, 3-21 days)
• Three clinical forms: local (not common), Cephalic (rare),
generalized (most common).
• Generalized tetanus: “lockjaw” –difficulty swallowing,
muscle rigidity, spasms
• Spasms continue for 3-4 weeks; complete recovery may
take months.
Neonatal tetanus:
Generalized tetanus in newborn infant
Infant born w/out protective passive immunity
Estimated more than 257,000 deaths worldwide in 2000-
2003
Incubation period
• The incubation period ranges from 3 to 21 days, usually
about 8 days. In general the further the injury site is from
the CNS, the longer the incubation period. The shorter the
incubation period, the higher the chance of death. In
neonatal tetanus, symptoms usually appear from 4 to 14
days after birth, averaging about 7 days.
Manifestation/ indication/ appearance
1. “Lockjaw”
2. The lips bulge, swell, and extend beyond, other corner
of the mouth are drawn out of shape , giving rise to the
sardonic grin (risus sardonicus). Heightened by
simultaneous elevation of the eyebrows and wrinkling of
the forehead , the eyes remain partially closed.
3. (opisthotonos) .
4. Slightest stimulation of the patient causes frightful
convulsions and causes unbearable pain .
Mode of transmission
• Break in skin integrity.
• Transmission is primarily by contaminated wounds
(apparent and inapparent). The wound may be major or
minor. In recent years, however, a higher proportion of
patients had minor wounds, probably because severe
wounds are more likely to be properly managed. Tetanus
may follow elective surgery, burns, deep puncture
wounds, crush wounds, otitis media (ear infections),
dental infection, animal bites, abortion, and pregnancy.
Management
A. Prevention
Active immunization with tetanus toxoid.

Tetanus toxoid for non-preggy women

1st dose given anytime -0.5 ml
2nd dose after 1 month Antitoxin is used for the treatment of
3rd dose after 6 month clinical tetanus and for passive
immunization/prophylaxis in recently
4th dose after 1 year wounded individuals.
th
5 dose after another
Tetanus Toxoid
Characteristics
• Tetanus toxoid was first produced in 1924, and tetanus
toxoid immunizations were used extensively in the armed
services during World War II.
• Tetanus toxoid consists of a formaldehyde-treated toxin.
The toxoid is standardized for potency in animal tests
according to Food and Drug Administration (FDA)
regulations.
• Tetanus toxoid is available as a single-antigen
preparation, combined with diphtheria toxoid as pediatric
diphtheria-tetanus toxoid (DT) or adult tetanus-diphtheria
(Td).
Control
• All wounds should be cleaned. Necrotic tissue and foreign
material should be removed.
• Tetanus immune globulin (TIG) is recommended for
persons with tetanus. TIG can only help remove unbound
tetanus toxin.
• All materials contaminated with secretions should be
securely wrapped in paper and burned.
Treatment
• Neutralized the toxin give skin test first.
• Give antibiotic/penicillin 1hr before meals to kill the
microorganism.
• Take muscle relaxants (Robaxin, Robaisal,) , Sedatives
(Valium), Tanquilizers – Thorazers
• Tracheostomy in needed.
- to keep the airway from closing prematurely and to
enable the physician to take further measures, if necessary,
to ensure that the patient has a patent
-the insertion of a short stationary tube into the trachea
Thank you for listening!!! 

Reporter: Theresita Mae Bayarcal