Tetanus (lock jaw)

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  • 1. Tetanus (Lock Jaw)It is an acute disease that result from the contamination of thewound by the sporesPunctures, lacerated and contused wound provide the bettergermination ground for the anaerobic organism to producethe toxin, than compared to clean cut open wound

2. Causative AgentThe causative agent of the disease is Exotoxin of theclostridium tetaniThe clostridium tetani isGram +ve, anaerobes spore bearing bacilli (Rod or drum stickappearance) 3. HostMan is the host of the diseaseAge: 5 40 years (More predispose to the trauma andaccident)Gender: The males are at most risk than femaleOccupation: Agricultural workerImmunity:No age is immune unless protected by the previousimmunization 4. Reservoir Of The InfectionDomestic animal especially the horse and the man himselfFaces of the man and animal contaminated the soil, which isthe immediate source 5. Mode Of The TransmissionDirect Transmission:Direct close free contact with the infectious persons viaa) Hand Shakingb) Embracingc) Sleeping TogetherIndirect Transmission:It is via using the non living things such asClothesTowels (Fomite borne) 6. Period Of The Incubation &CommunicabilityIncubation Period:Incubation period vary from the 4 days to 21 days or moreAverage is one to three weeksShort incubation period is more serious and fatalIt is not communicable from man to man 7. Susceptibility & ResistanceOld & YoungMale & Female are all susceptible to the infectionActive immunization with the tetanus toxoid provide theimmunity and the risk of the tetanus following the minorinjuries is reducedPassive immunization with the antitoxin is very useful 8. Environmental Factors Thatfavor The disease transmissiona) Unhygienic customs and habits such as application of thedust or the animal dung to the woundb) Unhygienic delivery practice, using the unstrelized,instrument for cutting the umbilical cordc) Ignorance Of The Infectiond) Lack Of The Primary Health care services 9. Types Of Tetanus1) Traumatic Tetanus2) Puerperal Tetanus3) Otogenic Tetanus4) Tetanus Neonatorum5) Idiopathic tetanus 10. Tetanus NeonatorumThe tetanus neonatorum is occurs in the new borne babiesInfant typically contact the disease at birth, when delivered innon aseptic condition, especially when the umbilical cord iscut with the unclean instrumentAlso when the umbilical stump is dressed with ashes, soil orcow dungThe first symptom is seen about the 7th dayThere is progressive difficulty in suckling & excessive cryingBody gets fits which are generalized, opisthotonous,There is also development of the cyanosis and apeanic spellmay also occurs 11. Clinical Feature1) Onset is usually insidious, heralded by stiffness of themuscles of the jaw, or neck2) Difficulty in opening the mouth, (Trismus or lock jaw)3) Difficulty in swallowing4) Spasm of the cheek muscles (Risus Sardonicus)5) Opisthotonus develop6) Sensorium remain unaltered7) Apprehension present8) Respiratory Obstruction & laryngiospasm9) Cyanosis10) Asphyxia11) Stimuli may cause the generalized spasm of the severalmin. 12. Differential DiagnosisLocal infection of the jaw or throatMeningitisEncephalitisRabiesStry chnine poisoningLow serum calcium level 13. Complication1) Pulmonary complication may follow aspiration2) Severe seizure may gives muscular haematoma and rib fracture3) Fluid & Electrolytes complication may occurs due to deficient intake of the fluid4) Disturbance of the autonomic control that may lead to variation in pulses, fluctuation in BP & variation in temperature 14. Pulmonary ComplicationAspiration PneumoniaAtelectasisPneumothoraxMediastinal EmphysemaApneaCaryngiospasm 15. PrognosisThe prognosis is depend upon theSeverity Of The DiseaseAge Of The PatientFacilities for the intensive careThe high mortality is in neonatal tetanusOver 60% mortality is lowest between 10 20 years agegroup (I.e. less than 20%) 16. PreventionActive ImmunizationPassive ImmunizationPassive Active Immunization 17. Active ImmunizationIt stimulate the production of the antitoxinsPreparation Available1) Combined Vaccine DPT:2) Monovalent Vaccine (plan or fluid for mal toxoid ortetanus vaccine adsorbed)Two doses of the tetanus vaccine adsorbed each of 0.5 mlinjected in to the arm given at 1 2 month interval is givenThe first booster dose is given a years after the initial doseSecond booster dose at 5 years after the 1st booster doseThese providing the much better response 18. Passive ImmunizationThis can be achieved by the injectionTIG: (Humane tetanus hyperimmunoglobulin)Anti tetanus serum (ATS) 19. TIG1) It is best prophylactic to use2) Dose is 250 500 IU for all age3) It does not cause the serum reaction4) Gives a long passive protection of up to 30 days or more 20. ATSa) It is prepared from the horse serumb) Dose is 1500 IU is given S/C after the test dosec) Gives passive protection for about 7 10 daysd) Rapidly excreted from the bodye) Cause the sensitivity reaction 21. Active & Passive ImmunizationSimultaneous active and passive immunization is given in non immune personThe purpose of the anti toxin is for immediate temporaryprotectionThe purpose of the toxoid is for long lasting protection 22. ProphylaxisCreating awareness by education among the people of thedanger of the injury and value of the immunization (active orpassive or both) is the first step in the preventionLocal treatment of the wound is insignificant but animportant in preventing the diseaseAll necrotic tissues debris, foreign bodies must be removedAll pregnant women should be immunized with tetanustoxoid 23. PreventionThus immunization against the tetanus is most effectivemethod of the preventionTetanus virtually never occurs in fully immunized personImmunization should be started shortly after the birthBooster should be given at school age and every 10 yearsthereafter throughout life