Tetanus (Lock Jaw) Tetanus (Lock Jaw)
It is an acute disease that result from the contamination of the wound by the spores Punctures, lacerated and contused wound provide the better germination ground for the anaerobic organism to produce the toxin, than compared to clean – cut open wound
Causative Agent
The causative agent of the disease is “Exotoxin of the clostridium tetani” The clostridium tetani is Gram +ve, anaerobes spore bearing bacilli (Rod or drum stick appearance)
Host
Man is the host of the disease Age: 5 – 40 years (More predispose to the trauma and accident) Gender: The males are at most risk than female Occupation: Agricultural worker
Immunity:No age is immune unless protected by the previous immunization
Reservoir Of The Infection
Domestic animal especially the horse and the man himself
Faces of the man and animal contaminated the soil, which is the immediate source
Mode Of The Transmission
Direct Transmission: : Direct close free contact with the infectious persons via a) Hand Shaking b) Embracing c) Sleeping Together
Indirect Transmission: It is via using the non – living things such as Clothes Towels (Fomite borne)
Period Of The Incubation & Communicability
Incubation Period: Incubation period vary from the 4 days to 21 – days or more
Average is one to three weeks
Short incubation period is more serious and fatal
It is not communicable from man to man
Susceptibility & Resistance
Old & Young Male & Female are all susceptible to the infection
Active immunization with the tetanus toxoid provide the immunity and the risk of the tetanus following the minor injuries is reduced
Passive immunization with the antitoxin is very useful
Environmental Factors That favor The disease transmission
a) Unhygienic customs and habits such as application of the dust or the animal dung to the wound b) Unhygienic delivery practice, using the unstrelized, instrument for cutting the umbilical cord c) Ignorance Of The Infection d) Lack Of The Primary Health care services
Types Of Tetanus
1) Traumatic Tetanus
2) Puerperal Tetanus
3) Otogenic Tetanus
4) Tetanus Neonatorum
5) Idiopathic tetanus
Tetanus Neonatorum
The tetanus neonatorum is occurs in the new borne babies Infant typically contact the disease at birth, when delivered in non – aseptic condition, especially when the umbilical cord is cut with the unclean instrument Also when the umbilical stump is dressed with ashes, soil or cow dung The first symptom is seen about the 7th day There is progressive difficulty in suckling & excessive crying Body gets fits which are generalized, opisthotonous, There is also development of the cyanosis and apeanic spell may also occurs
Clinical Feature
1) Onset is usually insidious, heralded by stiffness of the muscles of the jaw, or neck 2) Difficulty in opening the mouth, (Trismus or lock jaw) 3) Difficulty in swallowing 4) Spasm of the cheek muscles (Risus Sardonicus) 5) Opisthotonus develop 6) Sensorium remain unaltered 7) Apprehension present 8) Respiratory Obstruction & laryngiospasm 9) Cyanosis 10) Asphyxia 11) Stimuli may cause the generalized spasm of the several min.
Differential Diagnosis
Local infection of the jaw or throat
Meningitis
Encephalitis
Rabies
Stry chnine poisoning
Low serum calcium level
Complication
1) Pulmonary complication may follow aspiration
2) Severe seizure may gives muscular haematoma and rib fracture
3) Fluid & Electrolytes complication may occurs due to deficient intake of the fluid
4) Disturbance of the autonomic control that may lead to variation in pulses, fluctuation in BP & variation in temperature
Pulmonary Complication
Aspiration Pneumonia Atelectasis Pneumothorax Mediastinal Emphysema Apnea Caryngiospasm
Prognosis
The prognosis is depend upon the Severity Of The Disease Age Of The Patient Facilities for the intensive care The high mortality is in neonatal tetanus Over 60% mortality is lowest between 10 – 20 years age group (I.e. less than 20%)
Prevention
Active Immunization
Passive Immunization
Passive – Active Immunization
Active Immunization
It stimulate the production of the antitoxins Preparation Available 1) Combined Vaccine DPT: 2) Monovalent Vaccine (plan or fluid for mal toxoid or tetanus vaccine adsorbed) Two doses of the tetanus vaccine adsorbed each of 0.5 ml injected in to the arm given at 1 – 2 month interval is given The first booster dose is given a years after the initial dose Second booster dose at 5 – years after the 1st booster dose These providing the much better response
Passive Immunization
This can be achieved by the injection TIG: (Humane tetanus hyperimmunoglobulin)
Anti – tetanus serum (ATS)
TIG
1) It is best prophylactic to use
2) Dose is 250 – 500 IU for all age
3) It does not cause the serum reaction
4) Gives a long passive protection of up to 30 – days or more
ATS
a) It is prepared from the horse serum
b) Dose is 1500 IU is given S/C after the test dose
c) Gives passive protection for about 7 – 10 days
d) Rapidly excreted from the body
e) Cause the sensitivity reaction
Active & Passive Immunization
Simultaneous active and passive immunization is given in non – immune person The purpose of the anti – toxin is for immediate temporary protection The purpose of the toxoid is for long – lasting protection
Prophylaxis
Creating awareness by education among the people of the danger of the injury and value of the immunization (active or passive or both) is the first step in the prevention Local treatment of the wound is insignificant but an important in preventing the disease All necrotic tissues debris, foreign bodies must be removed All pregnant women should be immunized with tetanus toxoid
Prevention
Thus immunization against the tetanus is most effective method of the prevention Tetanus virtually never occurs in fully immunized person Immunization should be started shortly after the birth Booster should be given at school age and every 10 – years thereafter throughout life
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