In the name of ALLAH the

Beneficent and Merciful

 TETANUS

•Introduction
•Causes
•Distribution
•Control
Presented by
Aatifa Mukhtar Chaudhry
Presented to
Sir Muhammad Aatif
Introduction
Tetanus is a serious,
acute condition that is
caused by infection
with a bacterium known
as ‘Clostridium tetani’.
 It is characterized by
general rigidity and
convulsions of skeletal
muscles.
 Also known as ‘lockjaw’
or ‘Trismus’ is the
inability to normally
open the mouth due to
prolonged contraction
of skeletal muscle
fibers. It involves the
trigeminal nerve.
Background
 1884
 1889
 1897
 1924
 Clostridium tetani is:
an obligate anaerobic
gram-positive
spore forming
no encapsulated
drumstick shaped bacillus

Features The spores are resistant to:

heat
desiccation
antiseptics
disinfectants
autoclaving
phenol & other chemicals
Exotoxins

 Tetnolysin
 Tetanospasmin
Incubation period
3 days-3 weeks
Average: 8 days
Signs and symptoms
Irritability
Restlessness
Loss of appetite
High fever
Convulsions
Drooling
Difficulty in swallowing
Soar throat
Chills
Extreme pain
 Causes
Clostridium tetani
•Gram positive
•Form endospores
•Obligate anaerobic bacterium
•Has flagella
•C. tetani's spores are resistant to heat and
most antiseptics
•In the presence of anaerobic (low oxygen)
conditions,
• the spores of Clostridium tetani will germinate.
Incubation
period

The incubation period between exposure to the bacteria in a contaminated wound and development of the initial symptoms of tetainus ranges from two days to two months, but it's commonly within 14 days of injury.
•

Mode of transmission
1) Deep Puncture wounds and cuts by nails and knives (“rusty nail”)
2) Animal bites
3) Tooth infections
4) Ear infections
5) Pinprick/scratch
6) Severe burns
7) Not safe tattoos and piercing
8)Tetanus can be found in
soil and dust; it can enter
through breaks in the skin
9) Tetanus spores are resistant to heat, therefore it
survives standard sterilization and antiseptics
commonly used to treat wounds.
10) Once Tetanus find a hospitable environment that
lacks oxygen, the spores germinate and release
bacteria that attack nerves.

*Tetanus is not spread from person to person*

Symptoms
 The further the injury site is  Bacteria produce toxin which
from the central nervous system, spreads to body, resulting in
the longer it will take for it to painful muscle spasms (in
show symptoms. neck, arms, legs, stomach etc)
 It could take up to three weeks  Mostly in children, but could
for the first symptoms to appear. occur to adults, the spasms
  can lead to fractures.
 Headaches, crankiness, spasms
 Fever
of the jaw muscle (therefore  Sweating
Tetanus is also known as “Lock
 Elevated blood pressure
Jaw”)
 Spasms of the jaw muscle is one  Rapid heart rate

of the first symptoms for  Frequent spasms, which can

Tetanus. last for several minutes
Types of tetanus
 Generalized tetanus
 Localized tetanus

o Cephalic tetanus
o Neonatal tetanus
o

Generalized tetanus
All of the toxin cannot be absorbed by local nerve endings; therefore, it passes into the blood and lymph with subsequent absorption by motor nerves
Sign includes:
Trismus (lockjaw)
Facial spasm
Stiffness of neck
Difficulty in swallowing
Rigidity of pectoral muscles
Neonatal tetanus
It is a form of generalized tetanus that
occurs in newborns
Infants who have not acquired passive
immunity. It usually occurs through
infection of the unhealed umbilical stump
Neonatal tetanus is common in many
developing countries It is responsible for
about 14% (215,000) of all neonatal deaths,
but is very rare in developed countries
Localized tetanus
It is an uncommon form of the disease,
in which patients have persistent
contraction of muscles in the same
anatomic area as the injury
It presents with a ascending pattern
Toxins travel along the neural route
(peripheral nerves), causing a disease
confined to the extremities
It is seen most often in inadequately
immunized persons
The contractions may persist for many
weeks before gradually subsiding but it
may precede the onset of generalized
tetanus
It only about 1% of cases are fatal
Cephalic tetanus


It is a form of the localized

tetanus
Occasionally occurring
with otitis media (ear
infections) in which
C. tetani is present in the
flora of the middle ear
There is involvement of
the cranial nerves,
especially in the facial area
Complication in tetanus

1.Respiratory problems.
2.Bone fractures
3.Hypertension
4. Nosocomial infections
5.Aspiration pneumonia
Pathogenesis
 Medical
Examination

When to call the doctor

 
When to go to the hospital

Exams and Tests

When to call the
doctor

   Call your doctor if you

have questions regarding
whether your tetanus
immunization is current.
 If you have a wound, you

should seek medical

attention. If you are not
immunized or have not
kept up your booster
every 10 years, any
open wound is at risk of
developing tetanus.
 
When to go to the hospital

 Call your doctor and follow his or her

advice regarding whether or not you
should seek treatment in a hospital's
emergency department after an injury or
wound.
 If the wound is large, crushed, or heavily

contaminated, you should go to the

nearest hospital's emergency department
for evaluation.
 If you have a recent injury and are

starting to experience muscle cramps or

spasms at or near the injury, you should
go to a hospital's emergency department.
 If you have trouble swallowing or have

muscle spasms in the facial muscles, go

to the emergency department for
treatment
 
 
Examination and Tests

The diagnosis of
generalized tetanus
is usually made by:
 observing the

clinical presentation

 laboratory tests
Tetanus Treatment
 Self-Care at Home Medical Treatment
 Any wound that results in a  antibiotics (for example,

break in the skin should be metronidazole) to kill the bacteria

cleaned with soap and running  antitoxin to neutralize the toxin
water.  wound cleansing to remove any
 All open wounds are at risk to
obvious bacteria collections
develop tetanus. Wounds from (abscesses) or foreign bodies
objects outdoors or crush  pain medicine as needed

injuries are at higher risk.  sedatives such as diazepam (Valium)

 Apply a clean and dry cloth to
to control muscle spasms
stop or minimize bleeding.  ventilator support to help with
 Apply direct pressure to the
breathing in the event of spasms of
site of bleeding to help the vocal cords or the respiratory
minimize blood loss muscles
 IV rehydration because, as muscles

spasm constantly, increased metabolic

demands are placed on the body
Follow up
People who recover from
tetnus have no - long lasting
effects.
Active

Prevention
Active immunization ("tetanus shots") plays an essential role in
preventing tetanus.
There are two main vaccines recommended by the U.S. Centers
for Disease Control and Prevention (CDC).
For pediatric populations, DTaP (diphtheria, tetanus and
acellular pertussis combination vaccine) is used.
For non-immunized adults and booster shots, Tdap (tetanus
and reduced amounts of diphtheria and acellular pertussis
combination vaccine) is recommended.
precautions should be taken to avoid stepping on nails by wearing
shoes.
Cleaning If a penetrating wound should occur, it should be thoroughly
cleansed with soap and water and medical attention should be sought.
passive immunization can be administered in selected cases
(with specialized immunoglobulin).
schedule for active
immunization (tetanus shots)
All children should be immunized against
tetanus by receiving a series of five
DTaP vaccinations which generally are
started at 2 months of age and completed
at approximately 5 years of age.
Booster vaccination is recommended at 11
years of age with Tdap.
Follow-up booster vaccination is
recommended every 10 years thereafter.
While a 10-year period of protection exists
after the basic childhood series is
completed, should a potentially
contaminated wound occur, an "early"
booster may be given in selected cases and
the 10 years "clock" reset
Vaccine (shot)
complications
 Seizures
 Coma
 brain damage
 nerve problems,
 severe allergic

reactions
side effects of tetanus
immunization

Side effects of tetanus

immunization occur in
approximately 25% of vaccine
recipients.
The most frequent side effects are
usually quite mild (and familiar)
and include soreness, swelling
and/or redness at the site of the
injection.

 
Vaccine side effect
Side effects of tetanus
immunization occur in
approximately 25% of vaccine
recipients.
The most frequent side effects
are usually quite mild (and
familiar) and include soreness,
swelling and/or redness at the
site of the injection
passive immunization
(by way of specialized immunoglobulin)
In individuals who exhibit the
early symptoms of tetanus or
in those whose immunization
status is unknown or
significantly out of date, the
tetanus immunoglobulin (TIG)
is given into the muscle
surrounding the wound with
the remainder of the dose
given into the buttocks
•

Distribution
Distribution of patients according to their nationality

*Tetanus is still a common clinical entity, especially in under developed

countries.
 

 
In recent years, tetanus has
been fatal in approximately
11% of reported cases. Cases
most likely to be fatal are
those occurring in persons
age >60 years (18%, and
unvaccinated persons (22%).
In about 20% of tetanus
deaths, no obvious pathology
is identified and death is
attributed to the direct
effects of tetanus toxin.

 
Reasons
 most productive
age
 less effective

immunization
program in country.
Case reported and
death rate
Age distribution of
reported cases
 
25,000 infants die of tetanus every year in Pakistan.

 Pakistan accordingly
ranks 3rd in the world
for neonatal tetanus
 Pakistan is among nine

Asian countries which

have failed to control
neonatal tetanus, a
major cause of infant
mortality in the
country
25 percent of the infant
mortalityin Pakistan.

In big cities, such as Karachi and Lahore, every month 100 children die of the disease. Of them, 90% are newborn delivered at home.

This is because of the fact that

proper delivery care is only
30% in Pakistan.
Five girls were brought to the NICH from
Memon Goth, Malir, who developed
tetanus following traditional ear piercing
practice. Three of them died.
Cases reported after
disasters
 At least 22 victims
of the monster
earthquake in
Pakistan (Oct 2005)
have died of
tetanus, according
to the World Health
Organization (WHO)
Conclusion
Although tetanus is a
preventable infectious disease,
its prevalence is still high and
it remains a difficult to treat disease with a substantial morbidity
and mortality rate. Furthermore, to reduce the incidence of
tetanus more efforts are needed to provide appropriate wound
management as well as vaccination to the patients.
Tetanus still carries high morbidity and mortality rate despite the
available advanced management facilities including ICU care.
Questioning