Tetanus Lockjaw

1
? ? ? Tetanus ( Lockjaw )

• Definition
• Introduction
• Pathogen, Reservoir, Mode of transmission
• Incubation period
• primary immunization and scheduled boosters
• Side Effects and Adverse Reactions to DTP
  Immunization
• Symptoms
• Diagnosis
• Treatment
• Complications
• Prognosis

2
? ? ? Tetanus ( Lockjaw )

• Definition
• Introduction
• Pathogen, Reservoir, Mode of transmission
• Incubation period
• primary immunization and scheduled boosters

• Side Effects and Adverse Reactions to DTP
  Immunization
• Symptoms
• Diagnosis
• Treatment
• Complications
• Prognosis

3
Definition

• A disease caused by the toxin of the bacterium
  Clostridium tetani that affects the central
  nervous system, sometimes resulting in death.

4
Introduction

• Tetanus is caused by a germ that enters the body
  through a cut or wound.
• In the late 1940's, tetanus toxoid was introduced
  into routine childhood immunization.
• mortality among those who acquire the disease
  remains high
• elderly patients are particularly susceptible to
  tetanus and its complications

5
Introduction

• ? ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? 45 ? 1004 ? ? ? , ? ? ? ?
  ? ? ? ? ? , ? ? ? 61 ? ? ? ? ? ? ? 100 ? ? ? ,
• ? ? ? ? ? ? ? , ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
  , ? ? ? ? ? ? ? ? ? ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? , ? ? ?
  ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?

6
Pathogen

• Pathogen
• ? ? ? ? ? ( Clostridium tetani )
• ? ? ? ? ? Clostridium tetani ??slender(??)
  bacillus with terminal spore
• ? ? ? ? ? ? ? ? ? ? ( exotoxin ) ? ? ?
• ? ? ? ? ? ? ? ? ? 3090 ? ? , ? ? ? ? ? ? ? ? ?
  ?

7
Reservoir

• C. tetani? ? ? ? ? ? ? ? ? ( ? ? ? ? ) ? ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?

8
Mode of transmission (? ? ? ? )

• ? ? ? ? ? ? ? ( Spore ) ? ? ? ? ? ? ? , ? ? ? ? ?
  ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
  ? ? ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?

9
Causes, incidence, and risk factors

• Spores of the bacterium Clostridium tetani live
  in the soil and are distributed worldwide.
• In the spore form Clostridium tetani may remain
  dormant in the soil but infectious for periods
  longer than 40 years.
• Infection begins when the spores are introduced
  into an injury or wound.

10
Causes, incidence, and risk factors

• The spores germinate, releasing active bacteria
  that multiply, and produce a neurotoxin, called
  tetanospasmin.
• Tetanospasmin selectively blocks inhibitory nerve
  transmission from the spinal cord to the muscles,
  allowing the muscles to go into severe spasm.
• Spasmodic contractions may be so powerful that
  they tear the muscles or cause compression
  fractures of the vertebrae.

11
Incubation period

• The incubation period is 3 days to 3 weeks, with
  8 to 12 days as the average.
• In developing countries, tetanus frequently
  causes death in newborn infants when the
  umbilical stump becomes infected.

12
Incubation period (? ? ? )

• ? ? ? 3 ? 21 ?
• ? ? ? ? ? ? 14 ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? , ? ? ? ? ?
  ? ? ? ? ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?

13
primary immunization and scheduled boosters

• Tetanus is completely preventable by active
  tetanus immunization (vaccine).
• DPT shots (D diphtheria, P pertussis or
  whooping cough, and T tetanus).
• Boosters are given to teenagers and older adults
  as Td shots (adult tetanus and diphtheria) or
  singly as just tetanus.
• Immunization is considered to provide protection
  for ten years.

14
Susceptibility (? ? ? )

• ? ? ? ? ? ? ( Tetanus toxoid ) ? ? ? ? ? ? ? ? ?
  ? ? ? ? ? ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? (
  Tetanus immune globulin , TIG ) ? ? ? ? ( Tetanus
  antitoxin , TAT ) ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
  ? ? ? ? ? ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? , ? ? ? ? ? ? ? ? ,
  ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ( ? ? ? ? )

15
primary immunization and scheduled boosters

• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ( DPT ) ? ? ? ?
  ? ? ?
• ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? DT , ? ? ? ? ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? Td , ? ? ? ? ? ? ? ? ? ?
  ? ? ? ( ? ? ? ? ) ? ? ? ? ? ? ?

16
primary immunization and scheduled boosters

• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
  ? ? ? ? ? ? ? ? ? ( ? ? ? ) ? ? ? ? ? ? ? ? ? ? ?
  ? ? ? ? ? ?

17
DTP Immunization the Centers for Disease Control
and Prevention

• A child needs five DTP shots for complete
  protection.
• The first shot should be given at 2 months of
  age, and the second and third shots given within
  the child's first year(2,4,6M).
• The fourth shot is given at about 15 or 18
  months, and a fifth shot, or booster, is given
  when the child is about to enter school(4-6y/o).

18
Booster doses

• A booster dose of the adult formulated combined
  tetanus and diphtheria toxoids is recommended for
  all persons over 7 years of age.
• Normally the first booster dose is given 10 years
  after the last dose in the primary series
  (usually between 14 and 16 years of age), and
  then every 10 years thereafter.
• If a dose is given as part of wound management,
  the next booster dose is not needed for an
  additional 10 years.

19
WHO SHOULD NOT RECEIVE THE VACCINE

• Children with moderate or severe fever can be
  vaccinated as soon as they have recovered.
• Children with minor illness, such as a mild
  upper-respiratory infection with or without
  low-grade fever, can be vaccinated.

20
WHO SHOULD NOT RECEIVE THE VACCINE

• experienced difficulty in breathing following a
  previous dose of tetanus toxoid
• Persons on immunosuppressive therapies given for
  cancer or other treatments may not develop the
  same immune response as a normal person.

21
Side Effects and Adverse Reactions to DTP
Immunization

• Most children will get a slight fever and be
  cranky for a day or two after getting a DTP shot.
  
• Half of them will have a sore spot and some
  swelling where the shot was given.
• About once in 1,750 shots a child will have
  convulsions.
• These side effects are not long-lasting and have
  not been known to cause any permanent harm.

22
Symptoms

• spasms and tightening of the jaw muscle (hence
  the name lockjaw)
• stiffening of the neck and other muscles
• spasms of the neck and other muscles
• rigidity of the chest muscles
• rigidity of the abdominal muscles (abdominal
  rigidity)

23
Symptoms

• spasms and rigidity of the back muscles, often
  causing arching (opisthotonos)
• tetanic seizures (painful, powerful bursts of
  muscle contraction)
• irritability
• fever

24
Symptoms

• ? ? ? ? ? ? ? ? ? ? ( ? ? ? ? ? ? ? ? ? ? , ? ? ?
  ? ? ? ? )
• ? ? ? ? ? ? ? ? ? ? ? ? ? ( abdominal rigidity )
  ? ? ? ? ? ( spasm )
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ( opisthotonus
  ) ? ? ? ? ? ? ? ? ? ? ? ( risus sardonicus ) ? ?
  ? ?

25
Additional symptoms

• sweating, excessive
• swallowing difficulty
• hand or foot spasms
• drooling
• uncontrolled urination
• uncontrolled defecation

26
Diagnosis

• Diagnosis of tetanus is based on the history and
  physical findings that are characteristic of the
  disease.
• Diagnostic studies generally are of little value.
  
• Cultures of the wound site are negative for
  clostridia two-thirds of the time.

27
Diagnosis

• Diagnostic studies
• culture of the wound site
• tetanus antibody test
• other tests to rule-out meningitis, rabies,
  strychnine(????) poisoning or other diseases with
  similar symptoms

28
Treatment

• control and reverse the tetany with antitoxin
• remove and destroy the source of the toxin
• treat symptoms with supportive therapy

29
Treatment

• Persons who have wounds may need either the
  primary series, a booster dose, or no additional
  doses, depending on whether they previously have
  had tetanus toxoid.
• Tetanus toxoid can not act fast enough to give
  immunity to someone who has been wounded,
  particularly for those who are not completely
  vaccinated against tetanus.
• tetanus immune globulin (TIG) which can provide
  immediate immunity, and which may be given for
  tetanus- prone wounds.

30
Treatment

• Tetanus immune globulin is given to neutralize
  the toxin, tetanospasmin.
• Penicillin is given intravenously to kill the
  toxin-producing C. tetani, however, surgical
  removal of infected tissue may also be necessary.
  
• Muscle spasms can be treated with muscle
  relaxants such as diazepam.

31
Treatment

• Bedrest with a nonstimulating environment is also
  recommended (dim light, reduced noise, and stable
  temperature).
• Sedation may be necessary to keep the affected
  person quiet.
• Respiratory support with oxygen, endotracheal
  tube, and mechanical ventilation may necessary.

32
Management of tetanus involves

• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
• ? ? ? ? TIG 30006000 I.U. ? ? ? ? ? ? ? ? ? ? ?
  T A T ( ? ? ? ? ? ? ? ? ? ? ? ) ?
• ? ? ? ? Penicillin , ? ? 1014 ? ?

33
Management of tetanus involves

• ? ? ? ? ? ? ? ? ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? , ? ? ? ? ? ? ? ? ? ? ? ? ? ?
  ? ? ? ? ? ?
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?

34
Management of tetanus involves

• initial stabilization of the patient and
  protection of the airway
• prevention of tetanospasmin absorption by
  administration of human tetanus immune globulin
  3000-6000 IU
• eradication of Clostridium tetani with
  antimicrobial therapy (metronidazole 500 mg q8h).

35
Management of tetanus involves

• neuromuscular blocking agents such as pancuronium
  in patients requiring artificial ventilation, as
  well as
• benzodiazepines (midazolam 5-15 mg/h) for
  sedation and muscle relaxation.
• Autonomic dysfunction should be managed with
  beta-adrenergic blockers such as propranolol or
  labetalol

36
Complications

• airway obstruction
• respiratory arrest
• heart failure
• pneumonia
• fractures, vertebral

37
Complications

• vocal cords and/or spasms of the respiratory
  muscles
• fractures of the spine or long bones
• abnormal heartbeats
• generalized infection
• clotting in the blood vessels of the lung
• pneumonia
• coma, death

38
Prognosis

• The death rate is high in children and in the
  elderly.
• Wounds on the head or face seem to be more
  dangerous than those on the body.
• If the person survives the acute illness,
  recovery is generally complete.
• Uncorrected episodes of hypoxia (lack of oxygen)
  caused by muscle spasms in the larynx throat may
  lead to irreversible brain damage.

39
Prognosis

• The natural incidence and severity of tetanus
  varies greatly with social environment, season,
  climate and soil.
• Prognosis is influenced by age, source of
  infection and delay in treatment.