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