Tetanus is an acute, sometimes fatal, disease of the central nervous system, caused by a soluble exotoxin of bacteria clostridium tetani, which usually enters the body through an open wound. Tetanus bacteria live in soil and manure, but also can be found in the human intestine, animal saliva, and other places:
- Tetanus occurs more often in warmer climates or during the warmer months.
- Tetanus is very uncommon in the U.S. due to widespread immunization.
Epidemiology of Tetanus
Agent
Clostridium tetani, which is a gram positive anaerobic spore forming organism.
Mode of entry
Clostridium tetani enters the body through open wounds and produce a powerful neurotoxin.
Incubation period
Spores can survive for a long time in the environment for up to 100 years. Incubation period is 2 days to several weeks (3-21 days).
Host factors
Age- It can occur between 5 and 40 years of age. It occurs mostly in newborns, female during delivery, more in males.
Clinical Features of Tetanus
- Stiffness of the jaw (also called lockjaw)
- Stiffness of the abdominal and back muscles
- Contraction of the facial muscles
- Convulsions
- Fast pulse
- Fever
- Hyperpyrexia, hypertension, excessive sweating and cardiac arrhythmias occurs due to sympathetic nervous system involvement
- Painful muscle spasms near the wound area (if these affect the larynx or chest wall, they may cause asphyxiation)
- Difficulty swallowing
Diagnostic evaluation of Tetanus
- Diagnosis is mainly based on sign and symptoms.
- The organism may be isolated from wound and discharge.
Management of Tetanus
- Tetanus Antitoxin therapy is used to target toxins that have not yet attacked nerve tissues. This treatment, called passive immunization, is a human antibody to the toxin.
- Sedatives that slow the function of the nervous system can help control muscle spasms.
- Vaccination with one of the standard tetanus vaccinations helps your immune system fight the toxins.
- Antibiotics, given either orally or by injection, may help fight tetanus bacteria.
- Other drugs. Other medications might be used to regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine might be used for this purpose as well as for sedation.
Supportive therapies
- Supportive therapies include treatments to make sure your airway is clear and to provide breathing assistance.
- A feeding tube into the stomach is used to provide nutrients.
- The care environment is intended to reduce sounds, light or other possible triggers of generalized spasms.
Lifestyle and home remedies
Proper wound care is important for any cut or wound. Seek medical care if you have a puncture a deep cut, an animal bite, a foreign object in wound or a wound contaminated with soil, feces, rust or saliva.
If you have a minor wound, these steps will helpful to prevent infections:
- Control bleeding– Apply direct pressure to stop bleeding.
- Clean the wound– After the bleeding stops, rinse the wound with a saline solution, bottled water or clear running water.
- Use antibiotics– Apply a thin layer of an antibiotic cream or ointment to discourage bacterial growth and infection.
- Cover the wound– Bandages can keep the wound clean and keep harmful bacteria out. Keep the wound covered until a scab forms.
- Change the dressing– Rinse the wound, apply antibiotic ointment, and replace the bandage at least once a day or whenever the dressing becomes wet or dirty.
- Manage adverse reactions– If the antibiotic causes a rash, stop using it. If you’re allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and paper tape.
Prevention of Tetanus
Active immunization
- Active immunization is the best to prevent tetanus. children are given 3 doses of DPT vaccine and 2 booster doses of TT.
- 1st dose- 6th week (DPT)
- 2nd dose- 10th week (DPT)
- 3rd dose- 14th week (DPT)
- 1st booster- 18 month (DPT)
- 2nd booster- 6 years (DT)
- Immunizing pregnant ladies with 2 doses of 0.5 ml TT intramuscularly between 16 and 36 weeks of pregnancy, helps to prevent neonatal tetanus.
Passive immunization
- After sensitivity test, 1,500 IU, Anti tetanus serum is given, subcutaneously.