Tetanus

An acute disease induced by the exo-toxin of the bacillus, which is a neurotoxin called (tetanospasmin),affects neuromuscular junction. caused by tetanus bacillus which grows anaerobically at the site of injury. It inhibits the secretion of Acetylcholine-esterase enzyme leading to accumulation of Ach in the neuro-muscular junctions causing continuous re-polarization

characterized by painful muscular contraction primarily of the masseter muscle (locked jaw), facial muscle (reuses-sardonicus), neck, chest, abdomen, extremities (opisthotonus position),& the last dangerous sign (reflex spasm). Severity depends on: site of injury, size & depth of injury, incubation period, onset time & age.

Infectious agent: Clostridium tetani Dx.: clinical only Occurrence: worldwide, especially in agricultural & underdeveloped countries where contact with animals is high & immunization is inadequate. Reservoir: *intestine of horses & other animals & man where the organism is a harmless normal inhabitant *contaminated soil *spores which are ubiquitous

M.O.T.: spores introduced into a wound contaminated with soil. ppt. factors: deep wound, poor blood supply, foreign body, necrotic tissue, calcium salts, local infection. Incubation period: 3-21 days, usually 14 days P.O.C.: no direct transmission Susceptibility: general, infants get passive immunity from vaccinated mother.

Methods of control: A- Preventive measures: 1. Educate the public about necessity of complete immunization 2. Universal active immunization -routine schedule -population at risk -catch-up dose -ten-years boostering 3. wound management 4. prophylaxis in wound management

Tetanus Prophylaxis in routine wound management Hx. of Tetanus Immunization Clean minor wounds Td IG All other wounds Td IG Uncertain or less than 3 Yes No Yes Yes More than 3 No1 No No2 No 1 Yes if more than 10 years since last dose 2 Yes if more than 5 years since last dose

B. Control: Report No isolation, concurrent disinfection, quarantine or immunization of contacts. Specific Rx.: -Conservative Antitoxin after checking for hypersensitivity. C.P. or Metronidazole I.V. 7-14 days

Tetanus Neonatorum

Tetanus Neonatorum A Serious health problem, 500000 deaths/year C.F.R.> 80% Causes: dirty instruments, dressing & management during delivery. Clinical picture: normal neonate in the first few days of life followed by crying, reluctance to feed, generalized spasm with whistling expression.

Prevention 1.Improving maternity care 2.Active immunization of mother: 4th month+1+6+12+12 3.Encourege deliveries at hospital 4.Train& educate midwives & Control of birth attendants