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Tetanus
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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
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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.
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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
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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: days, usually 14 days P.O.C.: no direct transmission Susceptibility: general, infants get passive immunity from vaccinated mother.
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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
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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 No No No No 1 Yes if more than 10 years since last dose 2 Yes if more than 5 years since last dose
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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 days
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Tetanus Neonatorum
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Tetanus Neonatorum A Serious health problem,
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.
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Prevention 1.Improving maternity care
2.Active immunization of mother: 4th month 3.Encourege deliveries at hospital 4.Train& educate midwives & Control of birth attendants
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