tetanus

dr. Rohmania Setiarini

Tetanus is an acute,often fatal,disease caused by

an exotoxin produced by the bacterium
Clostridium tetani. But prevented by immunization
with tetanus toxoid.
It is characterized by generalized rigidity and
convulsive spasms of skeletal muscles.

epidemiology
Tetanus is an international health problem, as
spores are ubiquitous. The disease occurs
almost exclusively in persons who are
unvaccinated or inadequately immunized.
Tetanus occurs worldwide but is more common
in hot, damp climates with soil rich in organic
matter.
More common in developing countries.
More prevalent in industrial establishment,
where agricultures workers are employed.

Clostridium tetani
Cl.tetani is widely
distributed in soil & in
intestine of human
beings & animals.
They cause tetanus in
both man & animal.

Morphology
Gram-positive, 48m0.5m bacillus.
Has straight axis, parallel
sides & rounded ends.
Occurs singly &
occasionally in chains.
sensitive to heat and cannot
survive in the presence of
oxygen

Resistance
Spore resistance to heat show strain variation.
Majority are killed by boiling for 15min.
Some withstand boiling for 3hr & dry heat at

160C for 1hr.

Spores can survive in soil for years & are resistant
to most antiseptics.
Not destroyed by 5% phenol or 0.1% HgCl2
solution in 2 weeks or more.

Susceptibility
Autoclaving at 121C for 15min kills the spores
readily.
Iodine(1% aqueous soon) and H2O2 kills spores
within few hours.

Toxins
All types produce same toxins which are
pharmacologically & antigenically
identical.
Plasmid mediated.
1.Tetanolysin
2.Tetanospasmin

Tetanolysin
Heat & O2 labile hemolysin.
Cause red cell lysis.
Pathogenic role not clear.
.

Tetanospasmin
O2 stable & heat labile neurotoxin.
Good antigen & specifically neutralised by
antitoxin.
Similar to botulinum toxin

Incubation Period
Varies from 1 day to several months.
It is defined as the time from injury to the
first symptom.

Period of onset
A period of onset of less than 48 hr is
associated with the development of severe
tetanus.

pathogenesis

1. C. tetani enters body

from through wound.

3. Germinates under
anaerobic conditions and
begins to multiply and
produce tetnospasmin.

5. Travels along the axons

to the spinal cord.

2. Stays in sporulated
form until anaerobic
conditions are presented.

4. Tetnospasmin spreads using

blood and lymphatic system,
and binds to motor neurons.

6. Binds to sites responsible for

inhibiting skeletal muscle
contraction.

the toxin acts :

Blocks the release of inhibitory
neurotransmitters (glycine and
gamma-amino butyric acid)
across the synaptic cleft, which
is required to check the nervous
impulse.
If nervous impulses cannot be
checked by normal inhibitory
mechanisms, it leads to
unopposed muscular contraction

Local tetanus
Persistent spasm of
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musculature at site of primary
infection (injury site).
Contractions persist for weeks
before subsiding.
Its generally milder, 1% cases
are fatal but may precede the
generalised tetanus.

Cephalic tetanus
Primary site of infection is head injury or otitis
media.
Associated with disfunction of 1 or more cranial
nerves, most commonly facial nerve.
Poor prognosis.

Generalised tetanus
Most common form(80% of

cases).
Presents with a descending
pattern.
1st sign is trismus(lockjaw)
-due to spasm of masseter
muscles.
Followed by stiffness of the
neck, difficulty in swallowing,
rigidity of abdominal muscles.

Tetanus neonatorum
It is the generalised

tetanus that occurs in

newborn infants.
Occurs in infants of
non-immunised
mothers.

Tetanus neonatorum
Occurs from infection of
un-healed umbilical stump
particularly when stump is
cut with non-sterile
instrument.
Very poor prognosis

Clinical features
Risus sardonicus: Contraction of the muscles at the angle of
mouth and frontalis
Trismus (Lock Jaw): Spasm of Masseter muscles.
Opisthotonus: Spasm of extensor of the neck, back and legs to
form a backward curvature.
Muscle spasticity
Prolonged muscular action causes sudden, powerful, and
painful contractions of muscle groups. This is called tetany.
These episodes can cause fractures and muscle tears.

If respiratory muscle is involved apnoea.

Other symptoms include:

Excessive sweating
Fever
Hipertension
Hand or foot spasms
Irritability
Swallowing difficulty

Risus sardoricus
Characteristic sardonic
smile in tetanus
Results from sustained
contraction of facial
muscles.

Opthisthotonus
Back spasm seen in
tetanus

Diagnosis
There are currently no blood tests that can
be used to diagnose tetanus. Diagnosis is
done clinically.

Principle of Treatment
1. Neutralization of unbound toxin with
Human tetanus immunoglobulin
2. Prevention of further toxin production by
-Wound debridement
-Antibiotics

3. Control of spasm
- Nursing in quiet environment
- avoid unnecessary stimuli
- Protecting the airway
4. Supportive care
- Adequate hydration
- Nutrition
- Treatment of secondary infection