NEONATAL TETANUS Flashcards
The word tetanus comes from the Greek tetanos, which is derived from the term teinein, meaning to ————— .
Tetanus is characterized by an (acute or chronic?) onset of __________, (painless or painful?) muscular contractions (usually of the muscles of the ________ and ———), and generalized muscle spasms
stretch; Acute
hypertonia
jaw ; neck
Aetiopathogenesis
Caused by ______________
Gram ____ve (aerobe or anaerobe?) . (Encapsulated or Non-encapsulated?) bacillus
The spores are ___________ and are found in the found in animal and human feaces, soil, house dust, clothing, animal intestine, 10-25% of human GIT .
The spores that gain entry can persist in normal tissues from _________ to _______.
clostridium tetani
+ve anaerobe.
Non-encapsulated
ubiquitous ;months to yrs.
C.Tetani spores are resistant to __________ and ______________ .
heat desiccation and disinfectants
Pathophysiology
C. tetani need tissue with the proper ____________ condition to germinate .
Under anaerobic conditions they geminate and elaborate ____________ and ____________
Can survive for many years in dry dust or earth.
Releases ____________ that bind to the nerves
anaerobic
tetanospasmin ; tetanolysin
exotoxins
Pathophysiology
Not pathogenic to humans and animals by ____________ but by the production of a potent protein toxin tetanus toxin or ____________
invasive infection
tetanospasmin
Tetanus toxin
Produced when spores __________ and vegetative cells grow after gaining access to wounds.
The organism multiplies locally and symptoms appear _______ from the infection site.
Because the toxin has a specific affinity for nervous tissue, it is referred to as a ____________. The toxin has no known useful function to C. tetani.
germinate
remote
neurotoxin.
Tetanus Toxin
Once the toxin is synthesized it moves from the contaminated site to the ___________ in _________ days.
It is distributed via the _________ and _________ circulations to the _________ of all nerves.
Initially binds to ____________________
Transported within the _________ and across _________ until it reaches the central nervous system.
Becomes rapidly fixed to _________ at the presynaptic inhibitory motor nerve endings, then taken up into the axon by _________.
spinal cord ; 2-14 days.
lymphatics ; vascular circulations ;end plates
peripheral nerve terminals
axon ;synaptic junctions ;gangliosides
endocytosis.
Tetanus toxin
Blocks the release of ___________ neurotransmitters (___________ and ___________) across the synaptic cleft, which is required to check the nervous impulse, leading to failure of inhibition of motor reflex responses to sensory stimulation.
.
If nervous impulses cannot be checked by normal inhibitory mechanisms, it leads to unopposed muscular ___________ and ___________ that are characteristic of tetanus.
inhibitory ;glycine
gamma-amino butyric acid
muscular contraction ; spasms
Tetanus toxin
Generalized contraction of the __________ and __________ musculature is characteristic of a tetanic spasm.
Once the toxin becomes fixed to neurons, it (can or cannot?) be neutralized by antitoxin.
Recovery of nerve function from tetanus requires ————————————- and formation of new synapses.
agonist ; antagonist
cannot
sprouting of new nerve terminals
Epidemiology
Disease related to unhygienic conditions and customs
Delivery—cutting cord with ______________, scissors, knives especially TBAs
_________ of cord—tying old cloth, applying dirty herbs, _________,___________
Mother did not _____________ in preg
Others- circumcision, ear piercing, tongue tie native surgery
old , dirty razor
Dressing; cow dung, old talcum powder
receive TT
Risk factors for Neonatal Tetanus
•_____________________ of mother/ __________ of ____________ from mother to child
•Delivery under __________ conditions
•Harmful traditional ways of _____ and wound care
•Unhygienic _________ and ___________ practices
Non immunization
non transfer of antibodies
unhygienic conditions; cord
circumcision ; ear piercing
Clinical features
Incubation period—3 to 14 days
First symptom is __________ due to spasm of __________ muscles—cannot open mouth to feed nor swallow.
__________ of _______ muscles, spine-________________
Generalized spasms-__________ ___________ contractions ff noise, touch, light
Fever, respiratory problems- aspiration, bronchopneumonia, atelectasis
lock jaw ;spasm ; masseter muscles
Stiffness ;neck muscles
opistotonus; painful muscular
Principles of Management of Neonatal Tetanus
• ________________ of wound site
• ________________ of toxins
• Prevention of ____________
• ________________
• Supportive Care; secretions
• Cautious _______ on resolution of acute symptoms
• Close monitoring
Debridement ; Neutralization
spasms; Antibiotics
feeds
Prognosis
Incubation Period _______ days
The shorter the incubation the _______ the prognosis especially when less than _______
days.
Period of onset
Interval between the first symptom and onset of spasms. <_________ is poorer prognosis
NB: Neonatal Tetanus is always severe
3 – 14
poorer; 7
24 hours
Prognosis –Neonatal tetanus score
CRITERIA
• Age in days:_______ age better prognosis
• Onset interval (period of onset)in hours; less than _______, worse prognosis
• Spasm duration in mins: if _________, worse prognosis
• Temperature variation from normal: >______C (fever/subnormal temp) worse prognosis
• Presence of ___________: worse prognosis
older; 24hrs
persistent
3; pneumonia
Prevention
Mortality is _______%
Immunization of adolescents and women of child bearing age.
Active immunization of all preg women with _____ doses TT approx ___________ apart.
Passive immunization of at risk neonates with ________ iu ATS after test dose
40-90
2
1-2months
750
