Tetanus Flashcards
organism for tetanus? type of organism?
Clostridium tetani, anaerobic gram positive bacillus
Tetanus toxins produced?
Tetanolysin
Tetanospasmin (dangerous one)
Where does tetanus affect?
Inhibitory neurotransmissmiter neurones - GABA
Symptoms?
Trismus - lock jaw
Risus sardonicus - spasmed smile
Opisthotonos
Autonomic dysfunction
WHO definition of tetanus?
- Trismus (inability to open the mouth)
- Risus sardonicus (sustained spasm of the facial muscles)
- Painful muscular contractions.
1 of the above
Test for tetanus clinically?
Spatula test. Touch back of pharyngeal wall, get masseter spasm
Microbiological diagnosis of tetanus?
Culture
Bioassay (inject toxin into mice)
PCR
Incubation period for tetanus? When do spasms start?
0-7 days
Day 10
Bad prognostic features for tetanus?
- High risk point of entry
- quick onset of symptoms
- Generalised spasms
- High HR
- Pyrexia >40
Types of tetanus?
- Cephalic tetanus - CN palsies, facial stiffness, trimus
- Localised tetanus - rigidity and weakness in limb of wound
- Generalised tetanus (80%)
- Neonatal tetanus
Mode of transmission of tetanus?
Soil
Management of tetanus
- Prevent stimulation
- Muscle relaxation - benzos, non depolarising muscle relaxant
- Magnesium sulphate
- Ventilation if possible
-Neutralise toxin - antitoxin - Antibiotics: metronidazole
- Surgical debridement
- Autonomic dysfunction - morphine, clonidine, BBlockers
Complications of tetanus?
Rhabdomyolysis
Bone fractures
All the complications of long ICU stays
Management of tetanus broadly?
Supportive care
Stop toxin
Prevent and management complications
∆∆ of tetanus?
Strychnine poisoning
Rabies
What to do if a pregnant lady has not been vaccinated for tetanus?
- 2 doses tetanus toxoid one month apart
- 1 st dose as early as possible in pregnancy
- 2 nd dose at least one month later/3 weeks before delivery.
Definition of elimination of tetanus? (NNT Elimination)
<1 neonatal case per 1000 live births in every district in every country per year
How to prevent neonatal tetanus?
Clean practices for child birth
Vaccinate mother during pregnancy
Definition of maternal tetanus
Occuring during pregnancy or up to 6 weeks after any type of pregnancy including termination
Definition of neonatal tetanus
Normal ability to suck and cry in first 2 days of life, inability to suck and cry day 3 - 28, then developing muscle stiffness and spasms
Definition of tetanus
Muscle spasms with cardiovascular instability and preserved consciousness
Does infection cause immunity?
No
Classic conscious level in tetanus?
GCS 15
Wound, high risk, what post exposure care would you give for tetanus?
Fully vaccinated - booster
Not fully vaccinated - booster plus Immunoglobulin
Esp if not had a booster in last 5 years
