Tetanus

Question 1

organism for tetanus? type of organism?

Answer 1

Clostridium tetani, anaerobic gram positive bacillus

Question 2

Tetanus toxins produced?

Answer 2

Tetanolysin
Tetanospasmin (dangerous one)

Question 3

Where does tetanus affect?

Answer 3

Inhibitory neurotransmissmiter neurones - GABA

Question 4

Symptoms?

Answer 4

Trismus - lock jaw
Risus sardonicus - spasmed smile
Opisthotonos
Autonomic dysfunction

Question 5

WHO definition of tetanus?

Answer 5

1. Trismus (inability to open the mouth)
2. Risus sardonicus (sustained spasm of the facial muscles)
3. Painful muscular contractions.
   1 of the above

Question 6

Test for tetanus clinically?

Answer 6

Spatula test. Touch back of pharyngeal wall, get masseter spasm

Question 7

Microbiological diagnosis of tetanus?

Answer 7

Culture
Bioassay (inject toxin into mice)
PCR

Question 8

Incubation period for tetanus? When do spasms start?

Answer 8

0-7 days
Day 10

Question 9

Bad prognostic features for tetanus?

Answer 9

• High risk point of entry
• quick onset of symptoms
• Generalised spasms
• High HR
• Pyrexia >40

Question 10

Types of tetanus?

Answer 10

1. Cephalic tetanus - CN palsies, facial stiffness, trimus
2. Localised tetanus - rigidity and weakness in limb of wound
3. Generalised tetanus (80%)
4. Neonatal tetanus

Question 11

Mode of transmission of tetanus?

Answer 11

Soil

Question 12

Management of tetanus

Answer 12

• 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

Question 13

Complications of tetanus?

Answer 13

Rhabdomyolysis
Bone fractures

All the complications of long ICU stays

Question 14

Management of tetanus broadly?

Answer 14

Supportive care
Stop toxin
Prevent and management complications

Question 15

∆∆ of tetanus?

Answer 15

Strychnine poisoning
Rabies

Question 16

What to do if a pregnant lady has not been vaccinated for tetanus?

Answer 16

• 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.

Question 17

Definition of elimination of tetanus? (NNT Elimination)

Answer 17

<1 neonatal case per 1000 live births in every district in every country per year

Question 18

How to prevent neonatal tetanus?

Answer 18

Clean practices for child birth
Vaccinate mother during pregnancy

Question 19

Definition of maternal tetanus

Answer 19

Occuring during pregnancy or up to 6 weeks after any type of pregnancy including termination

Question 20

Definition of neonatal tetanus

Answer 20

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

Question 21

Definition of tetanus

Answer 21

Muscle spasms with cardiovascular instability and preserved consciousness

Question 22

Does infection cause immunity?

Answer 22

No

Question 23

Classic conscious level in tetanus?

Answer 23

GCS 15

Question 24

Wound, high risk, what post exposure care would you give for tetanus?

Answer 24

Fully vaccinated - booster
Not fully vaccinated - booster plus Immunoglobulin
Esp if not had a booster in last 5 years