Tetanus

Question 1

Etiology of Tetanus?

Answer 1

Clostridium Tetani

Question 2

Transmission of Tetanus?

Answer 2

Clostidial spores contaminate wound through dirt, saliva, feces

Question 3

Incubation period of Tetanus?

Answer 3

3-21 days

Question 4

Pathophysiology of tetanus

Answer 4

Toxin ( tetanospasmine) enters the nervous system primarily through the presynaptic terminals of lower motor neurons, where it can produce local failure of of neuromuscular transmission, diffuses to the terminals of the ihibitory cells including GABAergic and glycinergic interneurons

Question 5

4 clinical types of tetanus

Answer 5

• Generalized
• Localized
• Cephalic
• Neonatal

Question 6

Clinical features of generalized tetanus?

Answer 6

• Trismus i.e Lockjaw
• Risus sardonicus
• Opisthotonus
• Neck stiffness
• Abdominal rigidity
• Laryngospasms
• Autonomic dysfunction - circulatory arrest

Question 7

Clinical features of localized tetanus?

Answer 7

• Painful muscle contraction in areas surrounding the injury site only

Question 8

Clinical features of cephalic tetanus?

Answer 8

• In patients with open head or neck injuries
• Initially, only affects cranial nerves ( especially flaccid paralysis of CN VII) which can be mistaken for stroke

Question 9

Clinical features of neonatal tetanus?

Answer 9

• Occurs in infants of inadequately immunized mothers after unsterile management of the umbilical cord.
• Typically occure 5-9 days after birth, but it may take up to several weeks.
• Difficulty opening the mouth and feeding due to trismus and risus sardonicus
• Muscle stiffness and opithotonus
• Clenched hands

Question 10

Diagnosis of Tetanus?

Answer 10

• Typically a clinical diagnosis based on muscle spasms and rigidity
• Wound culture and serology may confirm the diagnosis but have low sensitivity and specificity
• Strychnine poisoning is the only condition that can truly mimic tetanus. In this case, toxicologic studies of serum and urine should be performed.

Question 11

Differential diagnosis of tetanus?

Answer 11

• Dental infections
• Drug reactions
• Hypocalcemia
• Meningitis
• Stroke
• Stiff man syndrome

Question 12

Treatment for Tetanus?

Answer 12

• Administer Benzodiazepine to controll spasms and decrease rigidity
• Administer Human tetanus immunoglobulins ( vaccine)
• Start metronidazole therapy ( Penicillin G alternatively)
• Manage the wound as indicated
• Depending to vaccination status, patient may be in need of active immunization as well.

Question 13

Tetanus Vaccine schedule

Answer 13

• Uknown, no vaccination, Low risk ( clean, minor wound ) = 1 dose vaccine Td then completed vaccination
• Uknown, no vaccination,
  High risk ( Dirty, huge wound) = 1 dose vaccine Td + Anti. tetanus immunoglobulins, then completed vaccination
• > 10 years since last doses, Low risk wound = 1 dose vaccine Td
• > 10 years since last doses,
  High risk wound? 1 dose vaccine Td + Anti- Tetanus immunoglobulin
• 5-10 years since last doses , Low risk wound = 1 dose Td Vaccine
• 5- 10 years since last doses,
  High risk wound = 1 dose vaccine Td
• <5 years since last doses, Low risk wound and High risk wound = NO prophylaxis, Wound cleasning as soon as possible