TETANUS

Question 1

Cause of tetanus

Answer 1

Clostridium tetani

Question 2

Habitat of C. tetani

Answer 2

Soil

Question 3

Tetanus-prone wounds

Answer 3

Burns
Puncture injuries
Wounds contaminated by soild/manure
Septic wounds
Wounds with much devitalized tissue
Compound fractures

Question 4

Incubation period of C. tetani

Answer 4

3-21 days

Question 5

Symptoms of tetanus

Answer 5

Difficulty or inability to open mouth
Constipation
Stiff body
Spasms

Question 6

Triggers for spasms in tetanus

Answer 6

noise
bright light
touch

Question 6

Treatment objectives in tetanus

Answer 6

To prevent further spasms
To eliminate Clostridium tetani to stop further toxin production
To neutralise circulating toxin
To provide adequate hydration and nutrition
To provide supportive care till spasms cease completely

Question 7

Signs of tetanus

Answer 7

Umbilicus may be infected
Presence of wound (but may have healed)
Irritability
Cyanosis during spasms
Sardonic (mocking) smile
Lock jaw (cannot open the mouth)
Opisthotonus (stiff arched back)
Rigid abdomen and stiff neck and limbs

Question 8

Non-pharmacological interventions in tetanus

Answer 8

Always admit a suspected case of tetanus
Maintain a clear airway
Avoid noise, bright light and unnecessary physical examination of the patient
Clean the infected umbilicus or wound with soap and water or antiseptic solution
Surgical debridement of the wound when necessary

Question 9

Antibiotic regimen in a patient diagnosed with tetanus

Answer 9

First line
Metronidazole

Second line
Benzylpenicillin
and
IV Gentamycin in neonates, 4mg/kg 24 hourly

Question 10

Metronidazole dose in tetanus

Answer 10

Metronidazole, IV,
Adults
500 mg 6 hourly for 7-10 days
Children
> 1 month 7.5 mg/kg 8 hourly for 7-10 day
Neonates
> 7 days; 7.5 mg/kg 12 hourly
< 7 days; 7.5 mg/kg 48 hourly

Question 14

Dose of benzylpenicillin in tetanus

Answer 14

Benzylpenicillin, IV,
Adults
50,000 units/kg stat, then 4 MU 6 hourly for 5 days
Children
50,000 units/kg 6 hourly for 5 days
Neonates
250,000 units 6 hourly for 7 days

Question 14

Pharmacological management to neutralise free circulating toxin in tetanus

Answer 14

Human Tetanus Immunoglobulin, IM or IV,

and

Tetanus Toxoid, IM,

Question 14

Dose of tetanus toxoid

Answer 14

Tetanus Toxoid, IM, (inject at different site from Human Tetanus Immunoglobulin)
Adults and Children
> 2 years; 0.5 ml stat. Repeat at 4-8 weeks (2nd dose) and at
6-12 months (3rd dose)
< 2 years; 3 doses of Pentavalent vaccine at
intervals of four weeks

Question 14

Dose of human tetanus immunoglobulin

Answer 14

Human Tetanus Immunoglobulin, IM or IV,
Adults and Children
500 units stat.
Neonates
250 units stat.

Question 15

Dose of chlorpromazine to control spasms in tetanus

Answer 15

Adults
Chlorpromazine, IM, 50 mg 4-8 hourly

Children
Chlorpromazine, IM or oral (via nasogastric tube), 12.5-25 mg 8 hourly

Neonates
Chlorpromazine, IM or oral (via nasogastric tube), 7.5 mg 8 hourly

Question 15

Treatment of spasms in tetanus

Answer 15

Adults
Chlorpromazine and Diazepam/Phenobarbitone

Children
Chlorpromazine and Diazepam/Phenobarbitone

Neonates
Chlorpromazine and Phenobarbitone, add Diazepam if spasms are not controlled

Question 16

Dose of diazepam to control spasms in tetanus

Answer 16

Adults
Diazepam, IV or IM, (by slow IV at a rate of not more than 5 mg/minute), 5-10 mg 3-6 hourly when required

Children
Diazepam, IV/IM/nasogastric tube/ suppository, 0.3 mg/kg 3-6 hourly when required (by slow IV at a rate of not more than 5 mg/minute)

Neonates
Diazepam, rectal, 0.5 mg/kg 3-6 hourly when required

Question 17

Dose of phenobarbitone to control spasms in tetanus

Answer 17

Adults
Phenobarbitone, IM, 200 mg 8-12 hourly, gradually reduce sedation after about 2 weeks

Children
Phenobarbitone, IM or oral (via nasogastric Tube), 10 mg/kg stat., then 2.5 mg/kg 12 hourly

Neonates
Phenobarbital (Phenobarbitone), IM or oral (via nasogastric tube), 30 mg stat. then 7.5 mg 12 hourly

Question 18

Tetanus infection does not provide immunity against future episodes. T/F

Answer 18

True

Question 19

When is immunisation for tetanus started

Answer 19

Start Immunisation before discharge from hospital in all patients because tetanus infection does not provide immunity against future episodes

Question 20

Tetanus immunisation after infection

Answer 20

A course of tetanus toxoid vaccinations should be given to any previously
unimmunised patient older than 2 years of age. Dose: 0.5 ml, IM or deep
SC, repeat at 4 weeks and 8 weeks (primary course)

Previously unimmunised children below the age of 2 years should receive 3 doses of 5 in 1 at intervals of four weeks

Question 20

How many doses of tetanus vaccine is needed for lifelong immunity

Answer 20

5 doses

Question 21

When is a booster dose required for tetanus

Answer 21

If 10 or more years (5 or more years for children below age 15 years) have
elapsed since primary course or last booster, give booster dose of 0.5 ml

Question 21

When is a booster dose required in tetanus prone wounds

Answer 21

A booster dose may be given if more than five years have elapsed since the last dose

Question 22

Tetanus vaccination for survivors of neonatal tetanus

Answer 22

Normal schedule for “Five in- One” (Penta-) vaccine

Question 23

Prevention of tetanus in tetanus prone wounds

Answer 23

Adequate wound toileting
Tetanus prophylaxis