An acute disease induced by the exotoxin of
An acute disease induced by the exo-toxin of the bacillus, which is a neurotoxin called (tetanospasmin), affects neuromuscular junction. caused by tetanus bacillus which grows anaerobically at the site of injury. It inhibits the secretion of Acetylcholine-esterase enzyme leading to accumulation of Ach in the neuromuscular junctions causing continuous re-polarization
characterized by painful muscular contraction primarily of the masseter muscle (locked jaw), facial muscle (reuses-sardonicus), neck, chest, abdomen, extremities (opisthotonus position), & the last dangerous sign (reflex spasm). Severity depends on: site of injury, size & depth of injury, incubation period, onset time & age.
Infectious agent: Clostridium tetani Dx. : clinical only Occurrence: worldwide, especially in agricultural & underdeveloped countries where contact with animals is high & immunization is inadequate. Reservoir: *intestine of horses & other animals & man where the organism is a harmless normal inhabitant *contaminated soil *spores which are ubiquitous
M. O. T. : spores introduced into a wound contaminated with soil. ppt. factors: deep wound, poor blood supply, foreign body, necrotic tissue, calcium salts, local infection. Incubation period: 3 -21 days, usually 14 days P. O. C. : no direct transmission Susceptibility: general, infants get passive immunity from vaccinated mother.
Methods of control: A- Preventive measures: 1. Educate the public about necessity of complete immunization 2. Universal active immunization -routine schedule -population at risk -catch-up dose -ten-years boostering 3. wound management 4. prophylaxis in wound management
Tetanus Prophylaxis in routine wound management Hx. of Tetanus Immunization Uncertain or less than 3 More than 3 Clean minor wounds Td IG Yes No No 1 All other wounds Td IG No 1 Yes if more than 10 years since last dose 2 Yes if more than 5 years since last dose Yes No 2 No
B. Control: n Report No isolation, concurrent disinfection, quarantine or immunization of contacts. n Specific Rx. : -Conservative n Antitoxin after checking for hypersensitivity. n C. P. or Metronidazole I. V. 7 -14 days n
Tetanus Neonatorum
Tetanus Neonatorum A Serious health problem, 500000 deaths/year C. F. R. > 80% Causes: dirty instruments, dressing & management during delivery. Clinical picture: normal neonate in the first few days of life followed by crying, reluctance to feed, generalized spasm with whistling expression.
Prevention n n 1. Improving maternity care 2. Active immunization of mother: 4 th month+1+6+12+12 3. Encourege deliveries at hospital 4. Train& educate midwives & Control of birth attendants
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