TETANUS

Also known as “Dhanustankar” & Luck Jaw.

Disorder is characterized by painful muscular rigidity primarily
involving Masseter and neck muscles.
Causative Agent: Clostridium tetani
(Anaerobic, Gram positive, Spore forming bacillus)
Mode of Transmission: Contamination and Contact, Birth
Incubation Period
3 Days to 3 Weeks (Average 8 Days)
Predisposing Factors
 Age: Neonates, All Ages
 Rural Areas
 Rainy Season
 Burn, crush injury
 Unclean Birth and Surrounding
 Chronic Supurative Otitis Media
 Unimmunized Mother
Pathophysiology
Injury/ wound/ Burn

Entrance of Organism

Production of Toxins

Tetanospasmin Tetanolysin
Acts through Spinal cord , Local Tissue Injury
Brain, Motor Nervous System Necrosis

Increases Muscle Excitibility

Muscle Stiffness

4 Requirements for Disease

 Presence of Bacteria / Spores
 Tissue Injury, Wound
 Favorable Wound Condition for Bacterial Growth
 Susceptible Host
Clinical Features
Difficulty in Sucking
Excessive Cry
Irritability
Nuchal rigidity
Progressive Stiffness- Neck and Jaw
Trismus (Difficulty in Opening Mouth)
Risus Sardonicus (Grinning face)
Opisthotonus Position
Board like rigidity- Abdomen, Limbs
Difficulty in Swallowing
Increased Responses to Stimuli- Visual, Auditory, Tactile
Pooling of Secretion- Oral Cavity
Respiratory Arrest
Pneumonia
Constipation
Others: Pain, Anxious Face, Anxiety, Increased Pulse and
Sweating.
Mortality: Neonate : 60% - 70%, Children : 30% - 45%
Treatment
1. HTIG (Human tetanus Immunoglobulin): 3000-6000
units/IM
2. ATS (Anti tetanus Serum): 5000-10000 units/ ½ IV ½ IM
3. Antibiotics: Inj. Penicillin G 200000/kg in 4 divided Doses for
2 weeks
4. Sedation: Inj. Diazapam 0.1 – 0.2 mg/kg/ 4 hourly
Inj. Medazolam 1mg/ kg
5. Neuromuscular Blocking Agents:
Inj. Pancuronium Bromide
6. Supportive Care:
 Isolation, Avoid Stimulation
 Vital monitoring( Respiratory Rate, SPO2)
 Oral Suctioning
 Keep Nil Per Oral, Feed after 5 days
 Place Nasogastri tube,
 Hydration
Prevention: Immunize mother, Safe delivery, Cord Care
Tetanus toxoide: (6, 10, 14 weeks, 18 months, 5, 11, 16 years)
Then 10 yearly or as needed.