Michael Erick Virtucio Jean Paola Yap

Section4-D Group 9-b

Pathophysiology of Tetanus
Precipitating Factors: Work (Farming) Exposure to bacteria (wounds/lacerations) No previous history of tetanus immunization

Clostridium tetani bacteria containing virulence plasmids enter wound

Toxins produced by growing cells Spores germinate under anaerobic conditions

Vegetative growth

Spore

Cell lysis occurs Release of bacterial endotoxins into surrounding

Tetanolysin

Tetanospasmin (potent neurotoxin)

Potentiating of infection Toxin circulated around the body through bloodstream and lymphatic system Enter Central Nervous System (CNS) along peripheral nerves

Release of biochemical mediators of inflammatory response (histamine, bradykinin)

Michael Erick Virtucio Jean Paola Yap

Section4-D Group 9-b

Inflammatory response initiated

Toxin not able to pass through blood-brain barrier

Increased capillary permeability Increased blood flow

WBCs such as neutrophils and monocytes enter Phagocytosis and removal of debris occur

Toxin makes its way to spinal cord

Toxin enters the CNS Toxin taken up by neuromuscular junction Crosses to synaptic cleft Irreversibly binds to gangliosides at presynaptic inhibitory motor nerve endings

Swellin

Rednes Phagocytes release endogenous pyrogens

Stimulation of hypothalamus to increase body temperature Fever

Taken up by preganglionic neuron axon through endocytosis Blocks the release of inhibitory neurotransmitters (glycine and GABA) Excitatory activities unregulated Generalized tonic muscle spasms occur

Pain

Pharynx

Cranial

Facial

Masseter

Glottis Respiratory muscles

Aspiration of oral secretions

Rapid firing of impulses

Pneumonia

Irritability of neurons Restless ness

Risus sardonicu s (fixed smile and elevated eyebrows )

Lockjaw

Failure to speak or cry

GI (laryn x, abdo minal wall)

Chest wall muscle Chest wall rigidity

Diaphrag m

Michael Erick Virtucio Jean Paola Yap

Section4-D Group 9-b

Headache Asphyxiation

Hypoxemia

Cardiac Arrest

DEATH

Respiratory failure

Treatment 1. HTIG (Human tetanus Immunoglobulin): 3000-6000 units/IM 2. ATS (Anti tetanus Serum): 5000-10000 units/ IV 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 IV Infusion. Atracurium Besylate 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 Intake of 3500-4000 Calories and at least 150g of protein