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Tetanus. Mary & Victoria. Tetanus. What is Tetanus? The Biology: Clostridium tetani Prevention by Vaccination Treatment. What is Tetanus?. Bacterial disease Affects the nervous system Often caused by infection to cuts/wounds, especially when they are deep Other causes: Burns - PowerPoint PPT Presentation
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TetanusMary & Victoria
Tetanus•What is Tetanus?•The Biology: Clostridium tetani•Prevention by Vaccination•Treatment
WHAT IS TETANUS? Bacterial disease Affects the nervous system Often caused by infection to cuts/wounds, especially
when they are deep Other causes:
Burns Abortion Frostbite IV drug abuse
Oposthotonus, by Sir Charles Bell (1809). Source: http://www.brown.edu/Courses/Bio_160/Projects2004/pertussis/diphther.htm
WHAT IS TETANUS? Continual excitatory discharge of the motor and
autonomic nervous system
Uncontrollable muscle spasms may lead to respiratory or cardiac arrest, and severe BP changes
– Lockjaw– Suffocation– Muscle
rigidity/spasms
– Stiffness– Bell’s Palsy– Dysphagia
WHAT IS TETANUS?
Uncommon Affects a specific area
of the body Same area as the
infection site May be a precursor to
generalized tetanus
Most common Symptoms may
progress in a descending pattern
Frequent muscle spasms lasting several minutes
Localized TetanusGeneralized Tetanus
WHAT IS TETANUS?
Affects newborns without passive immunity from their mother
Usually due to infected umbilical stump
Rare in U.S., but prevalent in underdeveloped countries
Neonatal Tetanus
Neonatal Tetanus ID# 6374 (1995). Source: Center for Disease Control--Public Health Image Library
WHAT IS TETANUS?
Rare form Mainly involving the
facial nerves Sometimes occurs
with ear infections, or after head injury
Cephalic Tetanus
Man with Cephalic Tetanus ID# 1657 (1965). Source: Center for Disease Control--Public Health Image Library
INCIDENCE OF TETANUS Decreased prevalence in industrialized nations Tetanus is rare in the U.S. due to immunizations
and improved wound care Approximately 5 deaths per year
In the U.S. it affects mostly older people Gardening during retirement years Mortality rate in the elderly: >50%
INCIDENCE OF TETANUS Worldwide public health issue
Ninth most common cause of death due to infectious disease
Approximately 250,000 deaths per year Global fatality rate: 30-50%
Neonatal tetanus Mortality rate: 90%
THE BIOLOGY: CLOSTRIDIUM TETANI Obligate anaerobe Bacillus
About 0.3-1.1µm by 3-12µm
Gram-positive Mesophile Endospores
“drum-stick” shape Motile
Some may produce flagella 3-4 times it’s length
Gram Stain of Clostridium tetani –ID#6372 (1995). Source: Center for Disease Control--Public Health Image Library
THE BIOLOGY: CLOSTRIDIUM TETANI Clostridium tetani
Produces two exotoxins: Tetanospasmin—neurotoxin that causes muscle spasms Tetanolysin—no known clinical significance
Incubation period = 3 - 14 days Produces spores
Extremely resilient to temperature, moisture, chemicals, and even 10-15 minutes of autoclaving (121˚C)
Germination occurs when exposed to anaerobic conditions such as wounds and tissue necrosis
THE BIOLOGY: CLOSTRIDIUM TETANI Commonly found in:
Soil Manure/human & animal feces Dust Rust
Noncommunicable
THE BIOLOGY: CLOSTRIDIUM TETANI Tetanospasmin:
Excreted into the bloodstream Travels through nerves or by lymphocytes to CNS Attach to presynaptic inhibitory nerve endings
Blocks the release of inhibitor neurotransmitters, causing muscle spasms
One of the most potent toxins known Lethal dose:
175 nanograms for a 154lb/70kg person (That’s 0.000175 miligrams!!)
PREVENTION BY VACCINATION The best way to prevent Tetanus is by
vaccination Virtually 100% efficacy rate in properly
immunized people
Girl Receives Vaccine–ID#9297 (2006). Source: Center for Disease Control--Public Health Image Library
PREVENTION BY VACCINATION Three types of Vaccines:
DTaP vaccine (Diphtheria, Tetanus, Pertussis) DT vaccine (Diphtheria, Tetanus) Td Vaccine (Tetanus, Diphtheria)
PREVENTION BY VACCINATION DTaP:
“3-in-1” Recommended for childhood immunization
Protects against Diphtheria, Tetanus, and Pertussis
Given 5 doses (2 months, 4 months, 6 months, 15-18 months, 4-6 years)
Only for children under age 7
PREVENTION BY VACCINATION DT
“2-in-1” For children less than 7 years old. If a child has an allergic reaction to the Pertussis
vaccine in DTaP.
PREVENTION BY VACCINATION Td
“2-in1” Adult vaccine Slightly differs in dosage of Diphtheria vaccine
than in DT. Anyone over the age of 7 Injected, usually in arm
PREVENTION BY VACCINATION T Vaccine:
A vaccine for Tetanus by itself can be given (Tetanus Immune Globulin/HTIG)-Injected into arm-Made from blood of person or animal containing antibodies against Tetanus
Typically for an adult who is having a dirty wound/injury taken care of
TREATMENT Although
immunization is available, Tetanus is not eradicated.
TREATMENTThose at risk: Lack of immunization Partial Immunization Fully immunized patients have still been
documented to contract the disease Very rare
TREATMENT Main Goals:
Use a method of attacking the anaerobic, spore-forming bacillus
Find a way around the actions of the nervous system caused by the Tetanus toxin
TREATMENT Recognition of Tetanus
Vital to the victim Stabilize and Resuscitate Neutralize Tetanus Toxin Clean wound with antibiotics Treat any muscle spasms Control Pain
TREATMENT Resuscitation
Most common cause of death in Tetanus is due to respiratory failure.
Can be a general complication of the disease, failure to treat spasms quickly enough, or as a side effect of medications.
Tracheotomy is performed as precaution.
Helps to prevent a stimulus from causing another spasm.
TREATMENTBenzodiazepines 1. Diazepam
2. MidazolamSpasm Control and Sedation
GABA-B Agonist 1. Inthrathecal baclofen Spasm Control Refractory to BZ
Muscle Relaxant 1. Dantrolene Spasm Control Alternative
Neuromuscular blocking agents
1. Vecuronium2. Pancuronium3. Succinylcholine
Spasm Control Refractory to BZ, Minimize Sedation
Antibiotics 1. Metronidazole2. Benzyl Penicillin3. Benzathine Penicillin
Elimination of C. Tetani Toxin
Alpha and Beta Blocker 1. Labetalol Control of Autonomic Dysfunction
Alpha 2 Agonist 1. Clonidine Control of Autonomic Dysfunction
Opioid 1. Morphine Sulfate Control of Pain and Peripheral Vasodilatation
Detoxified Exotoxin 1. DTaP2. Tetanus Toxoid
Active Immunization
Human Immunoglobin 1. HTIG Passive Immunization, Neutralizes Free Exotoxin, Treatment of Tetanus, Post exposure
Class Drug Indication
TREATMENT HTIG (immune globulin)
Tetanus toxin binds to nerve endings that normally calm the muscle, blocking the inhibitory signals.
HTIG neutralizes the free form tetanospasmin toxin by binding to it, prohibiting it from blocking signals
Frees the neurotoxin without crossing blood brain barrier
TREATMENT Administration of Td
Contracting the disease does not ensure immunity
Injected simultaneously with HTIG Enhances short-term (passive) immunity and
long-term (active) immunity.
TREATMENT Eliminating the toxin:
Excision – Surgical removal of the toxin producing organisms.
Creates an aerobic environment, hindering the growth of C. tetani spores
Only to be done after Td is given to the patient due to the release of tetanospasmin during the procedure
TREATMENT Antibiotic mode of action depends on which
antibiotic is used Metronidazole is used most often for tetanus
Works by inhibiting nucleic acid synthesis
QUESTIONS??