DR. SALMAN ABBASI
Associate professor Orthopaedic Surgery
AL-NAFEES MEDICAL COLLEGE
TETANUS
It is a non-communicable/infectious disease causing sustained muscular
spasm, contraction and convulsions.
When its bacteria invade the body, they produce a poison (Toxin) that causes
painful muscle contractions.
Tetanus is an infection caused by a bacterium called Clostridium Tetani.
Derived from Greek word Tetanos means stretch.
Tetanus is an infection caused by bacteria called Clostridium Tetani
Gram +ve
spore forming bacteria
The spores develop into bacteria when they enter the body.
The Tetanus bacteria are everywhere in the environment.
HOSTS
Human
Domestic
Wild Animals
TYPES
Dormant form
(spores)
Active form
(vegetative)
Types of Tetanus:
1. Generalized tetanus:
Most common & severe form affects allskeletal muscles
2. Local tetanus:
Manifests with muscle spasms at or near the infected wound
3. Cephalic tetanus:
Affects one or more muscles in face in 1 or 2 days after a head injury or ear
infection. Lockjaw occur that can easily progress to generalized tetanus.
4. Neonatal tetanus:
Is similar to generalized tetanus except that it affects a neonate
CAUSES OF TATNUS
wounds
llacerations,
injection sites
Abrasions
Burns
Frostbites
foreign bodies,
surgeries
unhygienic child births
Age:
Affect any age.
Distribution:
Tetanus occurs worldwide and is endemic in many developing countries.
Incidence:
In developed countries it is low due to effective vaccination programs.
Pathophysiology :
The spores enter through puncture wounds
Inside the body spores develop into active form that multiply.
They produce a powerful toxin Tetanospasmin
(a poison that attacks nervous system and blocks nerve signals from the
spinal cord to and from the muscles)
Diagnosis:
Diagnosis is based on clinical symptoms.
The bacteria, is recovered from wound in only 30% of cases.
Spatula test :
Posterior pharyngeal wall is touched with soft-tipped instrument.
Negative test: Elicits a gag reflex, patient tries to expel spatula.
Positive test: Results in the involuntary contraction of the jaw (biting
down the spatula)
Treatment:
Wound care
Medications
Supportive care
Vaccination
Wound care
Clean wound thoroughly by soap & water to remove dirt, foreign
bodies and dead tissue from wound to prevent growth of tetanus
spores.
Medications
Antibiotics.
To fight tetanus bacteria.
Sedatives.
Sedatives to control muscle spasms.
Other drugs.
Like magnesium sulfate, beta blockers & morphine to regulate involuntary muscle
activity, regularize heartbeat and breathingIV fluids.
Supportive therapies:
Long period of treatment in an intensive care settings. eg. Ventilator
Vaccines
Anti Tetanus vaccine
Tetanus toxoid (TT)
Immunoglobolins
Anti Tetanus vaccine
Tetanus antitoxin is an immunoglobulin.
Neutralizes the toxin produced by Clostridium tetani.
Used to provide temporary passive immunity.
Contraindication: not be used for prophylactic use or when anti
tetanus immunoglobulin is available or the patient is allergic (give test
dose)
The dose is usually in units.
Complications:
Once tetanus toxin bonds to nerve endings it is impossible to remove.
Complete recovery requires growth of new nerve endings and takes several
months.
Fractures due to severe muscular spasms.
Prolonged immobility by high doses sedatives leads to permanent disability.
Brain damage in infants.
Respiratory failure is the most common cause of death.
Preventions
Tetanus can be prevented through immunization.
Neonatal tetanus can be prevented by immunizing women of
childbearing age with TT, either during pregnancy or outside of
pregnancy.
This protects the mother and the baby.
(through a transfer of tetanus antibodies to the fetus)
KEY FACTS
Tetanus is acquired when the spores of the bacterium Clostridium Tetani
infect a wound or a new-born's umbilical stump.
The spores are universally present in the soil.
Spores germinate to produce an exotoxin, tetanospasmin, that causes rigidity
& spasms of voluntary skeletal muscles.
People of all ages can get tetanus but the disease is common and serious in
new-born babies.
Neonatal tetanus is a significant problem in developing countries due to poor
umbilical stump hygiene and lack of maternal immunization.
Acute condition requiring intensive care prevention is by immunization.
Pakistan is one of the 34 countries that have not achieved the
neonatal tetanus (NT) global elimination target set by the World
Health Organization (WHO).
It is one of the most underreported diseases and remains a major but
preventable cause of neonatal and infant mortality in many developing
countries.
Any adult who has not had a tetanus immunization within 10
years should get a single dose.
A booster shot should be given within 48 hours of an injury to people
whose immunization is out of date.
For people with high-risk injuries who are not fully immunized, tetanus
antitoxin may also be recommended.
Warning Signs of Tetanus
Headache
Increased blood pressure
Stiff jaw
Swallowing difficulty
Body spasms
GANGRENE
Gangrene essentially means death of tissues due to lack of blood
supply and invasion of deeper tissues with infection.
TYPES;
Dry Gangrene
Wet Gangrene
The gangrene manifest either as dry or wet form.
GAS GANGRENE
(Clostridial Myonecrosis)
Gas gangrene is most commonly caused by infection with a bacteria called
Clostridium Perfringens.
( Old name Clostridium welchii )
They gather in an injury or surgical wound that has no blood supply.
The bacterial infection produces toxins that release gas and cause tissue death.
Like wet gangrene, gas gangrene is a life-threatening condition.
Gas Gangrene can also be caused by ;
group A streptococcus
Staphylococcus aureus
Vibrio vulnificus.
(Clostridium is found nearly everywhere)
Gas gangrene, also called clostridial myonecrosis, is a particularly
virulent form of wet gangrene.
It is associated with poorly cleansed wounds.
It sometimes results from surgery in which the blood supply has
become damaged.
Dry forms result from a progressive loss of blood supply to tissues.
Signs & Symptoms
 If the affected area is inside the body (such as gangrene of the gallbladder
or gas gangrene), the symptoms may include:
 Confusion.
 Fever.
 Gas in tissues beneath the skin.
 General ill feeling.
 Low blood pressure.
 Persistent or severe pain.
Gas gangrene is suspected based on symptoms and results of a
physical examination.
X-rays are taken to check for gas bubbles in muscle tissue.
Computed tomography (CT)
Magnetic resonance imaging (MRI)
(to check for areas of dead muscle tissue)
TREATMENT
If gas gangrene is suspected, treatment must begin immediately.
High doses of antibiotics
(typically penicillin and clindamycin)
Penicillin-G in dosages of 10-24 million U/d was the drug of choice.
Currently, a combination of penicillin and clindamycin is widely used.
ROLE OF SURGERY
All dead and infected tissue should be removed Surgically .
Fresh healthy margins should be achieve.
Muscle should be pink and bleeding.
(About one of five people with gas gangrene in a limb requires amputation)
THANKS