Tetanus: Symptoms, Causes, And Treatments

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Discuss the etiology, pathology, diagnosis, clinical features, and management of tetanus.

Answer:

Tetanus:

  • It is a condition of toxemia due to the absorption of soluble toxin from the wound contaminated with Clostridium tetani.

Tetanus Etiology:

  • Clostridium tetani is the causative organism.
  • It is a gram-positive anaerobic rod with terminal round spore.
  • Exotoxins produced by it are tetanospasmin and tetanolysin.

Tetanus Pathology:

Tetanus occurs due to absorption of soluble exotoxin from the site of infection.
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Implantation of tetani pores into wound
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Germination of spores.
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Toxins reaches the central nervous system via.

Motor nerves or
Bloodstream or
Lymphatics
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Toxins reaches the cord and fixed to the motor cells of the anterior horn.
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Causes extreme hyperexcitability of motor neurons.

Tetanus Clinical Features:

  • Trismus combined with pain and stiffness of the neck, back, and abdomen.
  • Dysphagia.
  • Risussardonicus in which eyebrows and the comers of the mouth are drawn up.
  • Muscles of the neck and trunk gradually becomes rigid.
  • Muscles rigidity spreads in descending pattern from the jaw and facial muscles to the extensor muscles of the limb.
  • Constitutional symptoms are:
    • Temperature becomes elevated.
    • Pulse becomes rapid.
    • Cyanosis.

Tetanus Types:

  1. Acute tetanus – incubation period is less than 10 days.
  2. Chronic tetanus – incubation period is about 1 month.
  3. Delayed tetanus or latent tetanus.
    • Organism remans latent in the wound for months or years in it.
  4. Local tetanus.
    • In it there are local contractures of muscles.
  5. Cephalic tetanus.
    • In it there is irritation or paralysis of the cranial nerves.
  6. Bulbar tetanus.
    1. In it there is extensive spasm of muscles of deglutition and respiration.
  7. Late tetanus – Has a prolonged incubation period.
  8. Tetanus neonatorum.
  9. Recurrent tetanus.

Tetanus Treatment:

  1. Treatment of established cases.
    • Passive immunization with 4000 units of humotetalong with tetanus toxoid injection
    • Antibiotics.
      • High dose of injection penicillin 10 lac units every 4 hours.
      • Metronidazole 500 mg 4 8th hourly for 10 days.
    • Wound care.
      • Thorough cleansing and debridement of wound.
      • Removal of all necrotic tissues and foreign bodies.
      • Blood clots, foreign bodies, and pus are cleared off.
      • Patient is shifted to a quiet, dark, well-ventilated room.
  2. Mild cases.
    • Sedatives are used such as promazin 200 mg
    • I.M and a barbiturate or injection diazepam 5 – 40 mg 4.
    • Repeated 4 times in a day.
  3. Moderate cases.
    • Use of nasogastric tube for feeding.
    • Self-retaining catheter to drain urine.
    • Administration of 4 fluids.
  4. Severe cases.
    • Use of muscles relaxant, tubocurarine 40 mg 4 initially followed by IM.
    • A tracheostomy is carried out.
    • A sedative like pentothal sodium is used.
    • Nasogastric feeding.
    • Administration of 4 fluids and electrolytes.

Tetanus Diagnosis:

  1. Laboratory diagnosis.
    • Gram staining of the specimen is done to demonstrate Cl. Tetani bacilli.
  2. Spatula test.
    • Involves touching the oropharynx with a spatula or tongue blade.
    • In normal individual, it develop a reflex spasm of the masseter and the patients bite the spatula.
  3. Demonstration of toxin.
    • 0.2 ml of 2 – 4 days old cooked meat culture is injected.

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