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Tetanus

Tetanus

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Published by: Gina Albaladejo on Jan 10, 2013
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Definition

By Mayo Clinic staff Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and, ultimately, threaten your life. Tetanus is commonly known as "lockjaw." Thanks to the tetanus vaccine, cases of tetanus are rare in the United States and the developed world. The incidence of tetanus is much higher in less-developed countries. Around a million cases occur worldwide each year. Tetanus can be treated, but not always effectively. Fatality is highest in individuals who haven't been immunized and in older adults with inadequate immunization — wherever they may live. In countries with low vaccine rates, infants also are at high risk of severe illness and death.

Symptoms
By Mayo Clinic staff Signs and symptoms of tetanus may appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The average incubation period is seven to eight days. Common signs and symptoms of tetanus, in order of appearance, are:
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Spasms and stiffness in your jaw muscles Stiffness of your neck muscles Difficulty swallowing Stiffness of your abdominal muscles Painful body spasms, lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light Other signs and symptoms may include: Fever Sweating Elevated blood pressure Rapid heart rate

Causes

which actively impairs your motor neurons. injection drugs Gunshot wounds Compound fractures Crush injuries Burns Surgical wounds Ear infections Dental infections Animal bites Infected foot ulcers in people with diabetes Infected umbilical stumps in newborns born of inadequately immunized mothers Complications By Mayo Clinic staff Once tetanus toxin has bonded to your nerve endings it is impossible to remove. The effect of the toxin on your nerves can cause muscle stiffness and spasms — the major signs of tetanus.By Mayo Clinic staff The bacteria that cause tetanus. tattoos. dust and animal feces. such as a nail or splinter Swelling around the injury Tetanus cases have developed from the following types of injuries: Puncture wounds — including from splinters. Complications of tetanus infection may include: . nerves that control your muscles. Complete recovery from a tetanus infection requires the growth of new nerve endings and can take up to several months. certain factors are necessary for tetanus bacteria to proliferate in your body. When they enter a deep flesh wound. body piercings. Clostridium tetani. are found in soil. Risk factors By Mayo Clinic staff In addition. spores of the bacteria may produce a powerful toxin. tetanospasmin. These include:                  Lack of immunization or inadequate immunization — failure to receive timely booster shots — against tetanus A penetrating injury that results in tetanus spores being introduced to the wound site The presence of other infective bacteria Injured tissue A foreign body.

Treatment for tetanus typically involves the use of powerful sedatives to control muscle spasms. pertussis (whooping cough) and tetanus. Lack of oxygen may also induce cardiac arrest and death. This vaccination provides protection against three diseases: diphtheria (a throat and respiratory infection). Severe tetanus-induced (tetanic) muscle spasms can interfere with your breathing. In infants. Respiratory failure is the most common cause of death. Almost all cases of tetanus occur in people who've never been immunized or who haven't had a tetanus booster shot within the preceding 10 years. tetanus infections may cause lasting brain damage. typically given in the arm or thigh to children at ages:      2 months 4 months 6 months 15 to 18 months 4 to 6 years The booster A booster of the tetanus vaccine is typically given in combination with a booster of diphtheria vaccine (Td). ranging from minor mental deficits to cerebral palsy. a tetanus. causing periods in which you can't breathe at all.  Prevention By Mayo Clinic staff You can easily prevent tetanus by being immunized against the toxin. Pneumonia is another cause of death. The DTaP vaccine consists of a series of five shots. In 2005. Prolonged immobility due to the use of these drugs can lead to permanent disability. The primary vaccine series The tetanus vaccine usually is given to children as part of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. Death. Disability. diphtheria and pertussis (Tdap) vaccine was .

In order to stay up to date with all of your vaccinations. Medications . If you were never vaccinated against tetanus as a child. treatment consists of wound care. substitute it for your next Td booster dose and then continue on with Td boosters. medications to ease symptoms and supportive care. medical and immunization history. Treatments and drugs By Mayo Clinic staff Since there's no cure for tetanus. it's a good idea to have up-to-date immunity because tetanus may be more common where you're visiting. see your doctor about getting the Tdap vaccine. It's recommended that adolescents get a dose of Tdap. Tests and diagnosis By Mayo Clinic staff Doctors diagnose tetanus based on a physical exam. get another booster shot.approved for use in teens and adults under age 65 to ensure continuing protection against pertussis. especially if you're traveling to a developing country. foreign objects and dead tissue from the wound. If you receive a deep or dirty wound and it's been more than five years since your last booster shot. Laboratory tests generally aren't helpful for diagnosing tetanus. If you're traveling internationally. This involves removing dirt. If you've never received a dose of Tdap. preferably between the ages of 11 and 12. and the signs and symptoms of muscle spasms. and that a Td booster be given every 10 years thereafter. You can't get a tetanus infection from the vaccine. request that your doctor review your vaccination status on a regular basis. stiffness and pain. Wound care Cleaning the wound is essential to preventing growth of tetanus spores.

either orally or by injection. Other medications. Supportive therapies Tetanus infection often requires a long period of treatment in an intensive care setting. Having tetanus once doesn't make you immune to the bacteria afterward. Doctors generally use powerful sedatives to control muscle spasms.     Lifestyle and home remedies By Mayo Clinic staff Puncture wounds or other deep cuts. Other drugs. to fight tetanus bacteria. animal bites or particularly dirty wounds may put you at increased risk of tetanus infection. such as tetanus immune globulin. these steps will help prevent you from getting tetanus:  Control bleeding. Vaccine. If you have a minor wound. Morphine may be used for this purpose as well as sedation. such as your heartbeat and breathing. Since sedatives may result in shallow breathing. Your doctor may also give you antibiotics. prescribe an antibiotic and give you a booster shot of the tetanus toxoid vaccine. However. Leave unclean wounds open to avoid trapping bacteria in the wound with a bandage. your body should quickly make the needed antibodies to protect you against tetanus. Antitoxin. apply direct pressure to control the bleeding. Sedatives. If you've previously been immunized. Your doctor may give you a tetanus antitoxin. So you'll need to receive a tetanus vaccine in order to prevent future tetanus infection. Your doctor may need to clean the wound. may be used to help regulate involuntary muscle activity. If the wound is bleeding. Get medical attention if the wound is deep and dirty. the antitoxin can neutralize only toxin that hasn't yet bonded to nerve tissue. . Antibiotics. you may need to be supported temporarily by a ventilator. and particularly if you're unsure of your immunization status. such as magnesium sulfate and certain beta blockers.

Tetanus occurs after spores or vegetative bacteria gain access to tissues andproduce toxin locally. nonencapsulated. Tetanus may also follow elective surgery. It exists invegetative and sporulated forms. Clostridium tetani is agram-positive.In the presence of anaerobic conditions. Certain ingredients in some ointments can cause a mild rash in some people. but vegetative forms are susceptibleto the bactericidal effect of heat.dental infection. Spores arehighly resistant to disinfections by chemicalor heat.Toxins.obligatively anaerobic bacillus. Apply a new dressing at least once a day or whenever the dressing becomes wet or dirty to help prevent infection. Manure-treated soil may contain large numbers of spores too. If a rash appears. apply a thin layer of an antibiotic cream or ointment. These antibiotics won't make the wound heal faster. rinse the wound thoroughly with clean running water (or saline solution if available). burn wounds. Change the dressing. Cover the wound. Keep the wound clean. After you clean the wound. cattle. often fatal diseasecaused by an exotoxin produced in a woundby Clostridium tetani. guinea pigs andchicken. Neonatal tetanus usually follows infectionof the umbilical stump. abortion and pregnancy. stop using the ointment. Clean the area around the wound with soap and a washcloth.Clostridium tetani is a noninvasive organism. and a number of antibiotics. The usual mode of entry is trough a puncture wound orlaceration. Exposure to the air may speed healing. If you're allergic to the adhesive used in most bandages. otitis media. dogs. rats. Use an antibiotic. Blisters that are draining are vulnerable. cats. sheep. It is found in soil and in theintestine and feces of horses. chemicaldisinfectants. motile. TEXTBOOK DISCUSSIONPATHOPHYSIOLOGY TETANUS Tetanus is an acute. such as the multi-ingredient antibiotics Neosporin and Polysporin. but they can discourage bacterial growth and infection and may allow the wound to heal more efficiently. switch to adhesive-free dressings or sterile gauze and paper tape. but bandages can help keep the wound clean and keep harmful bacteria out. see your doctor. the spores germinate. If debris is embedded in a wound. After the bleeding has stopped. Keep them covered until a scab forms.including tetanolysin (which potentiates    .

One of the many complications from tetanus is respiratory failure secondary to spasms.brain and sympathetic nervous system. sore muscles. However. where it migrates retrograde transynaptically at the rate 75-250mm/day. This condition results from spasms of the jaw muscles that are responsible for chewing. obstruction by secretions. predominantly to inhibitory synapses to prevent the release of acetylcholine. spinal cord. Cardiovascular complications thought to be due to hyperactivity of the sympathetic nervous system include tachycardia. Autonomic dysfunction is seen as increased basal sympathetic activity and episodes of sympathetic over activity. direct inoculation can cause seizures. The effect of the toxin on the brain is controversial. often referred to as tetanustoxin. Tetanus Symptoms In generalized tetanus. The typical clinical manifestations of tetanus are caused when tetanus toxin interferes with release of neurotrasmitters. blocking inhibitor impulses Blockade of spinal inhibition is produced when the toxin acts at the synapse of inter neurons of inhibitory pathways and motor neurons. including peripheral motor end plates. •Facial muscles are often affected first. General muscle rigidity arises from uninhibited afferent stimuli entering the central nervous system from the periphery.infection) and tetanospasmin (apotent neurotoxin) are produced. A . causes clinical tetanus.Trismus or lockjaw is most common. the initial complaints may include any of the following: • Irritability. weakness. it does not enter the central nervoussystem through this route. Tetanospasmin. protected from neutralizing antitoxin. The toxin is exclusively taken up by the neuromuscular junction. The toxin produced is disseminated through thebloodstream and lymphatic system. or difficulty swallowing are commonly seen. with heart rates over 180 beats per minute. exhaustion and pulmonary aspiration. The toxin acts after the incubation period (3-14) days) at several sites with int he central nervous system. as it cannot cross the blood brain barrier except at thefourth ventricle. severe vasoconstriction and hypertension. a process which takes 3-14 days. muscle cramps.

•Severe cases can involve spasms of the vocal cords or musclesinvolved in breathing. unless medical help(mechanical ventilation with a respirator) is readily available. death is likely. of the stomach. which is where bone begins to form in thesoft tissues. making breathing difficult.is a characteristic feature that results from facial muscle spasms. temporaryspasm that usually lasts for between 30-60 seconds. which can lead to a lower respiratory tractinfection. Laryngospasm Laryngospasm is where the larynx (voicebox) goes into a brief. Muscle spasms may be intenseenough to cause bones to break and joints to dislocate. Aspiration pneumonia If you have a tetanus infection.Aspiration pneumonia occurs as a result of inhaling the secretions. Laryngospasm preventsoxygen from reaching your lungs. orcontents. . Complications of Tetanus In cases of severe tetanus infection.sardonic smile --medically termed risussardonicus-. as wellas in other bones. Bone fractures can sometimes result in a condition calledmyositis ossificans circumscripta. •Muscle spasms are progressive and may include a characteristicarching of the back known as opisthotonus. muscle rigidity (stiffness) can make coughingand swallowing difficult. often around a joint. If this happens. a number of possible complications candevelop Fractures The repeated muscle spasms and convulsions that are caused by a tetanusinfection may lead to fractures in the vertebrae (bones in the back). This can cause aspiration pneumonia to develop.

resulting in myoglobin (a muscleprotein) leaking into the urine. It is therefore vital that treatment is givenimmediately in the form of anti-clotting medication and. Someone with a severe tetanus infection may experience severe andfrequent tetanic seizures. This can lead to acute (severe) renal failure(kidney failure). Theycan occur in severe cases of tetanus where the infection has spread to thebrain.It is caused by a blockage in a blood vessel in the lungs that can affectbreathing and circulation. Acute renal failure The severe muscle spasms that are associated with a tetanus infection cancause a condition that is known as rhabdomyolysis. Symptoms of Tetanus       Stiffness of your abdominal muscles Painful body spasms Fever Sweating Spasms and stiffness in your jaw muscles Stiffness of your neck muscles . if required. Preventing tetanus Immunisation is the best way to prevent a tetanus infection from occurring. Thevaccine enables your body to create antibodies against the tetanus toxin(tetanospasmin).The complete course of the tetanus vaccination consists of five doses. Rhabdomyolysis is wherethe skeletal muscles are rapidly destroyed. providing protection from the illness should you be exposedto the Clostridium tetani bacterium in the future. Pulmonary embolism A pulmonary embolism is a serious and potentially life-threatening condition. oxygentherapy.Tetanic seizures Tetanic seizures are convulsions (fits) that are similar to epileptic fits.

Nursing Intervention for Tetanus Client         Protect the client from injury. Prevent client from having spasms by: Controlling the environment Avoiding stress.   Maintain adequate airway and ventilation. Lack of rest requirements related to frequent seizures. Monitor client for signs of arrythmias. . turning. Provision of cluster care is a must. Maintain an intravenous line. Provide comfort measures. coughing. cluster care is doing all nursing measures in one setting. Breathing pattern disorders related to impaired airway due to spasm of respiratory muscles Lack of knowledge of the client and family about tetanus disease related to lack of information. and jarring the bed of the client The nurse should organize the activity of the client. The nurse should also turn the client to prevent respiratory problems. less than body requirements related to the mastication muscle stiffness Disturbed interpersonal relationships related to speech difficulties Impaired daily needs related to the condition of weak and frequent seizures The risk of fluid and electrolyte imbalances related to intake of less and oliguria Risk of injury related to frequent seizures Ineffective airway clearance related to the accumulation of sputum in the trachea and respiratory muscle spasms.   Difficulty swallowing Elevated blood pressure Rapid heart rate Nursing Diagnosis for Tetanus           Increased body temperature (hyperthermia) related to the effects of toxins (bacteremia) Changes in nutrition. Gentle nursing care is also required. or flatus to occur to the patient Avoid touching. pain.

Therefore they will need to be vaccinated. prevention and control of tetanus Once a person has tetanus. Neonatal tetanus can also be prevented by vaccinating women of childbearing age with tetanus toxoid vaccine. This protects the mother and enables anti-tetanus antibodies to be transferred to the growing fetus in her uterus. or the pentavalent (fivefold) vaccine. need to implement a series of prevention strategies. which include those listed in Box 3.  Do you think that tetanus can ever be eradicated? Explain why. Tetanus toxoid (TT) vaccination The tetanus vaccine contains inactivated tetanus toxoid (poison). either during pregnancy or before pregnancy. Tetanus toxoid vaccination is given routinely to newborns and infants as part of the threefold DPT vaccine (with diphtheria and pertussis vaccines). which is why it is often called TT vaccine. tetanus. Notice that elimination of a communicable disease does not mean there are no cases — just very few right across a country or region. Reveal answer To achieve the elimination goal. and a bacterium called Haemophilus influenzae type B (Hib). Elimination in this case would mean that the number of neonatal tetanus cases would have to be reduced to below one case per 1. prevention is the best strategy. and vaccination is the best way to prevent tetanus.  What is the name given to this mode of transmission? (You learned about it in Study Session 1 in reference to infectious agents being transferred from mother to baby). However. People who recover from tetanus do not have increased natural immunity and so they can be infected again. Reveal answer Cleanliness is also very important. The World Health Organization (WHO) and UNICEF set a goal to eliminate neonatal tetanus by 2005. Eradication means the total and sustained disappearance of the disease from the population.1.Treatment. . which includes vaccines for diphtheria. Antibiotics are medicines that destroy bacteria. or stop them from multiplying in the body.000 live births per year in every district. even if she has been vaccinated with TT vaccine. or why not. especially when a mother is delivering a baby. Hence. he or she will be treated by an antibiotic drug. countries like Ethiopia. with a high number of tetanus cases every year. many people who have tetanus die despite the treatment. Hepatitis B (a virus). Clean delivery practices are described in the Labour and Delivery Care Module. pertussis.

. through better hygiene and care of the newborn’s umbilicus.1 Strategies to prevent and control tetanus  Vaccinating a higher percentage of pregnant women against tetanus with vaccines containing tetanus toxoid (TT).  Vaccinating all females of childbearing age (approximately 15–45 years) with TT vaccine in high-risk areas where vaccination coverage is currently low.  Outreach vaccination campaigns where health workers go to rural villages and give TT vaccine.Box 3.  Promoting clean delivery and childcare practices. usually three times at intervals (known as a ‘three-round’ vaccination campaign).  Improving surveillance and reporting of cases of neonatal tetanus. The case finding and reporting will help us to give appropriate treatment and vaccination to children.

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