Tetanus (Lockjaw)
 Causative agent: Clostridium tetani
 Incubation period: 3 days to 3 weeks
 Period of communicability: None
 Mode of transmission: Direct or indirect
contamination of a closed wound
 Immunity: Development of the disease
gives lasting natural immunity
 Active artificial immunity: Tetanus
toxoid contained in DTaP vaccine
 Passive artificial immunity: Tetanus
immune globulin
 Tetanus, a highly fatal disease if untreated,
is caused by an anaerobic, spore-forming
bacillus found in soil and the excretions of
animals.
 It enters the body through an open wound.
 If the wound is deep, such as a stab
wound, where the distal end of the wound
is shut off from an oxygen source, tetanus
bacilli begin to reproduce.
 The organism may also enter through a
burn site, which crusts, thus creating an
anaerobic environment. As the bacilli
grow, they produce exotoxins that cause
the disease symptoms by affecting the
motor nuclei of the central nervous system
 The entrance site of the bacillus does not
appear infected (no pus or reddened area
is present unless a secondary infection
also exists).
 After the incubation period, the exotoxins
have developed to such an extent,
however, that they are capable of
disrupting the nervous system.
 In the US, most children are vaccinated
against tetanus. In developing countries, it
continues to have a high incidence, caused
by infection of an entry point such as the
umbilical cord at birth
S/Sx
 first symptoms that are noticeable are
stiffness of the neck and jaw (lockjaw).
 Within 24 to 48 hours, muscular rigidity
of the trunk and extremities develops. The
back becomes arched (opisthotonos), the
abdominal muscles are stiff and boardlike,
and the face assumes an unusual
appearance, with wrinkling of the
forehead and distortion of the corners of
the mouth (a “sardonic grin” sign).
 Any stimulation, such as a sudden noise, a
bright light, or a touch, causes painful,
paroxysmal spasms.
 The sensorium is clear throughout the
course of the disease, so the child is aware
of the pain associated with the muscle
spasms.
 As these spasms begin to include the
larynx, respiratory obstruction and death
by asphyxiation can occur.
THEARAPEUTIC MANAGEMENT
 A child needs to be cared for in a quiet,
stimulation-free room with total parenteral
nutrition, sedation, and a muscle relaxant
to prevent aspiration from muscle spasms.
 If the wound is fi lled with necrotic tissue,
it may be debrided to ensure no secondary
infections arise.
 Tetanus immune globulin (human) is
administered to supply passive antitoxin
 parenteral penicillin G or erythromycin
will be administered to reduce the number
of growing forms of the bacillus.
 A child may need to be intubated and
mechanical ventilation begun to maintain
respiratory func
PREVENTION
 can be prevented through active
immunization and suitable booster
immunizations.
 Children routinely receive tetanus
immunization as part of routine DTaP
immunization with a booster dose at
school age; thereafter, they should receive
a booster dose every 10 years.
 At the time of a wound, the wound site
should be cleaned well with soap and
water and a suitable antiseptic.
 It SHOULD NOT be sutured but should
be left open to heal by secondary
intention to reduce the possibility of an
anaerobic pocket forming in the wound.
 If the child received basic immunization
against tetanus and it has been fewer than
10 years since the last injection, no
booster or antitoxin management is
needed at the time of the wound.
 If a child’s immunization record cannot
be obtained, or if it has been more than 10
 years since the child received a booster
injection or an initial injection for tetanus,
a child will be treated with a booster
injection and tetanus immune globulin.
 The booster injection provides tetanus
antigen to the child. The booster injection
will cause the body to “remember” how
to make tetanus antibodies so, by the time
the invading tetanus organisms from the
wound have passed their long incubation
period (3 days to 3 weeks), the child will
have antibodies in the system prepared to
eradicate the organisms.
 If the initial immunizations were
incomplete or are unknown, in addition to
tetanus antigen, the child will also receive
the passive antibodies included in tetanus
immune globulin.
Helminthic Infections
 Helminths are pathogenic or parasitic
worms. They include roundworms
(nematodes), flukes (trematodes), or
tapeworms (cestodes).
 Most helminths begin life when the eggs
or larvae are eliminated in the feces or
urine of humans.
 They are then transmitted to the oral
cavity by contaminated foods or hands.
 Children tend to be careless about washing
their hands before eating or tend to suck
their thumbs, it makes them prone to these
infections.
Roundworms (Ascariasis)
 The roundworm parasite lives in the
intestinal tract.
 Larvae, which hatch from the ingested
eggs, penetrate the intestinal wall and
enter the circulation. From there, they may
migrate to any body tissue.
 S/Sx; Children develop a loss of appetite
and perhaps nausea and vomiting.
Intestinal obstruction may occur from a
mass of roundworms in the intestine.
 Ascariasis can be prevented by the
sanitary disposal of feces to prevent
contamination of the soil.
 A single dose of an anthelmintic such as
pyrantel pamoate (Antiminth) controls the
infection.
Hookworms
 Hookworm eggs, like roundworm eggs,
are found in human feces.
 They enter children’s bodies through the
skin and then migrate to the intestinal
tract, where they attach themselves onto
the intestinal villi and suck blood from the
intestinal wall to sustain themselves.
 If a great number of hookworms are
present, severe anemia may result.
 Treatment is with anthelmintics.
 Children may also need therapy for the
anemia.
Pinworms
 Pinworms are small, white, threadlike
worms that live in the cecum.
 At night, the female pinworm migrates
down the intestinal tract and out of the
anus to deposit eggs on the skin in the anal
and perianal region.
 The movement of the worms causes the
anal area to itch, and the child will awaken
at night crying and scratching.
 Some of the eggs are then carried from the
child’s fingernails to the mouth. After
being ingested, they hatch in the child’s
intestinal tract, and the cycle is repeated
 The worms are large enough that they can
be seen if the child’s buttocks are
separated.
 Pressing a piece of cellophane tape against
the anus, then inspecting it under a
microscope will generally reveal pinworm
eggs.
 Treatment is with a single dose of
mebendazole (Vermox) or pyrantel
pamoate (Antiminth)
 Underclothing, bedding, towels, and
nightclothes should be washed before
reuse.
 In addition, all family members need to be
treated for pinworm infestation because
the worms are easily transmitted from
person to person.
 Teach children to avoid nail biting and to
wash their hands before food preparation
or eating to avoid transfer of pinworm
eggs and to prevent this type of infection.