1. Tetanus

2. An acute disease induced by the exo-toxin of the bacillus, which is a neurotoxin called (tetanospasmin),affects neuromuscular junction.
caused by tetanus bacillus which grows anaerobically at the site of injury.
It inhibits the secretion of Acetylcholine-esterase enzyme leading to accumulation of Ach in the neuro-muscular junctions causing continuous re-polarization

3. characterized by painful muscular contraction primarily of the masseter muscle (locked jaw), facial muscle (reuses-sardonicus), neck, chest, abdomen, extremities (opisthotonus position),& the last dangerous sign (reflex spasm).
Severity depends on: site of injury, size & depth of injury, incubation period, onset time & age.

4. Infectious agent: Clostridium tetani Dx.: clinical only
Occurrence: worldwide, especially in agricultural & underdeveloped countries where contact with animals is high & immunization is inadequate.
Reservoir:
*intestine of horses & other animals & man where the
organism is a harmless normal inhabitant
*contaminated soil
*spores which are ubiquitous

5. M.O.T.: spores introduced into a wound contaminated with soil.
ppt. factors: deep wound, poor blood supply, foreign body, necrotic tissue, calcium salts, local infection.
Incubation period: days, usually 14 days
P.O.C.: no direct transmission
Susceptibility: general, infants get passive immunity from vaccinated mother.

6. Methods of control: A- Preventive measures:
1. Educate the public about necessity of
complete immunization
2. Universal active immunization
-routine schedule
-population at risk
-catch-up dose
-ten-years boostering
3. wound management
4. prophylaxis in wound management

7. Tetanus Prophylaxis in routine wound management
Hx. of Tetanus Immunization
Clean minor wounds
Td IG
All other wounds Td IG
Uncertain or
less than 3
Yes No
Yes Yes
More than 3
No No
No No
1 Yes if more than 10 years since last dose
2 Yes if more than 5 years since last dose

8. B. Control: Report No isolation, concurrent disinfection,
quarantine or immunization of contacts.
Specific Rx.: -Conservative
Antitoxin after checking for hypersensitivity.
C.P. or Metronidazole I.V days

9. Tetanus Neonatorum

10. Tetanus Neonatorum A Serious health problem,
deaths/year C.F.R.> 80%
Causes: dirty instruments, dressing & management during delivery.
Clinical picture: normal neonate in the first few days of life followed by crying, reluctance to feed, generalized spasm with whistling expression.

11. Prevention 1.Improving maternity care
2.Active immunization of mother: 4th month
3.Encourege deliveries at hospital
4.Train& educate midwives & Control of birth attendants