Tetanus Case Presentation

7/27/2019 Tetanus Case Presentation

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(lockjaw)



Tetanus is caused by the bacterium Clostridium tetani , the

spores of which are widespread in the environment. The

disease is caused by the action of a neurotoxin, produced

by the bacteria when they grow in the absence of oxygen,

e.g. in dirty wounds or in the umbilical cord if it is cut with a

non-sterile instrument. Tetanus is not transmitted from

person to person. A person usually becomes infected with

tetanus when dirt enters a wound or cut. Tetanus germs are

likely to grow in deep puncture wounds caused by dirty

nails, knives, tools, wood splinters, and animal bites (WHO,

2012).



As a result of widespread immunization, tetanus

is now a rare disease in the United States.

Tetanus occurs more often in older people and

in agricultural workers for who contact with

animal manure is more likely and immunization

is inadequate. Neonatal (newborn) tetanus

remains a major problem in many developingcountries where women are not immunized

appropriately against tetanus.



In unvaccinated individuals, tetanus is

contracted through a cut or deep wound which

becomes contaminated with the organism.Tetanus has also been associated with clean

wounds, surgical procedures, insect bites, dental

infections, and intravenous drug use. It is nottransmitted from person to person.



These spores are usually present throughout the

environment and is commonly found in soilcontaminated with manure, and animal and

human feces.



A common first sign of tetanus is muscular

stiffness in the jaw (lockjaw), followed by

stiffness of the neck, difficulty in swallowing,

rigidity of abdominal muscles, spasms, sweating,

and fever.



The incubation period is usually eight days but

may range from three days to three weeks.

Shorter incubation periods are associated with

more heavily contaminated wounds.



• The use of tetanus toxoid-containing vaccine andtetanus immune globulin (TIG) or antitoxin in themanagement of wounds depends on the nature

of the wound and the history of immunization.Persons with clean , minor wounds may need tocatch-up their tetanus toxoid-containing vaccine.For more severe wounds, persons may need TIG

in addition to vaccine.• If the disease develops, supportive care and

therapy to control severe spasms are indicated.



• TT vaccine protects only against tetanus and neonatal tetanus.

• DTP, or diphtheria-tetanus-pertussis vaccine, protects againstdiphtheria, tetanus, and pertussis (see Section 1 of thisModule).

• DT, or diphtheria-tetanus toxoids vaccine, protects againstdiphtheria and tetanus. Because it contains high levels of diphtheria toxoid, it should not be given to children older thansix years old or adults.

• TD, or tetanus-diphtheria toxoids adult dose vaccine, is the

same vaccine as DT, but with a lower diphtheria toxoid dose. Itis suitable for children older than six years old and adults,including pregnant women. Td has the added advantage of protecting against diphtheria and tetanus.



When given to women of childbearing age, vaccines that containtetanus toxoid (TT or Td) not only protect women against tetanus, butalso prevent neonatal tetanus in their newborn infants. When TT or Tdvaccine is given to a woman who is or who becomes pregnant, theantibodies that form in her body are passed to her fetus. Theseantibodies protect the baby against tetanus during birth and for a fewmonths afterwards. They also protect the woman against tetanus.

When vaccines containing tetanus toxoid stand for a long time, thevaccine separates from the liquid and looks like fine sand at the

bottom of the vial. Shake the vial to mix the vaccine and liquid againbefore giving the vaccine. TT/DT/Td/DTP vaccines should never befrozen. The “Shake test" will determine if the vaccine has beendamaged by freezing. If the vaccine fails the shake test you mustdiscard it.



Mild reactions to TT, Td, and DT vaccines include:

• Soreness. About one in ten people who receivethe vaccines have mild pain, redness, warmth,

and swelling at the injection site for about one tothree days after the injection. This mild reactionis likely to be more common after later dosesthan earlier ones, and may affect between 50%

and 85% of people who receive booster doses.• Fever. About one in ten people may develop a

mild fever after receiving the vaccines



Mild local or systemic reactions are common

and increase in frequency with increasing

numbers of doses, and may constitute a

contraindication to further doses.



Anaphylactic reaction to previous dose.



Toxoid as DPT, DT, TD or TT at least threeprimary doses given by the intramuscular route.



• Spasm of the vocal cords

• Spasms of the respiratory muscles causing

interference with breathing.

• Fractures of the spine or long bones from stiff

muscles

• Elevated blood pressure

• Abnormal heartbeats

• Coma



• Generalized infection

•

Clotting in the blood vessels of the lung• Pneumonia.

• Death occurs in about 11 percent of all cases,

especially in persons 60 years of age and olderand unvaccinated individuals.



• People of all ages can get tetanus but the

disease is particularly common and serious in

newborn babies ("neonatal tetanus").

• WHO estimated that neonatal tetanus killed

about 180 000 babies in 2002.



• Dosage: 0.5ml

•

Injection site: Outer upper arm• Injection type: Intramuscular

• Storage: Between 2°C –8°C. Never freeze

Tetanus Case Presentation

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