TETANUS

CASE PRESENTATION BY BINAL JOSHI

 ANATOMY OF NERVOUS SYSTEM
• The nervous system is an organ system
containing a network of specialized cells called
neurons that coordinate the actions and transmit
signals between different parts of its body. The
nervous system consists of two parts, central
and peripheral.
• The central nervous system contains the brain,
and spinal cord. The peripheral nervous system
consists of sensory neurons, clusters of
neurons called ganglia, and nerves connecting
them to each other and to the central nervous
system.
• The Brain – Processes incoming
information from within the body, and
outside the body by way of the sensory
nerves of sight, touch, smell, sound, and
taste. Commands are then sent back
throughout the body.
• The brain also stores and processes
language, communication, emotions,
thoughts, dreams, and memories. In other
words, the brain is where all thinking and
decision-making takes place.
• The Spinal Cord – Is the main pathway for
information connecting the brain and
peripheral nervous system. It extends
from the brain about 18 inches down the
bony spinal column, which serves as its
protection. The spinal cord is a tube
made up of nerve fibers. Electrical
impulses travel through the nerves and
allow the brain to communicate with the
rest of the body.
The PNS includes:

– The Somatic Nervous System

(SNS) – Responsible for all
muscular activities that we
consider voluntary or that are
within our conscious control.
The Autonomic Nervous System (ANS) –
• Responsible for all activities that occur
automatically and involuntarily, such as
breathing, muscle contractions within the
digestive system, and heartbeat. The
components of the ANS work together to
create a balanced response to outside
stimuli1.
TETANUS
• A disease caused by chemicals which are
produced by a bacterium (clostridium
tetani) and are toxic to the nerves.
• The infection usually occurs when the
bacteria enter the body through a deep
wound - these bacteria are anaerobic and
hence don't need oxygen to survive
TETANUS
• Tetanus is an acute, often
fatal disease caused by an
exotoxin produced in a
woundby Clostridium tetani.

• Clostridium tetani is a gram-

positive, nonencapsulated,
motile, obligatively anaerobic
bacillus.
• It exists in vegetative and sporulated
forms.

• Spores are highly resistant to

disinfections by chemical or heat, but
vegetative forms are susceptible to the
bactericidal effect of heat, chemical
disinfectants, and a number of
antibiotics.
 PATHOPHYSIOLOGY IN BOOKS

• Clostridium tetani is a noninvasive

organism. It is found in soil and in the
intestine and feces of horses, sheep,
cattle, dogs, cats, rats, guinea pigs and
chicken. Manure-treated soil may contain
large numbers of spores too.
• After the spores of the bacterium
germinate, they release a toxin, which is
what causes all the ill-effects of the
disease.
• The toxin attacks the nervous system of
the body. The toxin, which is known as
tetanospasmin, runs along the spinal
cord, the blood stream of the peripheral
nervous system and prevents the neuron
from releasing the a neurotransmitter that
helps the body muscles to relax after a
contraction.
• Slowly as the bacterium proliferates in
the body, more and more toxin is
produced and it manages to find its way
to different groups of muscles. The toxin
particularly affects the jaw muscles, the
muscles of the back, arms, legs, neck and
abdomen, and the muscles that
control the diaphragm and the chest wall.
 Tetanus Symptoms

• Irritability, muscle cramps, sore muscles,

weakness, or difficulty swallowing are
commonly seen.
• Facial muscles are often affected first. Trismus
 or lockjaw is most common. This condition
results from spasms of the jaw muscles that are
responsible for chewing. A sardonicsmile --
medically termed risussardonicus –
• is a characteristic feature that
• results from facial muscle spasms.
• Muscle spasms are progressive and may include
a characteristic arching of the back known as
opisthotonus. Muscle spasms may be intense
enough to cause bones to break and joints to
dislocate.
• Severe cases can involve spasms of the vocal
cords or muscles involved in breathing. If this
happens, death is likely, unless medical help
(mechanical ventilation with a respirator) is
readily available
CLINICAL MANIFESTATION
• Signs and symptoms in the textbook
• Irritability/ Restlessness
• muscle cramps
• Weakness
• difficulty swallowing
• Lockjaw
• Stiffness
CLINICAL MANIFESTATION
• Reflex spasms
• high Blood pressure
• temperature
• Irregular heart beat
• Sweating
• Seizure
Complications of Tetanus
• In cases of severe tetanus infection, a number of
possible complications can develop
• Fractures
• The repeated muscle spasms and convulsions that
are caused by a tetanus infection may lead to
fractures in the vertebrae (bones in the back), as
well as in other bones. Bone fractures can
sometimes result in a condition called myositis
ossificans circumscripta, which is where bone
begins to form in the soft tissues, often around a
joint.
Pneumonia

• If you have a tetanus infection, muscle

rigidity (stiffness) can make coughing and
swallowing difficult. This can cause
aspiration pneumonia to develop. Aspiration
pneumonia occurs as a result of inhaling the
secretions, or contents, of the stomach,
which can lead to a lower respiratory tract
infection.
Laryngospasm
• Laryngospasm is where the larynx
(voicebox) goes into a brief, temporary
spasm that usually lasts for between 30-60
seconds. Laryngospasm prevents oxygen
from reaching your lungs, making breathing
difficult.
Tetanic seizures

• Tetanic seizures are convulsions (fits) that

are similar to epileptic fits. They can occur in
severe cases of tetanus where the infection
has spread to the brain. Someone with a
severe tetanus infection may experience
severe and frequent tetanic seizures.
Pulmonary embolism
• A pulmonary embolism is a serious and
potentially life-threatening condition. It is
caused by a blockage in a blood vessel in
the lungs that can affect breathing and
circulation. It is therefore vital that treatment
is given immediately in the form of anti-
clotting medication and, if required, oxygen
therapy.
Acute renal failure
• The severe muscle spasms that are
associated with a tetanus infection can
cause a condition that is known as
rhabdomyolysis. Rhabdomyolysis is where
the skeletal muscles are rapidly destroyed,
resulting in myoglobin (a muscle protein)
leaking into the urine. This can lead to acute
(severe) renal failure (kidney failure).
MANAGEMENT OF TETANUS
• Three principles apply:
• 1. Prevent further toxin release.
• 2. Neutralise toxin present in the body
outside the CNS.
• 3.Minimise the effects of the toxin already
in the CNS.
SPECIFIC TREATMENT
• Sedation
• Muscle relaxation
• Treatment of autonomic dysfunction.