Mcq

• Tetanus


  Disease resulting from infection with Clostridium tetani, a commensal in the gut of humans and domestic animals found in soil. Infection enters the body through wounds, which may be trivial.

  
• Tetanus is rare in developed countries, occurring mostly in gardeners and farmers, but a recent increase has been seen in injection drug users.

  
• Tetanus is common in many countries, where dust contains spores derived from animal and human excreta.

  
• Unhygienic practices soon after birth may lead to infection of the umbilical stump or site of circumcision, causing tetanus neonatorum.
• Tetanus is still one of the major killers of adults, children and neonates in low-income countries, where the mortality rate can be nearly 100% in the newborn and around 40% in others.

  
• Tetanus infection


  1. Spores germinate

  2. Bacilli multiply in anaerobic conditions

  3. Bacilli produce exotoxin

  4. Exotoxin affects motor nerve endings and cells

  
• Tetanus exotoxin


  • Has affinity for motor nerve endings and motor nerve cells
  • Affects anterior horn cells after passing into blood stream
• Trismus


  Spasm of the masseter muscles, causing difficulty in opening the mouth and masticating
• Lockjaw in tetanus is painless, unlike the spasm of the masseters due to dental abscess, septic throat or other causes.

  
• Tetanus symptoms


  • Tonic rigidity spreads to involve muscles of face, neck and trunk
  • Contraction of frontalis and muscles at angles of mouth leads to 'risus sardonicus'
  • Rigidity of neck and trunk muscles
  • Back arched ('opisthotonus')
  • Board-like abdominal wall

  
• Severe tetanus cases


  • Violent spasms lasting a few seconds to 3-4 minutes
  • Spasms occur spontaneously or induced by stimuli
  • Spasms are painful and exhausting
  • Spasms gradually increase in frequency and severity for about 1 week
• Patients may die from exhaustion, asphyxia or aspiration pneumonia.
• In less severe illness, periods of spasm may not commence until a week or so after the first sign of rigidity, and in very mild infections they may never appear.
• Autonomic involvement may cause complications, such as hypertension.
• Rarely, the only cause of cardiovascular manifestation of the disease may be "local tetanus"- stiffness or spasm of the muscles near the infected wound- and the prognosis is good if treatment is commenced at this stage.

  
• Diagnosis

  Made on clinical grounds, laboratory testing supports but treatment should not be delayed
• Tetanus management


  1. Neutralise absorbed toxin

  2. Prevent further toxin production

  3. Control spasms

  4. General measures
• Neutralise absorbed toxin


  Use human tetanus antitoxin or IVIG if antitoxin unavailable

  
• Prevent further toxin production

  • Debride wound
  • Give metronidazole or penicillin G
• Control spasms

  • Nurse in quiet room
  • Avoid unnecessary stimuli
  • Give IV diazepam
  • Paralyse and ventilate if spasms continue
• General measures


  • Maintain hydration and nutrition
  • Treat secondary infections
  • Vaccination following recovery
• Tetanus prevention


  • Immunisation
  • Prompt treatment of contaminated wounds by debridement and antibiotics

  
• Tetanus can be prevented by immunisation and prompt treatment of contaminated wounds by debridement and antibiotics.

  
• Tetanus is a serious, life threatening, infectious disease but easily preventable with appropriate wound management and vaccination program.