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

  
• 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 anterior horn cells

  
• 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 slightly arched ('opisthotonus')
  • Board-like abdominal wall

  
• Severe tetanus cases


  • Violent spasms lasting for a few seconds to 3-4 minutes, occurring spontaneously or induced by stimuli
  • Spasms are painful and exhausting, and suggest a grave outlook

  
• Diagnosis of tetanus


  Made on clinical grounds, with laboratory testing supporting the diagnosis, but treatment should not be delayed while waiting for results

  
• Preventing further toxin production

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


  • Nurse in quiet room
  • Avoid unnecessary stimuli
  • Give IV diazepam
  • If spasms continue, paralyse patient and ventilate
• General measures


  • Maintain hydration and nutrition
  • Treat secondary infections
  • Vaccination following recovery
• Antibiotics for contaminated wounds

  Metronidazole, penicillin G, tetracyclines, macrolides, clindamycin, cephalosporins, chloramphenicol
• Tetanus is a serious, life threatening, infectious disease but easily preventable with appropriate wound management and vaccination program.