Tetanus is an infection characterized by a widespread hypertonic state that appears as excruciating jaw and neck muscular spasms. The disease most frequently strikes unvaccinated or older individuals with decreasing immunity. Tetanus causes spasms that can last for minutes to weeks and begin in the face before spreading to the rest of the body. Toxins released by the bacterium Clostridium tetani cause the symptoms.
There is no specific laboratory test to validate the clinical diagnosis of tetanus. Tetanus immunoglobulin, muscle spasms neuromuscular inhibition, antibiotic therapy, supportive care for breathing problems and autonomic instability, are all included in the treatment. After recovery from the illness, complete tetanus immunization is necessary. Survivors have described long-term effects.
Epidemiology
Tetanus affects people of all ages, although infants and young children have the highest prevalence. According to the World Health Organization, tetanus vaccination efforts have been active in recent years, decreasing tetanus fatality rates. The WHO estimates that there were 14,132 cases of tetanus worldwide in 2011, down from an estimated 275,000 cases in 1997.
With fatality rates ranging from 20% to 45% due to the infection, tetanus is still disproportionately more common in low-reserve settings than in developed nations. The accessibility of resources, mainly mechanical breathing, blood pressure monitoring, and early treatment, affect mortality rates.
Due to widespread routine vaccination against tetanus, pertussis, and diphtheria, in addition to other vaccines, the prevalence of neonatal tetanus is declining. Tetanus cases in newborns are primarily brought on by insufficient neonatal vaccination. Around the world, 84% of infants younger than 12 months old were tetanus-free in 2013.
Intravenous drug users are at risk because of infected needles or substances. Tetanus is a condition that only affects developing nations. It occurs more frequently in males, in hotter regions, and in areas with higher farming. Additionally, neonates and infants in nations without an immunization regimen are more likely to contract it.
Anatomy
Pathophysiology
Tetanospasmin and Tetanolysin, which C. tetani releases, cause the recognizable tetanic spasm, or generalized tightening of antagonistic and agonist muscles. Tetanospasmin alters the way nerves and muscles move, resulting in the clinical condition of muscle spasms, autonomic instability, and stiffness. Tetanolysin, on the other hand, harms the tissues.
Tetanus spores penetrate in body through the inoculation site and grow in the wound. Specific anaerobic conditions, such as devitalized tissue with low oxidation-reduction potential, are required for germination. They produce tetanospasmin, which is released into the blood during germination.
The incubation phase can vary from one to sixty days, but it usually lasts between seven and ten. The proximity of the central nervous system affects how severe the symptoms are, and shorter incubation times are linked to more severe symptoms. Autonomic dysfunction starts to manifest once the neurotoxin extends to the brainstem, usually in the second week after the onset of symptoms.
Patients may present with labile blood pressure and heart rate, cardiac arrest, bradyarrhythmia, and diaphoresis due to the lack of autonomic control. A 10% death rate for persons with the infection is common; it is significantly greater for those who have not received vaccination in the past. Symptoms might continue for weeks or months. Although survivors frequently experience long-term motor and neuropsychiatric difficulties, many recover fully.
Etiology
The bacterium Clostridium tetani, present in the dirt, dust, or animal feces, causes tetanus infections. It is an obligate anaerobic gram-positive bacillus that produces spores. Although these bacteria and their spores can be found worldwide, they are usually found in hot, humid areas with rich organic soil. C. tetani may enter a person’s body through a bite from an infected insect or through a wound puncture, laceration, skin break, or inoculation with an infected syringe.
The most frequent cause of infection is a small, perhaps invisible wound, like a laceration from thorns, splinters, or pieces of metal. Unvaccinated, immunosuppressed individuals, and intravenous drug users, are among the high-risk groups. Surgical operations, compound fractures, intramuscular injections, dental infections, and dog bites have all been linked to additional infection-causing factors.
Tetanus spores are resilient and can endure for a long time in some settings. In most instances, a wound, frequently caused by a minor injury, is the source of the infection. Lack of immunization is one of the most frequent causes of tetanus. Immunity declines with age, even in people who have received vaccinations.
The following are risk factors for neonatal tetanus:
Unvaccinated mother delivery at home
Severing the umbilical cord septically
A previous child who had neonatal tetanus
Application of infectious materials, such as mud, animal dung, or other similar materials, to the umbilical stump.
Genetics
Prognostic Factors
The interval between the initial symptom and the initial spasm determines the prognosis after tetanus. The prognosis is typically poor due to the rapid onset of symptoms. Tetanus healing is difficult and might take months. The prognosis for both newborn and cephalic tetanus is not good.
Some individuals experience autonomic dysfunction and hypotonia that linger for months or years. Tetanus toxoid is required even for those who survive because the infection does not provide immunity. Though recovery is slow, patients typically recover from this condition; some patients may continue to be hypotonic.
Indicated for Tetanus
Active tetanus: 3000-6000 Units intramuscular
Prophylaxis: 250 units intramuscular as single dose
Clean minor wound
No. of doses is 0-2 doses/unknown: toxoid only
No. of doses is >3 doses: toxoid if it is >10 years ago
All other wounds
No. of doses is 0-1 doses/unknown: toxoid and IG
No. of doses is 2 doses: toxoid, no IG, if the wound <24 hrs old
No. of doses is >3 doses: toxoid if it is >5 years ago, no IG
Indicated for Tetanus as Prophylaxis
Age <7 years
4 units/Kg or 250 units intramuscular
Age >7 years
250 units intramuscular as a single therapy
Tetanus therapy
3000-6000 Units intramuscular
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References
https://www.ncbi.nlm.nih.gov/books/NBK459217/
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Tetanus is an infection characterized by a widespread hypertonic state that appears as excruciating jaw and neck muscular spasms. The disease most frequently strikes unvaccinated or older individuals with decreasing immunity. Tetanus causes spasms that can last for minutes to weeks and begin in the face before spreading to the rest of the body. Toxins released by the bacterium Clostridium tetani cause the symptoms.
There is no specific laboratory test to validate the clinical diagnosis of tetanus. Tetanus immunoglobulin, muscle spasms neuromuscular inhibition, antibiotic therapy, supportive care for breathing problems and autonomic instability, are all included in the treatment. After recovery from the illness, complete tetanus immunization is necessary. Survivors have described long-term effects.
Tetanus affects people of all ages, although infants and young children have the highest prevalence. According to the World Health Organization, tetanus vaccination efforts have been active in recent years, decreasing tetanus fatality rates. The WHO estimates that there were 14,132 cases of tetanus worldwide in 2011, down from an estimated 275,000 cases in 1997.
With fatality rates ranging from 20% to 45% due to the infection, tetanus is still disproportionately more common in low-reserve settings than in developed nations. The accessibility of resources, mainly mechanical breathing, blood pressure monitoring, and early treatment, affect mortality rates.
Due to widespread routine vaccination against tetanus, pertussis, and diphtheria, in addition to other vaccines, the prevalence of neonatal tetanus is declining. Tetanus cases in newborns are primarily brought on by insufficient neonatal vaccination. Around the world, 84% of infants younger than 12 months old were tetanus-free in 2013.
Intravenous drug users are at risk because of infected needles or substances. Tetanus is a condition that only affects developing nations. It occurs more frequently in males, in hotter regions, and in areas with higher farming. Additionally, neonates and infants in nations without an immunization regimen are more likely to contract it.
Tetanospasmin and Tetanolysin, which C. tetani releases, cause the recognizable tetanic spasm, or generalized tightening of antagonistic and agonist muscles. Tetanospasmin alters the way nerves and muscles move, resulting in the clinical condition of muscle spasms, autonomic instability, and stiffness. Tetanolysin, on the other hand, harms the tissues.
Tetanus spores penetrate in body through the inoculation site and grow in the wound. Specific anaerobic conditions, such as devitalized tissue with low oxidation-reduction potential, are required for germination. They produce tetanospasmin, which is released into the blood during germination.
The incubation phase can vary from one to sixty days, but it usually lasts between seven and ten. The proximity of the central nervous system affects how severe the symptoms are, and shorter incubation times are linked to more severe symptoms. Autonomic dysfunction starts to manifest once the neurotoxin extends to the brainstem, usually in the second week after the onset of symptoms.
Patients may present with labile blood pressure and heart rate, cardiac arrest, bradyarrhythmia, and diaphoresis due to the lack of autonomic control. A 10% death rate for persons with the infection is common; it is significantly greater for those who have not received vaccination in the past. Symptoms might continue for weeks or months. Although survivors frequently experience long-term motor and neuropsychiatric difficulties, many recover fully.
The bacterium Clostridium tetani, present in the dirt, dust, or animal feces, causes tetanus infections. It is an obligate anaerobic gram-positive bacillus that produces spores. Although these bacteria and their spores can be found worldwide, they are usually found in hot, humid areas with rich organic soil. C. tetani may enter a person’s body through a bite from an infected insect or through a wound puncture, laceration, skin break, or inoculation with an infected syringe.
The most frequent cause of infection is a small, perhaps invisible wound, like a laceration from thorns, splinters, or pieces of metal. Unvaccinated, immunosuppressed individuals, and intravenous drug users, are among the high-risk groups. Surgical operations, compound fractures, intramuscular injections, dental infections, and dog bites have all been linked to additional infection-causing factors.
Tetanus spores are resilient and can endure for a long time in some settings. In most instances, a wound, frequently caused by a minor injury, is the source of the infection. Lack of immunization is one of the most frequent causes of tetanus. Immunity declines with age, even in people who have received vaccinations.
The following are risk factors for neonatal tetanus:
Unvaccinated mother delivery at home
Severing the umbilical cord septically
A previous child who had neonatal tetanus
Application of infectious materials, such as mud, animal dung, or other similar materials, to the umbilical stump.
The interval between the initial symptom and the initial spasm determines the prognosis after tetanus. The prognosis is typically poor due to the rapid onset of symptoms. Tetanus healing is difficult and might take months. The prognosis for both newborn and cephalic tetanus is not good.
Some individuals experience autonomic dysfunction and hypotonia that linger for months or years. Tetanus toxoid is required even for those who survive because the infection does not provide immunity. Though recovery is slow, patients typically recover from this condition; some patients may continue to be hypotonic.
Indicated for Tetanus
Active tetanus: 3000-6000 Units intramuscular
Prophylaxis: 250 units intramuscular as single dose
Clean minor wound
No. of doses is 0-2 doses/unknown: toxoid only
No. of doses is >3 doses: toxoid if it is >10 years ago
All other wounds
No. of doses is 0-1 doses/unknown: toxoid and IG
No. of doses is 2 doses: toxoid, no IG, if the wound <24 hrs old
No. of doses is >3 doses: toxoid if it is >5 years ago, no IG
Indicated for Tetanus as Prophylaxis
Age <7 years
4 units/Kg or 250 units intramuscular
Age >7 years
250 units intramuscular as a single therapy
Tetanus therapy
3000-6000 Units intramuscular
https://www.ncbi.nlm.nih.gov/books/NBK459217/
medtigo
Tetanus
Updated :
September 6, 2023
Tetanus is an infection characterized by a widespread hypertonic state that appears as excruciating jaw and neck muscular spasms. The disease most frequently strikes unvaccinated or older individuals with decreasing immunity. Tetanus causes spasms that can last for minutes to weeks and begin in the face before spreading to the rest of the body. Toxins released by the bacterium Clostridium tetani cause the symptoms.
There is no specific laboratory test to validate the clinical diagnosis of tetanus. Tetanus immunoglobulin, muscle spasms neuromuscular inhibition, antibiotic therapy, supportive care for breathing problems and autonomic instability, are all included in the treatment. After recovery from the illness, complete tetanus immunization is necessary. Survivors have described long-term effects.
Tetanus affects people of all ages, although infants and young children have the highest prevalence. According to the World Health Organization, tetanus vaccination efforts have been active in recent years, decreasing tetanus fatality rates. The WHO estimates that there were 14,132 cases of tetanus worldwide in 2011, down from an estimated 275,000 cases in 1997.
With fatality rates ranging from 20% to 45% due to the infection, tetanus is still disproportionately more common in low-reserve settings than in developed nations. The accessibility of resources, mainly mechanical breathing, blood pressure monitoring, and early treatment, affect mortality rates.
Due to widespread routine vaccination against tetanus, pertussis, and diphtheria, in addition to other vaccines, the prevalence of neonatal tetanus is declining. Tetanus cases in newborns are primarily brought on by insufficient neonatal vaccination. Around the world, 84% of infants younger than 12 months old were tetanus-free in 2013.
Intravenous drug users are at risk because of infected needles or substances. Tetanus is a condition that only affects developing nations. It occurs more frequently in males, in hotter regions, and in areas with higher farming. Additionally, neonates and infants in nations without an immunization regimen are more likely to contract it.
Tetanospasmin and Tetanolysin, which C. tetani releases, cause the recognizable tetanic spasm, or generalized tightening of antagonistic and agonist muscles. Tetanospasmin alters the way nerves and muscles move, resulting in the clinical condition of muscle spasms, autonomic instability, and stiffness. Tetanolysin, on the other hand, harms the tissues.
Tetanus spores penetrate in body through the inoculation site and grow in the wound. Specific anaerobic conditions, such as devitalized tissue with low oxidation-reduction potential, are required for germination. They produce tetanospasmin, which is released into the blood during germination.
The incubation phase can vary from one to sixty days, but it usually lasts between seven and ten. The proximity of the central nervous system affects how severe the symptoms are, and shorter incubation times are linked to more severe symptoms. Autonomic dysfunction starts to manifest once the neurotoxin extends to the brainstem, usually in the second week after the onset of symptoms.
Patients may present with labile blood pressure and heart rate, cardiac arrest, bradyarrhythmia, and diaphoresis due to the lack of autonomic control. A 10% death rate for persons with the infection is common; it is significantly greater for those who have not received vaccination in the past. Symptoms might continue for weeks or months. Although survivors frequently experience long-term motor and neuropsychiatric difficulties, many recover fully.
The bacterium Clostridium tetani, present in the dirt, dust, or animal feces, causes tetanus infections. It is an obligate anaerobic gram-positive bacillus that produces spores. Although these bacteria and their spores can be found worldwide, they are usually found in hot, humid areas with rich organic soil. C. tetani may enter a person’s body through a bite from an infected insect or through a wound puncture, laceration, skin break, or inoculation with an infected syringe.
The most frequent cause of infection is a small, perhaps invisible wound, like a laceration from thorns, splinters, or pieces of metal. Unvaccinated, immunosuppressed individuals, and intravenous drug users, are among the high-risk groups. Surgical operations, compound fractures, intramuscular injections, dental infections, and dog bites have all been linked to additional infection-causing factors.
Tetanus spores are resilient and can endure for a long time in some settings. In most instances, a wound, frequently caused by a minor injury, is the source of the infection. Lack of immunization is one of the most frequent causes of tetanus. Immunity declines with age, even in people who have received vaccinations.
The following are risk factors for neonatal tetanus:
Unvaccinated mother delivery at home
Severing the umbilical cord septically
A previous child who had neonatal tetanus
Application of infectious materials, such as mud, animal dung, or other similar materials, to the umbilical stump.
The interval between the initial symptom and the initial spasm determines the prognosis after tetanus. The prognosis is typically poor due to the rapid onset of symptoms. Tetanus healing is difficult and might take months. The prognosis for both newborn and cephalic tetanus is not good.
Some individuals experience autonomic dysfunction and hypotonia that linger for months or years. Tetanus toxoid is required even for those who survive because the infection does not provide immunity. Though recovery is slow, patients typically recover from this condition; some patients may continue to be hypotonic.
https://www.ncbi.nlm.nih.gov/books/NBK459217/
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