Tetanus

Definition
Tetanus is an infectious disease caused by contamination of wounds from bacteria that live in the soil. The causative bacterium Clostridium tetani is a hardy organism capable of living many years in the soil in a form called a spore.

The usual locations for the bacteria to enter your body are puncture wounds, such as those caused by rusty nails, splinters or insect bites. Burn, any break in the skin, and IV drug access sites are also potential entryways for the bacteria. Tetanus is acquired through contact with environment; it is not transmitted from person to person.

Etiology
1. Surgery
2. Crush wound
3. Abscess
4. Child birth
5. IV drug users (site of needle injection).



Clinical Manifestation
1. Severe and uncontrolled muscle spasm
2. Jaw is locked due to muscle spasm
3. Respiratory muscle spasm
4. Lack of oxygen supply to brain
5. Fever
6. Elevated blood pressure
7. Irregular heart beat
8. Death

Investigations
The "spatula test" is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a sterile, soft-tipped instrument, and observing the effect.
A +ve test result is the involuntary contraction of the jaw (biting down on the "spatula")
A -ve test result would normally be a gag reflex attempting to expel the foreign object.



Treatment
If mild tetanus
1. Debridement (removal of dead tissues)
2. Anti-tetanospasmin Immunoglobulin
3. Antibiotic - Metronidazole, Penicillin
4. Analgesia
5. Sedative - Diazepam
6. Rehydration
7. Ventilator
................................................................................
If severe tetanus
8. Tracheostomy
9. Intravenous (I/V) Magnesium
10. I/V Diazepam
11. I/V Total Parental Nutrition (TPN)

Prevention
Tetanus vaccination