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anus
Tetanus
T etanus is a severe infectio n d ue to the bacillus Clostridium tetani, which is fo und in so il,
and h um an and anim al w aste. T h e infectio n is no t co m m unicable. C. tetani is
intro d uced into the bo d y thro ugh a wo und and p ro d uces a to xin who se actio n o n the
central nervo us sy stem is resp o nsible fo r the sy m p to m s o f tetanus.
T etanus is co m p letely p reventable th ro ugh vaccinatio n. I n unvaccinated ind ivid uals,
m o st break s in the sk in o r m uco us m em branes carry a risk o f tetanus, but the wo und s
with the greatest risk are: um bilical co rd stum p in newbo rns, o p erative sites in surgical
o r o bstetrical p ro ced ures p erfo rm ed und er no n-sterile co nd itio ns, p uncture wo und s,
wo und s with tissue lo ss o r co ntam inatio n with fo reign m aterial o r so il, avulsio n and
crush injuries, sites o f no n- sterile injectio ns, ch ro nic wo und s ( e.g. lo wer extrem ity
ulcers), burns and bites.
T etanus d evelo p s in p erso ns who have no t been co rrectly vaccinated befo re exp o sure,
o r have no t received ad equate p ro p hy lactic treatm ent im m ed iately after exp o sure.
Clinical features
G eneralised tetanus is the m o st frequent and severe fo rm o f the infectio n. I t p resents as
m uscular rigid ity , which p ro gresses rap id ly to invo lve the entire bo d y , and p aro xy sm al
m uscle sp asm s, which are very p ainful. L evel o f co nscio usness is no t altered .
Children and adults
– A verage p erio d fro m exp o sure to o nset o f sy m p to m s is 7 d ay s (3 to 2 1 d ay s)
– M uscular rigid ity is first seen in th e jaw m uscles ( d ifficulty , th en inability , in
o p ening th e m o uth [trism us], p reventing the p atient fro m sp eak ing, eating) then,
extend s to tho se o f the face (fixed sm ile [risus sard o nicus]), the neck (d ifficulty in
sw allo w ing ) , trunk ( restrictio n o f resp irato ry m uscles; h y p erextensio n
[o p isth o to no s]) , abd o m en (guard ing) and lim bs ( extensio n o f the lo wer lim bs and
flexio n o f the up p er lim bs).
– M uscle sp asm s ap p ear at the o nset o r when m uscular rigid ity beco m es generalised .
T hey are triggered by stim uli o r arise sp o ntaneo usly . S p asm s o f the th o racic and
lary ngeal m uscles m ay cause resp irato ry d istress o r asp iratio n.
Newborns
– In 9 0 % o f cases, initial sy m p to m s ap p ear within 3 to 1 4 d ay s o f birth.
– T he first signs are significant irritability and suck ing d ifficulties (rigid ity o f the lip s,
trism us), then rigid ity beco m es generalised , as in ad ults. A n infant qualifies as a case
of neonatal tetanus if it has suck ed and cried no rm ally fo r the first 2 d ay s o f life, then
beco m es irritable and sto p s suck ing 3 to 2 8 d ay s after birth , and d em o nstrates
rigid ity and m uscle sp asm s.
– A ltho ugh the um bilicus is alm o st alway s the p o rtal o f entry , clinical infectio n o f the
co rd site (o m p halitis) is evid ent in o nly o ne half o f cases.
– C heck fo r sep ticaem ia, which is frequently asso ciated .
170
Tetanus
T etanus is a severe infectio n d ue to the bacillus Clostridium tetani, which is fo und in so il,
and h um an and anim al w aste. T h e infectio n is no t co m m unicable. C. tetani is
intro d uced into the bo d y thro ugh a wo und and p ro d uces a to xin who se actio n o n the
central nervo us sy stem is resp o nsible fo r the sy m p to m s o f tetanus.
T etanus is co m p letely p reventable th ro ugh vaccinatio n. I n unvaccinated ind ivid uals,
m o st break s in the sk in o r m uco us m em branes carry a risk o f tetanus, but the wo und s
with the greatest risk are: um bilical co rd stum p in newbo rns, o p erative sites in surgical
o r o bstetrical p ro ced ures p erfo rm ed und er no n-sterile co nd itio ns, p uncture wo und s,
wo und s with tissue lo ss o r co ntam inatio n with fo reign m aterial o r so il, avulsio n and
crush injuries, sites o f no n- sterile injectio ns, ch ro nic wo und s ( e.g. lo wer extrem ity
ulcers), burns and bites.
T etanus d evelo p s in p erso ns who have no t been co rrectly vaccinated befo re exp o sure,
o r have no t received ad equate p ro p hy lactic treatm ent im m ed iately after exp o sure.
Clinical features
G eneralised tetanus is the m o st frequent and severe fo rm o f the infectio n. I t p resents as
m uscular rigid ity , which p ro gresses rap id ly to invo lve the entire bo d y , and p aro xy sm al
m uscle sp asm s, which are very p ainful. L evel o f co nscio usness is no t altered .
Children and adults
– A verage p erio d fro m exp o sure to o nset o f sy m p to m s is 7 d ay s (3 to 2 1 d ay s)
– M uscular rigid ity is first seen in th e jaw m uscles ( d ifficulty , th en inability , in
o p ening th e m o uth [trism us], p reventing the p atient fro m sp eak ing, eating) then,
extend s to tho se o f the face (fixed sm ile [risus sard o nicus]), the neck (d ifficulty in
sw allo w ing ) , trunk ( restrictio n o f resp irato ry m uscles; h y p erextensio n
[o p isth o to no s]) , abd o m en (guard ing) and lim bs ( extensio n o f the lo wer lim bs and
flexio n o f the up p er lim bs).
– M uscle sp asm s ap p ear at the o nset o r when m uscular rigid ity beco m es generalised .
T hey are triggered by stim uli o r arise sp o ntaneo usly . S p asm s o f the th o racic and
lary ngeal m uscles m ay cause resp irato ry d istress o r asp iratio n.
Newborns
– In 9 0 % o f cases, initial sy m p to m s ap p ear within 3 to 1 4 d ay s o f birth.
– T he first signs are significant irritability and suck ing d ifficulties (rigid ity o f the lip s,
trism us), then rigid ity beco m es generalised , as in ad ults. A n infant qualifies as a case
of neonatal tetanus if it has suck ed and cried no rm ally fo r the first 2 d ay s o f life, then
beco m es irritable and sto p s suck ing 3 to 2 8 d ay s after birth , and d em o nstrates
rigid ity and m uscle sp asm s.
– A ltho ugh the um bilicus is alm o st alway s the p o rtal o f entry , clinical infectio n o f the
co rd site (o m p halitis) is evid ent in o nly o ne half o f cases.
– C heck fo r sep ticaem ia, which is frequently asso ciated .
170
