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Tetanus

Tetanus. Mary & Victoria. Tetanus. What is Tetanus? The Biology: Clostridium tetani Prevention by Vaccination Treatment. What is Tetanus?. Bacterial disease Affects the nervous system Often caused by infection to cuts/wounds, especially when they are deep Other causes: Burns

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Tetanus

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  1. Tetanus Mary & Victoria

  2. Tetanus What is Tetanus? The Biology: Clostridium tetani Prevention by Vaccination Treatment

  3. What is Tetanus? • Bacterial disease • Affects the nervous system • Often caused by infection to cuts/wounds, especially when they are deep • Other causes: • Burns • Abortion • Frostbite • IV drug abuse Oposthotonus, by Sir Charles Bell (1809). Source: http://www.brown.edu/Courses/Bio_160/Projects2004/pertussis/diphther.htm

  4. What is Tetanus? • Continual excitatory discharge of the motor and autonomic nervous system • Uncontrollable muscle spasms may lead to respiratory or cardiac arrest, and severe BP changes • Lockjaw • Suffocation • Muscle rigidity/spasms • Stiffness • Bell’s Palsy • Dysphagia

  5. What is Tetanus? Localized Tetanus Generalized Tetanus • Uncommon • Affects a specific area of the body • Same area as the infection site • May be a precursor to generalized tetanus • Most common • Symptoms may progress in a descending pattern • Frequent muscle spasms lasting several minutes

  6. What is Tetanus? Neonatal Tetanus • Affects newborns without passive immunity from their mother • Usually due to infected umbilical stump • Rare in U.S., but prevalent in underdeveloped countries Neonatal Tetanus ID# 6374 (1995). Source: Center for Disease Control--Public Health Image Library

  7. What is Tetanus? Cephalic Tetanus • Rare form • Mainly involving the facial nerves • Sometimes occurs with ear infections, or after head injury Man with Cephalic Tetanus ID# 1657 (1965). Source: Center for Disease Control--Public Health Image Library

  8. Incidence of Tetanus • Decreased prevalence in industrialized nations • Tetanus is rarein the U.S. due to immunizations and improved wound care • Approximately 5 deaths per year • In the U.S. it affects mostly older people • Gardening during retirement years • Mortality rate in the elderly: >50%

  9. Incidence of Tetanus • Worldwide public health issue • Ninth most common cause of death due to infectious disease • Approximately 250,000 deaths per year • Global fatality rate: 30-50% • Neonatal tetanus • Mortality rate: 90%

  10. The Biology: Clostridium tetani • Obligate anaerobe • Bacillus • About 0.3-1.1µm by 3-12µm • Gram-positive • Mesophile • Endospores • “drum-stick” shape • Motile • Some may produce flagella 3-4 times it’s length Gram Stain of Clostridium tetani–ID#6372 (1995). Source: Center for Disease Control--Public Health Image Library

  11. The Biology: Clostridium tetani • Clostridium tetani • Produces two exotoxins: • Tetanospasmin—neurotoxin that causes muscle spasms • Tetanolysin—no known clinical significance • Incubation period = 3 - 14 days • Produces spores • Extremely resilient to temperature, moisture, chemicals, and even 10-15 minutes of autoclaving (121˚C) • Germination occurs when exposed to anaerobic conditions such as wounds and tissue necrosis

  12. The Biology: Clostridium tetani • Commonly found in: • Soil • Manure/human & animal feces • Dust • Rust • Noncommunicable

  13. The Biology: Clostridium tetani • Tetanospasmin: • Excreted into the bloodstream • Travels through nerves or by lymphocytes to CNS • Attach to presynaptic inhibitory nerve endings  Blocks the release of inhibitor neurotransmitters, causing muscle spasms • One of the most potent toxins known • Lethal dose: • 175 nanograms for a 154lb/70kg person (That’s 0.000175 miligrams!!)

  14. Prevention by Vaccination • The best way to prevent Tetanus is by vaccination • Virtually 100% efficacy rate in properly immunized people • Girl Receives Vaccine–ID#9297 (2006). Source: Center for Disease Control--Public Health Image Library

  15. Prevention by Vaccination • Three types of Vaccines: • DTaPvaccine (Diphtheria, Tetanus, Pertussis) • DT vaccine (Diphtheria, Tetanus) • Td Vaccine (Tetanus, Diphtheria)

  16. Prevention by Vaccination • DTaP: • “3-in-1” Recommended for childhood immunization • Protects against Diphtheria, Tetanus, and Pertussis • Given 5 doses (2 months, 4 months, 6 months, 15-18 months, 4-6 years) • Only for children under age 7

  17. Prevention by Vaccination • DT • “2-in-1” For children less than 7 years old. • If a child has an allergic reaction to the Pertussis vaccine in DTaP.

  18. Prevention by Vaccination • Td • “2-in1” Adult vaccine • Slightly differs in dosage of Diphtheria vaccine than in DT. • Anyone over the age of 7 • Injected, usually in arm

  19. Prevention by Vaccination • T Vaccine: • A vaccine for Tetanus by itself can be given (Tetanus Immune Globulin/HTIG)-Injected into arm-Made from blood of person or animal containing antibodies against Tetanus • Typically for an adult who is having a dirty wound/injury taken care of

  20. Treatment • Although immunization is available, Tetanus is not eradicated.

  21. Treatment Those at risk: • Lack of immunization • Partial Immunization • Fully immunized patients have still been documented to contract the disease • Very rare

  22. Treatment • Main Goals: • Use a method of attacking the anaerobic, spore-forming bacillus • Find a way around the actions of the nervous system caused by the Tetanus toxin

  23. Treatment • Recognition of Tetanus • Vital to the victim • Stabilize and Resuscitate • Neutralize Tetanus Toxin • Clean wound with antibiotics • Treat any muscle spasms • Control Pain

  24. Treatment • Resuscitation • Most common cause of death in Tetanus is due to respiratory failure. • Can be a general complication of the disease, failure to treat spasms quickly enough, or as a side effect of medications. • Tracheotomy is performed as precaution. • Helps to prevent a stimulus from causing another spasm.

  25. Treatment Class Drug Indication

  26. Treatment • HTIG (immune globulin) • Tetanus toxin binds to nerve endings that normally calm the muscle, blocking the inhibitory signals. • HTIG neutralizes the free form tetanospasmintoxin by binding to it, prohibiting it from blocking signals • Frees the neurotoxin without crossing blood brain barrier

  27. Treatment • Administration of Td • Contracting the disease does not ensure immunity • Injected simultaneously with HTIG • Enhances short-term (passive) immunity and long-term (active) immunity.

  28. Treatment • Eliminating the toxin: • Excision – Surgical removal of the toxin producing organisms. • Creates an aerobic environment, hindering the growth of C. tetanispores • Only to be done after Td is given to the patient due to the release of tetanospasmin during the procedure

  29. Treatment • Antibiotic mode of action depends on which antibiotic is used • Metronidazole is used most often for tetanus • Works by inhibiting nucleic acid synthesis

  30. Questions??

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