It is a condition of toxemia due to absorption of soluble toxin from the wound contaminated with clostridium tetani.
Clostridium tetani is an anerobic gram +ve bacteria with a terminal spore giving a characteristic drum stick appearance. This is mainly found in manure and soil.
It mainly releases mainly two types of exotoxins
1. Tetanospasmin: it is a neurotoxin acts on motor end plates
2. Tetanolysin: it is a oxygen labile haemolytic toxin
Mode of entry:
1. usually through a penetrating wound
2. dirty abrasions
3. chronic ulcers like boils, paronychia, dental extractions
4. subcutaneous injections of irritant drugs
5. contaminated umbilical cord of a neonate
6. post abortal and post puerperal
7. post operative tetanus
3days to 3weeks on an average 7days
The time interval between 1st symptom and 1st reflex spasm is called period of onset. The less the onset period the condition is more fatal.
The soluble toxin is absorbed from the site of infection.
The spores germinate in the anaerobic condition which is contributed by necrosis and devitalisation of site of injury, Calcium ions derived from soil or hemorrhage.
The toxin reaches the central nervous system either through nervous route, blood stream or by lymphatic channel.
Then it gets fixed to the anterior horn cells of the nerve and causes hyperexitability of motor neurons and inhibits cholinesterase leading to reflex spasms
1. Trismus (locked jaw)
2. Stiffness of muscles of head, neck, back, abdomen.
3. Risus sardonicus
4. Opisthotonous (bow like bending) of the body. Some times psoas and abdominal muscles may rupture
5. Dysphagia due to spasm of deglutition muscles
6. At early stages the spasms are conditional & later becomes unconditional
7. Constitutional symptoms like fever, cyanosis are present
8. High temperature (fever) of 38C (100.4F), or above
9. Rapid heartbeat (tachycardia)
10. Sore throat
13. Extreme sensitivity to touch
Main Causes of death
1. Pulmonary infections mainly bronchopneumonia
2. Aspiration of pharyngeal contents leading to Suffocation (asphyxia)
3. Laryngeal spasm
4. Pulmonary embolism due to dislodgement of emboli
5. Anemia & exhaustion due to repeated convulsions
7. Compression fracture of thoracic vertebrae
8. Blood poisoning (septicaemia)
9. Heart attack
10. Kidney failure
1. to give active immunization of alum precipitated tetanus toxoid Im along with diphtheria and pertusis (DPT) In the child hood for every newborn
2. proper surgical wound care is necessary
3. isolation of patient in a quiet, dark room
1.It has tetanic convulsions with opisthotonos, distortion of eyes and face, with dyspnoea excited by any external impression.
2. convulsion of muscles renewed by the slightest external impression,
3. risus sardonicus
4. respiratory spasm
5. blue cyanosed face
6. clear mind..
1. It produces a persistent tonic spasm from its direct action on the spinal cord. It shows itself in the muscles of the face, jaws and back.
2. There is trismus or locked jaw, risus sardonicus and impeded respiration, with lividity and frothing at the mouth; the rigidity is firm
3. The body is bent backwards
4. The attack is sudden
5. There is less reflex excitability.
6. Painful stiffness and stretching of the limbs.
7. The lips are drawn back showing the teeth and the jaws are locked.
1. Sudden rigidity and jerkings followed by prostration.
2. Great oppression of breathing.
3. Locked jaw.
4. Opisthotonos renewed by touch.
5. There are oesophageal spasms
6. A marked symptom is fixed eyes staring at one point.
1. The sensory nerves are irritable.
2. There are tetanic spasms stiffness of spine and legs
3. Alternate dilation and contraction of the pupils.
1. Tetanic convulsions
2. Spasms of glottis and chest worse from light or touch.
1. Tetanus, with fever
2. Numbness and tingling from exposure to cold
3. The face changes color.
4. Great Fear of death
1. Pale face
4. Patient loses consciousness with each spasm.
5. Coldness of extremities.
1. Trismus from injury to nerves.
2. Useful in spinal injuries
1. Tetanus of infants.
2. Stiffness of jaws.
1. Magnesia phosphorica, Carbolic acid,. Phenol, Passiflora, Ignatia