Tetanus

Tetanus, sometimes referred to as lockjaw, is a dangerous but curable illness that affects the muscles and nerves of the body. It often develops from a skin wound that becomes infected with the Clostridium tetani bacterium, which is frequently found in soil.

Mode of transmission:

• Skin integrity has been compromised.
• When babies receive inadequate cord care, tetanus neonatrum arises.
• While still present in the wound, the microorganism releases a toxin that has long-lasting effects.

Incubation period:

• 3-4 weeks (mild).
• 3 days (severe).
• The prognosis is worse the sooner the incubation period begins.

Gram-positive, anaerobic, motile, and obligatory, Clostridium tetani is a bacillus. It is nonencapsulated and produces heat-, desiccation-, and disinfectant-resistant spores. The bacillus looks like a turkey leg because the colorless spores are at one end of the cell. They can be discovered in excrement, dust from homes, animal intestines, and dirt. Spores can survive for months to years in healthy tissue.

The spores need precise anaerobic circumstances in order to germinate, such as wounds with low oxidation-reduction potential (eg, dead or devitalized tissue, foreign body, active infection). When they germinate in these circumstances, they might release their toxin. Because the organism cannot cause inflammation unless coinfection with other organisms occurs, infection by C tetani causes a benign appearance at the portal of entry.

The spores germinate under the right anaerobic circumstances and create the following 2 toxins:

• Tetanolysin: A hemolysin, this substance has no known pathologic effects.
• Tetanospasmin: The clinical symptoms of tetanus are caused by this toxin, which is one of the most potent known toxins by weight with an estimated minimum lethal dose of 2.5 mg/kg body weight.

Tetanospasmin is produced as a 150-kD protein with a disulfide link connecting its 50-kD light chain to its 100-kD heavy chain. Tetanospasmin binds to the presynaptic motor neuron through the heavy chain, which also serves as a port for the entry of the light chain into the cytosol. The synaptobrevin-cleaving light chain is a zinc-dependent protease.

Retrograde axonal transport takes the light chain from the polluted site to the spinal cord in 2–14 days after it enters the motor neuron. The poison enters central inhibitory neurons as it reaches the spinal cord. The protein synaptobrevin, which is necessary for the attachment of vesicles containing neurotransmitters to the cell membrane, is broken down by the light chain.

As a result, vesicles holding glycine and gamma-aminobutyric acid (GABA) are not released, and the inhibitory effect on motor and autonomic neurons is lost. In addition to autonomic hyperactivity and uncontrolled muscular contractions (spasms) in response to common stimuli like noises or lights, this loss of central inhibition causes.

Antitoxin cannot remove a toxin that has attached itself to neurons. New neuron terminals and synapses must form in order to restore nerve function after exposure to tetanus toxins.

When only the nerves feeding the afflicted muscle are damaged, localized tetanus occurs. When the toxin released at the site travels through the lymphatics and blood to several nerve terminals, generalized tetanus develops. The blood-brain barrier prevents direct entry of toxic to the CNS.

• Administration of tetanus immunoglobulin (human) or Horae serum antitoxin, an anti-tetanus serum: Horse serum antitoxin is administered in doses ranging from 25,000 to 50,000 units intravenously (IV) or intramuscularly (IM) for tetanus immune gamma globulin.
• Antibiotics: Following an injury, antibiotics should be administered as quickly as feasible. A single intramuscular injection of 1.2 mega units of a long-acting penicillin (benzathine penicillin) will deliver a sustained concentration of the medication for 3–4 weeks. For children who respond to penicillin, 500 mg of erythromycin should be taken orally six hours a day for seven days.
• The elimination of the toxin's source.
• Keep the umbilical cord open and clean with spirit or gentian violet (in case of cord infection).
• Leave the incision open after clearing it of dead tissue (in case of another infected wound).

Supportive care:

• While avoiding harsh light, keep the space quiet and well-ventilated.
• Keep the child away from pointless stimuli.
• Minimumbleeding.
• As the youngster is unable to suckle or swallow, keep the airway open using the oxygen hypothesis, appropriate suctioning, and posture. If NG feeding is not an option, IV fluid infusion should be used to maintain nutrition and hydration.
• Keep a record of your vital indicators and routinely monitor them.
• If a ventilator is required, get the youngster ready and provide the appropriate care.
• The tracheostomy tray should be prepared.
• As directed, provide medication.
• In the event of a spasm, administer diazepam and phenobarbital as directed.
• Follow the intake-output chart exactly.
• Accurate reporting and documentation of a child's condition.
• Psychological assistance for families and parents.

Preventive care:

Immunization:

• DPT(diphtheria, pertussis, tetanus) vaccine:
  • Given 3 times within 4 weeks, starting 6 weeks after delivery. The Vastuslaterailis is the site of administration for the 0.5cc dosage.
• Tetanus toxoid:
  • Is administered to pregnant women in their second trimester in two doses spaced one month apart. The deltoid muscle receives a 0.5cc intramuscular injection.