Tetanus Symptoms And Treatment

Tetanus Symptoms And Treatment

Discuss etiology, clinical features. Differential diagnosis and treatment of tetanus.
Or
Discuss the clinical features and management of tetanus
Or
Discuss etiology, clinical features and management of tetanus.

Answer. Tetanus is also called as lockjaw.

It is a disease of nervous system characterized by intensive activity of motor neuron and resulting in severe muscle spasm.

Tetanus Etiology

It is caused by anaerobic, gram-positive Bacillus Clostridium tetani.

“Symptoms Of Tetanus In Adults”

Tetanus Clinical Features

Tetanus Symptoms

• Trismus is common.
• Presence of jaw stiffess and pain.
• Sweating is present and patient is anxious.
• Presence of headache, delirium and sleeplessness.
• Presence of dysphagia and dyspnea.

Tetanus Signs

• Spasm and rigidity of all muscles.
• Hyper-reflxia
• Respiratory changes due to laryngeal muscle spasm,infection, aspiration.
• Tonic-clonic convulsions.

“Comprehensive Overview Of Tetanus Symptoms”

• Abdominal wall rigidity often with hematoma formation.
• Severe convulsion may often lead to fractures, joint dislocations and tendon ruptures.
• Fever and tachycardia.
• Retention of urine (due to spasm of urinary sphincter),constipation (due to rectal spasm).
• Rarely features of carditis are seen due to involvement of the cardiac muscle, which is dangerous, as it often leads to cardiac arrest and death.
• Symptoms will be aggravated by stimuli-like light and noise.

“Causes Of Tetanus Infection”

Tetanus Differential Diagnosis

• Strychnine poisoning
• Trismus due to various causes such as dental, oral, tonsillar sepsis, oral malignancy.
• Meningitis
• Hydrophobia
• Convulsive disorders
• Epilepsy
• Symptomatic hyperactivity.

Tetanus Treatment/Management

• Patient is admittd and isolated in a dark, quiet room.
• Antitetanus globulin (ATG), 3,000 units IM single dose is given.
• Anti-tetanus serum (ATS): When ATG is not available or when patient cannot affrd, after IV test dose (l ,000 units
  of ATS), full dose is given, i.e. l,00,000 units, half of it is given IM and half of it is given IV.
• Wound debridement, drainage of pus, injection of ATG 250-500 units locally to reduce the toxin effct.
• Ryle’s tube has to be passed, initially to decompress, so as to prevent aspiration, but later for feeding purpose.
• Catheterization should be done.
• IV flids and electrolyte balance has to be maintained.
  • Tetanus toxoid should be given as disease will not give immunity against further infections.
  • To start fist dose, second dose after one month, third dose after six months.
  • Aluminum phosphate absorbed tetanus toxoid 0.5 mL is injected into deltoid muscle.
  • Booster dose should be given every 4 years or after any signifiant trauma.
  • In patients who have not been immunized earlier it needs 30 days to to develop antibody after tetanus toxoid injection.

“The Role Of Antitoxins In Treating Tetanus”

• IV diazepam 20 mg 4th or 6th hourly. Dose is adjusted depending on severity and convulsions.
• IV phenobarbitone 30 mg 6th hourly.
• IV chlorpromazine 25 mg 6th hourly.
• Injection crystalline penicillin 20 lacs 6th hourly and injection gentamicin and metronidazole to prevent secondary infection.
• Regular suction and clearance of respiratory tract.
• Nasal oxygen is given.
• In severe cases, patient is curarised and placed in ventilator.
• Endotracheal intubation or tracheostomy are often lifesaving procedures.
• Good nursing care: Change of position, prevention of bedsores, prevention of DPT.
• Chest (respiratory) physiotherapy during recovery period.
• Steroids are given when carditis is suspected.
• Cardiac pacemaker may be useful in refractory bradycardia and arrhythmias.
• Following treatment patient often gets spasm of diffrent muscles (tics) for a long period which can be prevented by giving methocarbamol for 6 months to one year.