Ques. 1 What is Tetanus?
Ans. Tetanus is a serious wound infection caused by Clostridium Tetani, and anaerobic (spore bearing) organism, characterized by tonic & clonic muscular contraction of body generalized toxaemia.
Nature of injury :
- Post-operative and post-partum tetanus from the unclean vaginal pad.
- Tetenus neonatorum from umbilical cord infection.
- Organism is clostridium Tetani, a gram positive, motile, rod shaped, spore bearing, & produces highly lethal exotoxin. Certain wounds, e.g. penetrating wounds contaminated by soil or with faeces, neglected wounds and burns, and bed sores are liable to tetanus infection.
- Hydrophobus, operative.
Ques. 2 What is the pathology of tetanus?
Ans. The exotoxin has two-fold effect on the nervous system :-
- It causes an extreme hyper-excitability of the anterior horn cells. The result is manifested in violent & widespread reflex clonic muscular spasms in response to even minor stimuli. Thus muscles are in a continued state of hypertonicity & also exhibit violent spasms in response to minor stimuli. There effects are purely physiological because there are no organic changes in the cord or brain.
- It causes an imbalance between acetylcholine – cholinesterase levels at the peripheral motor end plates. The results is continuous excess of acetylcholine & this produce a sustained state of tonic muscular spasm.
Ques. 3 What are the clinical features of Tetanus?
Ans. Clinical Features : Incubation period – usually 2 to 21 days.
- Fracture of vertebra, etc.
- Central Nervous System involvement – sleep pattern in E.E.G.
- Early symptoms – (i) difficulty in deglutition, (ii) ‘Risus Sardonicus’ – ‘Devils laugh’ or smile, (iii) trismus or lock jaw. (iv) history of wound (typical) usually present, (v) pain in neck and back,
- Late symptoms – (i) opisthotonos. (ii) generalized parts of the body (extension), (iii) dysphagia, (iv) dyspnoea. (v) spasm of muscles of various parts of body, (vi) neck rigidity,
- Feature of spinal injury like – paraplegia.
- Sympathetic over stimulation – sweating, and other cardiovascular complications.
Prognosis : The lesser the incubation period (and the period of onset) the worse is the prognosis. Tetanus neonatorum, bulbar tetanus & post-operative tetanus are almost always fatal. The extremes of age are dangerous for disease. Mortality in late case is high.
Causes of Death : Lung complications are commonest causes of death, viz. sudden loss of air entry either due to laryngeal spasm or due to vigorous spasm of muscles of respiration, aspiration of pharyngeal contents into lungs and/or lack of ventilation of lungs due to spasms of muscles of respiration.
Laboratory Diagnosis : Culture of wound exudates & material.
Management : Prophylactic –
- Antitoxin – (Passive) (A.T.S.) – Immediate need – Dose will depend on the severity. Single – 1500 I.U. If previously immunized : 50,000 to 1 lac –required repeated.
- A.T.G. : Anti-tetanic globulin (human donor) – Single (250 mg.). The cardinal principle of treatment : Treatment of the toxaemia, control of reflex spasm, management of wound.
- Toxoid (Active) (Tet/Vac)= .5cc x 3 doses : immediate, after 6 weeks and after 6 months.
Ques. 4 What is the treatment of tetanus?
Ans. Treatment –
- Mild cases : immunity, sedation anti-bacterial agent, and isolation – from all stimuli.
- Moderate cases : Above + nutrition, Respiration – tracheostomy.
- Severe cases : Above 1 and 2 + sympathetic counter act.
Homoeopathic remedies :
- Cuprum – Tetanic spasm. Jaws closed, with loss of consciousness, and foam at mouth. Twitching, jerking, or starting during sleep. Stiffness of whole body.
- Cicuta Virosa : Lockjaw and titanic rigidity from injuries inflicted upon head and spinal column. Convulsion, with loss of consciousness. Of limbs and whole body. Body bent backwards. Inability to swallow.
- Hypericum – Tetanus, darting pain in back; contraction of muscles of various parts of body, resultant on injuries to nerves; involving sensory nerves; retention of urine, great nervous depression.
- Stramonium- Tetanus, eye wide open, rolling, squinting, lockjaw, mouth spasmodically closed. Bending of neck backwards. Violent motion of limbs, with stretching and trembling of hands.