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Michael Erick Virtucio Jean Paola Yap

Section4-D Group 9-b

Pathophysiology of Tetanus Precipitating Factors:  Work (Farming)  Exposure to bacteria (wounds/lacerations)  No previous history of tetanus immunization

Clostridium tetani bacteria containing virulence plasmids enter wound

Toxins produced by growing cells Spores germinate under anaerobic conditions

Vegetative growth

Spore

Cell lysis occurs Release of bacterial endotoxins into surrounding

Tetanolysin

Tetanospasmin (potent neurotoxin)

Potentiating of infection

Release of biochemical mediators of inflammatory response (histamine, bradykinin)

Toxin circulated around the body through bloodstream and lymphatic system

Enter Central Nervous System (CNS) along peripheral nerves

Michael Erick Virtucio Jean Paola Yap

Section4-D Group 9-b

Inflammatory response initiated

Increased capillary permeability

WBCs such as neutrophils and monocytes enter

Increased blood flow

Swellin

Toxin not able to pass through blood-brain barrier

Toxin makes its way to spinal cord

Phagocytosis and removal of debris occur

Rednes Phagocytes release endogenous pyrogens

Stimulation of hypothalamus to increase body temperature

Toxin enters the CNS Toxin taken up by neuromuscular junction Crosses to synaptic cleft Irreversibly binds to gangliosides at presynaptic inhibitory motor nerve endings

Fever Taken up by preganglionic neuron axon through endocytosis Blocks the release of inhibitory neurotransmitters (glycine and GABA) Excitatory activities unregulated

Pain

Pharynx

Aspiration of oral secretions

Pneumonia

Cranial

Rapid firing of impulses

Irritability of neurons Restless ness

Facial

Risus sardonicu s (fixed smile and elevated eyebrows )

Masseter

Lockjaw

Generalized tonic muscle spasms occur

Glottis

Failure to speak or cry

Respiratory muscles

Chest wall muscle Chest wall rigidity

Diaphrag m

GI (laryn x, abdo minal wall)

Michael Erick Virtucio Jean Paola Yap

Section4-D Group 9-b

Headache Asphyxiation

Hypoxemia

Cardiac Arrest

DEATH

Treatment 1. HTIG (Human tetanus Immunoglobulin): 3000-6000 units/IM 2. ATS (Anti tetanus Serum): 5000-10000 units/ ½ IV ½ IM 3. Antibiotics: Inj. Penicillin G 200000/kg in 4 divided Doses for 2 weeks 4. Sedation: Inj. Diazapam 0.1 – 0.2 mg/kg/ 4 hourly Inj. Medazolam 1mg/ kg 5. Neuromuscular Blocking Agents: Inj. Pancuronium Bromide IV Infusion. Atracurium Besylate 6. Supportive Care: 

Isolation, Avoid Stimulation



Vital monitoring( Respiratory Rate, SPO2)



Oral Suctioning



Keep Nil Per Oral, Feed after 5 days



Place Nasogastri tube,



Hydration



Intake of 3500-4000 Calories and at least 150g of protein

Respiratory failure