Tetanus

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Tetanus

• Anele Mandela

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Temperament of tetanus and organs involved

• Cold and dry
• Organs involved are the muscles and it affects
  the central nervous system

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Definition

• Tetanus is a rare but often fatal disease, it
  affects the central nervous system by causing
  painful and often violent muscular contractions.
• It begins when the tetanus bacterium (Clostridium
  tetani ) enters the body, usually through a wound
  or cut that has come in contact with the spores
  of the bacterium. Tetanus spores are commonly
  found in soil, dust, and animal manure. Tetanus
  is a non-communicable disease, meaning that it
  cannot be passed directly from one person to
  another.

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Tibb definition

• tetanus is cold and dry
• It is a melancholic imbalance humour
• pathway one

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Signs and symptoms

• The disease can show 4 possible types
• -Generalized tetanus can affect all skeletal
  muscles. It is the most common as well as the
  most severe form of the four types.
• - Local tetanus manifests with muscle spasms
  at or near the wound that has been infected with
  the bacteria.-Cephalic tetanus primarily
  affects one or several muscles in the face
  rapidly (in one to two days) after a head
  injury or ear infection. Trismus ("lockjaw") may
  occur. The disease can easily progress to
  generalized tetanus.
• -Neonatal tetanus is similar to generalized
  tetanus except that it affects a baby that is
  less than 1 month old (called a neonate). This
  condition is rare in developed countries.

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Signs and symptoms

• The time between an injury and the occurrence of
  the first symptoms is typically less than two
  weeks but may range from 5 days to 15 weeks.
• The presenting symptoms are often jaw or neck
  stiffness, difficulty swallowing, and
  irritability, often begins with mild spasms in
  the jaw muscles (lockjaw). There might be pain or
  tingling at the site where the tetanus bacteria
  entered, followed by spasticity of nearby
  muscles.
• Spasms of the respiratory muscles may cause acute
  asphyxia. Airway obstruction is common.
• The patient remains awake and alert throughout
  the illness.

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• The spasms can also affect the chest, neck,
  back, and abdominal muscles. Back muscle spasms
  often cause arching, called opisthotonos.
• Sometimes the spasms affect muscles that help
  with breathing, which can lead to breathing
  problems.
• Prolonged muscular action causes sudden,
  powerful, and painful contractions of muscle
  groups. This is called tetany. These episodes can
  cause fractures and muscle tears.
• Other symptoms include
• Drooling,excessive sweating,fever,hand or foot
  spasms, irritability, swallowing
  difficulty,uncontrolled urination or defecation

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Diagnosis

• Tetanus is diagnosed by the clinical symptoms and
  a medical history that shows no tetanus
  immunization.
• There are no blood tests that can be used to
  diagnose tetanus. The diagnosis is based on the
  presentation of tetanus symptoms and does not
  depend upon isolation of the bacteria, which is
  recovered from the wound in only 30 of cases and
  can be isolated from patients who do not have
  tetanus. Laboratory identification of C.
  tetani can only be demonstrated by production of
  tetanospasmin in mice.
• The "spatula test" is a clinical test for tetanus
  that involves touching the posterior pharyngeal wa
  ll with a sterile, soft-tipped instrument, and
  observing the effect. A positive test result is
  the involuntary contraction of the jaw (biting
  down on the "spatula"), and a negative test
  result would normally be a gag reflex.

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Treatment and management

• Immune globulin, given intramuscularly, is the
  immediate treatment of unimmunized individuals
  exposed to material likely to contain
  the tetanus bacteria. Treatment includes bed rest
  and quiet conditions.
• Sedation, paralysis with certain medications, and
  mechanical ventilation (i.e.respirator) may be
  necessary to control the spasms.
• Antimicrobial drugs, such as penicillin, are used
  to eradicate the bacteria.
• Keeping wounds and scratches clean is important
  in preventing infection. SinceC. tetani grows
  only in the absence of oxygen, the wounds must be
  adequately cleaned of dead tissue and foreign
  substances. Run cool water over the wound and
  wash it with a mild soap. Dry it with a clean
  cloth or sterile gauze

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Medication

• Drugs used to treat muscle spasm, rigidity, and
  tetanic seizures include sedative-hypnotic
  agents, general anesthetics, centrally acting
  muscle relaxants, and neuromuscular blocking
  agents. Antibiotics are used to prevent
  multiplication of C tetani, thus stopping
  production and release of toxins.

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• Anticonvulsants
• Sedative-hypnotic agents are the mainstays of
  tetanus treatment. Benzodiazepines are the most
  effective primary agents for muscle spasm
  prevention and work by enhancing GABA inhibition.
  Diazepam is the most frequently studied and used
  drug. Diazepam reduces anxiety, produces
  sedation, and relaxes muscles.
• Phenobarbital is another anticonvulsant that may
  be used to prolong effects of diazepam.
  Phenobarbital is also used to treat severe muscle
  spasms and provide sedation when neuromuscular
  blocking agents are used.
• E.g- phenobarbitol and diazepam (valium)

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• Skeletal muscle relaxants
• These agents can inhibit both monosynaptic and
  polysynaptic reflexes at spinal level, possibly
  by hyperpolarization of afferent terminals.
• E.g. Baclofen (Lioresal), Dantrolene (Dantrium)

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• Antitoxins
• These agents are used to neutralize any toxin
  that has not reached the CNS.
• E.g. Tetanus immune globulins (Hyper-Tet,
  Bay-Tet)- it is used as prophylaxis against
  tetanus and to treat patients with circulating
  tetanus toxin. TIG provides passive immunity

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• Antibiotics
• Are administer to patients with clinical tetanus.
  Antibiotics prevent multiplication of C tetani,
  thus halting production of toxin. Penicillin G is
  the drug of choice. Metronidazole is considered
  by some to be a better drug.  Tetracycline is an
  alternative drug for patients who are allergic to
  penicillin or metronidazole.
• E.g. Penicillin G (Pfizerpen), Metronidazole
  (Flagyl), Doxycycline (Vibramycin, Doxychel),

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• Neuromuscular blocking agents
• These agents inhibit the transmission of nerve
  impulses at neuromuscular junctions of skeletal
  muscles and/or autonomic ganglia.
• E.g.- Vecuronium (Norcuron)

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Tibb treatment

• Treatment (single herb) Acoras calamus Allium
  sativum Paeonia emodi Delphinium denudatum
  Castoreum-an anticonvulsant and
  antispasmodicColchicum luteum Purified ferula
  foetida Sarssurea lappa.
• Medication Cognium Tablets- it is dry and hot
  and is suitable for phlegmatic,cereberal/nervous
  system disorders Tibb-Septogaurd- is dry and hot
  it has immunomodulatory functions and it helps
  prevent re-infection. neurotone

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• Diet avoid cold and dry foods like apples, sour
  fruits, coffee and mealie meal.
• The person must eat foods that fall into the
  treatment frames which are dry and hot, hot and
  dry hot and moist. E.g- chicken, all bran,
  pungent spices.
• Sleep 8 hours of sleep
• Massage heating oils like ginger and
  rosemary(hd) and olive oil (hm)
• Tibb Fast deep breathing exercises
• No strenuous exercises

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Alternative Therapies

• Castor oil is a natural remedy that can be used
  to clean out a wound and prevent tetanus. When a
  wound is sustained, a cotton ball dunked in
  castor oil should be placed on the wound, and
  then fixed on the wound with a bandage. Castor
  oil has tremendous drawing power and can pull out
  rust and other infectious agents. The dressing
  should be changed every 2 hours on the first day
  of treatment and twice a day for the next three
  days.

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• Homeopathy is a kind of medicine where the
  underlying philosophy is based on treating like
  with like. By introducing a similar treatment to
  the ailment, it is believed that the body will
  work to heal itself. Homeopaths will use a
  variety of methods to treat a whole range of
  illnesses.

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• Nux Vomica
• This is one of the leading homeopathic treatments
  due to its wide range. In terms of
  treating tetanus, the nux seeds are rich in
  copper, which can produce cramping, one of the
  effects of tetanus. Strychnia, which is an
  alkaloid of nux vomica, can create a near image
  of tetanus by creating convulsions and
  respiratory spasms.
• Cicuta Virosa
• This remedy can be effective with tetanus due to
  the symptoms it creates. It affects the nervous
  system, creating sometimes violent convulsions
  similar to what someone experiencing tetanus
  would undergo. The patient taking this may have
  fixed eyes and slowed breathing as a result.

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• Physostigma
• This remedy is known for affecting the motor
  abilities of a patient. It stimulates the heart
  and raises the blood pressure, all symptoms of
  tetanus. Physostigma can cause tremors in the
  body, but can also induce paralysis. The remedy
  is also effective in dulling the pain of tetanus
  due to its effect on the nervous system.
• Aconite
• Aconite, also known as aconitum napellus, is
  used to treat tetanus when a fever is present.
  The treatment works to calm inflamed nerves,
  tension in the arteries, and emotional and
  physical conditions brought on by anxiety. The
  remedy causes only a functional disturbance in
  the body and does not alter the tissues.
• Belladonna
• Belladonna is known for its ability to bring on
  sudden symptoms that mirror anxiety and fear. It
  affects the nervous system directly and is known
  to cause twitching, jerks, and even convulsions.
  It can mimic an epileptic spasm followed by
  vomiting. It is primarily used in treating
  tetanus in infants with lock jaw.

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• Traditional medical treatment revolves around
  drug therapy, traditional Chinese medicine herbal
  remedies are the most common alternative
  treatment for tetanus. Herbs that have sedative
  effects should be given to reduce the frequency
  of convulsions, along with herbs to fight the
  bacteria.
• Tetanus and convulsions can be treated with a
  concoction made from the dried body of a
  long-nosed pit viper, called this drug Qi She in
  Mandarin. Chan Tui, orcicada slough (the skin the
  cicada sheds) is also helpful. Also helpful are
  the dried root of the Saposhnikovia divaricata,
  called divaricate saposhnikovia root, and
  jack-in-the-pulpit tuber, if it is treated to
  remove toxins.

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Prognosis

• For patients who survive tetanus, recovery can be
  long (1 to 2 months) and burdensome. Muscle
  spasms may begin to decrease after 10 to 14 days
  and disappear after another week or so. Residual
  weakness, stiffness, and other complaints may
  persist for a prolonged period, but complete
  recovery can occur from uncomplicated tetanus.
• Patients with tetanus are hospitalized in an
  intensive care unit until it is clear that the
  progression of the disease has stabilized at a
  level that does not interfere with vital
  functions, and that therapy can be managed
  outside the unit.

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Prognosis

• Acute respiratory failure is the leading cause of
  death in tetanus infections. A short incubation
  period is associated with a particularly grim
  prognosis. In individuals under age 50, mortality
  is nearly 100 if symptoms begin within 1 to 2
  days.
• Morbidity is reduced to 35 to 40 if the
  incubation period is greater than 10 days. The
  overall mortality rate ranges from less than 10
  to as high as 50. High mortality rates are also
  associated with early onset of convulsions,
  individuals who require mechanical ventilation,
  or delay in treatment.
• Contaminated wounds located on the head and face
  are more dangerous than wounds located on other
  parts of the body. The individual's age and
  severity of symptoms also affect prognosis.
  Recovery is complete if the individual survives
  the infection.

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Thank you