TETANUS Tetanus is an acute, often-fatal disease of the nervous system that is caused by nerve toxins produced by the bacterium

Clostridium tetani. This bacterium is found throughout the world in the soil and in animal and human intestines. Causative agent: Clostridium tetani History: Tetanus was known to ancient people, who recognized the relationship between wounds and fatal muscle spasms. In 1884, Arthur Nicolaier isolated the strychnine-like toxin of tetanus from free-living, anaerobic soil bacteria. The etiology of the disease was further elucidated in 1890 by Antonie Carl and Giorgio Rattone, who demonstrated the transmissibility of tetanus for the first time. They produced tetanus in rabbits by injecting their sciatic nerve with pus from a fatal human tetanus case in that same year. In 1889, C. tetani was isolated from a human victim, by Kitasato Shibasabur, who later showed that the organism could produce disease when injected into animals, and that the toxin could be neutralized by specific antibodies. In 1897, Edmond Nocard showed that tetanus antitoxin induced passive immunity in humans, and could be used for prophylaxis and treatment. Tetanus toxoid vaccine was developed by P. Descombey in 1924, and was widely used to prevent tetanus induced by battle wounds during World War II. Characteristics: C. tetani is a rod-shaped, obligate anaerobe which stains Gram positive in fresh cultures; established cultures may stain Gram negative. During vegetative growth, the organism cannot survive in the presence of oxygen, is heat-sensitive and exhibits flagellar motility. As the bacterium matures, it develops a terminal spore, which gives the organism its characteristic appearance. C. tetani spores are extremely hardy as they are resistant to heat and most antiseptics.The spores are distributed widely in manure-treated soils and can also be found on human skin and in contaminated heroin.

Mode of Transmission: The bacteria can be transmitted directly from the soil, or through dirty nails, dirty knives and tools, which contaminate wounds or cuts. A newborn baby can become infected if the knife, razor, or other instrument used to cut its umbilical cord is dirty, if dirty material is used to dress the cord, or if the hands of the person delivering the baby are not clean. Unclean delivery is common when mothers give birth at home in poor communities, but it can be prevented by skilled birth attendants Signs and symptoms: During a one- to seven-day period, progressive muscle spasms caused by the tetanus toxin in the immediate wound area may progress to involve the entire body in a set of continuous muscle contractions. Restlessness, headache, and irritability are common. The tetanus neurotoxin causes the muscles to tighten up into a continuous ("tetanic" or "tonic") contraction or spasm. The jaw is "locked" by muscle spasms, giving the name "lockjaw" (also called "trismus"). Muscles throughout the body are affected, including the vital muscles necessary for normal breathing. When the breathing muscles lose their power, breathing becomes difficult or impossible and death can occur without life-support measures. Even with breathing support, infections of the airways within the lungs can lead to death. Diagnosis: The "spatula test" is a clinical test for tetanus that involves touching the posterior pharyngeal wall 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 attempting to expel the foreign object. Methods of control: The tetanus vaccine contains inactivated tetanus toxoid (poison), which is why it is often called TT vaccine. Tetanus toxoid vaccination is given routinely to newborns and infants as part of the threefold DPT vaccine (with diphtheria and pertussis vaccines), or the pentavalent (fivefold) vaccine, which includes vaccines for diphtheria, tetanus, pertussis, Hepatitis B (a virus), and a bacterium called Haemophilus influenzae type B (Hib). Neonatal tetanus can also be prevented by vaccinating women of childbearing age with tetanus toxoid vaccine, either during pregnancy or before pregnancy. This protects the mother and enables anti-tetanus antibodies to be transferred to the growing fetus in her uterus. Cleanliness is also very important, especially when a mother is delivering a baby, even if she has been vaccinated with TT vaccine. People who recover from tetanus do not have increased natural immunity and so they can be infected again. Therefore they will need to be vaccinated. The World Health Organization (WHO) and UNICEF set a goal to eliminate neonatal tetanus by 2005. Elimination in this case would mean that the number of neonatal tetanus cases would have to be reduced to below one case per 1,000 live births per year in every district. Notice that elimination of a communicable disease does not mean there are no cases just very few right across a country or region. Eradication means the total and sustained disappearance of the disease from the population. Treatment: General measures to treat the sources of the bacterial infection with antibiotics and drainage are carried out in the hospital while the patient is monitored for any signs of

compromised breathing muscles. Treatment is directed toward stopping toxin production, neutralizing its effects, and controlling muscle spasms. Sedation is often given for muscle spasm, which can lead to life-threatening breathing difficulty.In more severe cases, breathing assistance with an artificial respirator machine may be needed.The toxin already circulating in the body is neutralized with antitoxin drugs. The tetanus toxin causes no permanent damage to the nervous system after the patient recovers.After recovery, patients still require active immunization because having the tetanus disease does not provide natural immunization against a repeat episode.

Clinical Manifestations of tetanus