tetanus teaching basics by dr.t.v.rao md
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Clostridium tetaniteaching basics
Dr.T.V.Rao MD
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Clostridia: general characteristics
G!"s Clostridium co!tai!s a larg!"#br o$ gra#%&ositi( s&or%$or#i!gs&cis( sral o$ )*ic* ar abl to
&rod"c disas i! *"#a!s.Most s&cis ar obligat a!arobs(so# )ill gro) "!dr #icroaro&*ilic
co!ditio!s.+at"ral *abitat: soil a!d t* i!tsti!alTract
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History
, Tta!"s )as )ll -!o)! to a!ci!t
&o&l( )*o rcog!id t*
rlatio!s*i& bt)! )o"!ds a!d $atal#"scl s&as#s. ! 188( rt*"r
+icolair isolatd t* stryc*!i!%li-
toi! o$ tta!"s $ro# $r%lii!g(a!arobic soil bactria.
, Ros!bac* a!d itasato co!trib"td
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Clostridium tetani
, Clostridium tetani is a rod%
s*a&d( a!arobic bactri"# o$ t*
g!"s Clostridium.. C. tetani is $o"!d
as s&ors i! soil or as &arasits i! t*
gastroi!tsti!al tract o$ a!i#als. C.
tetani &rod"cs a &ot!t biological
toi!( tta!os&as#i!( a!d is t* ca"satiag!t o$ tta!"s
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Clostridium tetani
, Clostridium tetani is
a! a!arobic
&at*og!ic bactri"#
t*at is &ri#arily $o"!di! soil a!d a!i#al
i!tsti!al tracts.
, Cotto!( d"st
, 4lastr o$ 4aris
, Cat"g"t
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Morphology, Gra# bacilli
, %8 0.5 #icro!s
, Dr"#stic-a&&ara!c
, 6bligatory
a!arob
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C"lt"ral c*aractristics'
, Gro)s o! blood agar )it* ada!ci!g
dgs
, ! glati! stab $ir tr a&&ara!c, ! Robrtso! coo-d #at #di"#
&rod"cs t"rbidity gas
, Mat is !ot digstd t"r!s blac-, irst 9 *#olysis $ollo)d by *#olysis
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C. tta!i: -y c*aractristics
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Resistance of the Clostridium tetani
.Survives boiling upto3 hours
, They can not
survive autoclavingat !".# $% &'' $C(for ) minutes.
, The spores are also
relatively resistantto phenol and otherchemical agents.
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Aioc*#ical ractio!s
, !dol
, MR a!d V4 tst
!gati
, ?2 B !ot &rod"c
, +itrits ar !ot
rd"cd
, Glati! lii$icatio!occ"rs
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Tetanus etiology
, ! !crotic a!d i!$ctd )o"!ds(
a!arobic co!ditio!s )ill &r#it
gr#i!atio!. Co!ta#i!atd&"!ct"r )o"!ds ca! b
&artic"larly da!gro"s(
s&cially )*! a $orig! body
is &rs!t.08/23/15 Dr.T.V.Rao MD @ Rao's Microbiology 11
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Mode of Transmission %
Tta!"s, Mode of Transmission* Transmission isprimarily by contaminated +ounds,
Tissue in-ury& surgery, burns,deep
puncture +ounds, crush +ounds, titis
media ,dental infection, animal bites,
abortion, and pregnancy
, /ncubation 0eriod* # D12S & 3' D12S(
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Type of Tetanus
, Traumatic tetanus
, 0uerperal tetanus
, togenic tetanus
, /diopathic tetanus
, Tetanus4eonatroum
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Tetanus – Toxin oriented disease
, C. tetani "s"ally !trs a *ost t*ro"g* a)o"!d to t* s-i! a!d t*! it r&licats.6!c a! i!$ctio! is stablis*d( C.
tetani &rod"cs t)ootoi!s( tta!olysi! a!d tta!os&as#i!..T* g!s t*at &rod"c toi! ar !coddo! a &las#id )*ic* is &rs!t i! alltoig!ic strai!s( a!d all strai!s t*at arca&abl o$ &rod"ci!g toi! &rod"cid!tical toi!
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4ature of To5ins
, C. tetani produces t+o e5oto5ins,tetanolysin and tetanospasmin.The function of tetanolysin is not
6no+n +ith certainty., Tetanospasmin is a neuroto5in and
causes the clinical manifestations of
tetanus., Tetanospasmin estimated Human lethaldose .7 ng86g
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To5ins, ?#olysi! = tta!olysi! >
, +"rotoi! = Tta!os&as#i! >
, +o! s&as#og!ic toi!
, Tta!olysi! is *at labil a!d oyg! laibl
, Toi! is rs&o!sibl $or t* Tta!"s
, ?at laibl i!actiatd at 750c
, Mol )t ?ay c*ai! 3(000
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Tetanospasmin
, Mol )t ?ay c*ai! 3(000
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Tta!os&as#i!
, Tta!os&as#i! is distrib"td i! t*
blood a!d ly#&*atic syst# o$ t*
*ost. T* toi! acts at sral sits)it*i! t* c!tral !ro"s syst#(
i!cl"di!g &ri&*ral !r tr#i!als(
t* s&i!al cord( a!d brai!( a!d )it*i!t* sy#&at*tic !ro"s syst#.
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Tta!os&as#i!
, T* toi! is ta-! "& i!to )it*i! t*
!r ao! a!d tra!s&ortd across
sy!a&tic E"!ctio!s( "!til it rac*s t*c!tral !ro"s syst#( )*r it is
ra&idly $id to ga!gliosids at t*
&rsy!a&tic E"!ctio!s o$ i!*ibitory#otor !r !di!g
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0athogenicty
, T* s&ors gr#i!at i!
rd"cd oyg! &ot!tial
ditalid tiss"s(
&rs!c o$ $orig!
bodis
, Motor !"ro!s absorb
, B&rad !traao!ally to
C+B
, idly $id to
ga!gliosids o$ gray
#attr
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Mechanism of Action
of Tetanus Toxin
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Tta!os&as#i!, Rs#bls stryc*!i! bloc-s sy!a&tic
i!*ibitio! i! t* s&i!al cord
, t i!*ibitory tr#i!als t*at "s glyci! a!d
GA as !"rotra!s#ittrs
, Toi! acts &rsy!a&tically "!li-
styrc*!i! &ost sy!a&tically
, M"scl s&as#s o$ ago!ists a!d
a!tago!ists
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Ho+ To5in acts
, T* toi!( by bloc-i!g t* rlas o$
i!*ibitors( -&s t* i!old #"scls
i! a stat o$ co!tractio! a!d lads tos&astic &aralysis ( a co!ditio! )*r
o&&osi!g $lor a!d t!sor #"scls
si#"lta!o"sly co!tract. Dat* is"s"ally $ro# rs&iratory $ail"r.
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Clinical manifestations
, T* cli!ical #a!i$statio!s o$ tta!"sar ca"sd )*! tta!"s toi! bloc-si!*ibitory i#&"lss( by i!tr$ri!g )it*
t* rlas o$ neurotransmitters,
i!cl"di!g glyci! a!d ga##a%
a#i!ob"tyric acid. T*is lads to"!o&&osd #"scl co!tractio! a!ds&as#.
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Tta!"s, !ols so#atic #"sc"l-ar syst#, !E"ris, 4"!ct"rd )o"!d
, B"rgry, 6titis #dia, B&tic abortio!, Co) d"!g a&&licatio!s
, Far bori!g circ"#cisio!, !c"batio! 2 days to )-s, rag 7 12 days
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pisthotonus
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Photo Courtesy of U.S. Centers for Disease
Control and Prevention08/23/15 Dr.T.V.Rao MD @ Rao's Microbiology 28
http://www.idph.state.il.us/about/vpcd.htm
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Tetanus symptoms 9 signs
, C*aractristic
$at"rs ar risus
sardonicus =arigid
s#il>( trismus =co##
o!ly -!o)! as loc-%
Ea)>( a!dopisthotonus =rigid( arc*d bac->.
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Risus Sardonicus in Tetanus 0atient
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:aboratory Diagnosis
, Cli!ical diag!osis #ost i#&orta!t
i! #a!ag#!t
, Microsco&y, C"lt"r
, !i#al !oc"latio!, Microsco&y !ot rliabl
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Culture, Do! o! Alood agar
, 6! *al$ o$ &lat s&rads to ot*r *al$ a$tr 1 2days o$ i!c"batio! a!robically
, T*r t"bs o$ coo-d #at brot* i!oc"latd, 1 t"b 800c $or 15 #t
, 2 t"b 800c $or 5 #t
, 3 t"b "!*atd
, ll ar i!c"batd at 3;0c "&to days
, B"bc"lt"rd
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Clostridium tetani Gram Stain
Round terminal spores give cells a ;drumstic6< or ;tennis
rac6et< appearance.08/23/15 Dr.T.V.Rao MD @ Rao's Microbiology 3
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Sho+ing spores and =r+oth on
>lood 1gar plate
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To5igenicty tests
, ! a &lat o$ Alood diidd i!to 2 *als $irst *al$
i!cor&oratd )it* 1500 / #l o$ a!titoi!
, ?#olysis )it*o"t a!titoi!
, Aactria gro)! i! Robrtso! coo-d #at#di"# i!oc"latd i!to tail o$ a #ic
, 2!d a!i#al i!Ectd )it* tta!"s a!titoi! 1000
"!its a! *o"r arlir t* tst, B&as# o$ tail o$ "! i!oc"latd #ic s&rad to
li#b a!d ot*r sid a!d t* a!i#al dis
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Tta!"s bactria gro) i! RCM
Mdi"#
, Aactriagro)! i!
Robrtso!coo-d #at
#di"#
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Treatment
, Trat#!t i!ols dbrid#!t( t* a!tibiotic#tro!idaolH acti i##"!iatio! )it*tta!"s tooid ( a!d &assi i##"!iatio! )it*tta!"s i##"! glob"li!.
, 4r!tio! is t*ro"g* acti i##"!iatio! )it*tta!"s tooidHH. T* tooid sti#"lats t* bodyto #a- !"tralii!g a!tibodis agai!st t*bi!di!g co#&o!!t o$ t* tta!"s toi!. 6!ct* a!tibody bi!ds to t* toi!( t* toi! ca! !olo!gr bi!d to t* rc&tors o! t* *ost cll##bra!
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0reventionTetanus carries a 35% mortality rate, making revention very imortant!The "est course is childhood immuni#ations, $ith consistent "ooster doses,
and romt cleaning of $ounds $ith hydrogen eroide.
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4ro&*ylais
, B"rgical att!tio!
, !tibiotics
, ##"!iatio!
, !tibiotics I *o"rs
, Fryt*ro#yci! 5000 #g Aid
, 4!cilli!
,
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0assive /mmuni?ation
, Tta!"s a!titoi! 1(500 J s/c M
, Tst dos to b gi!
, ?"#a! !ti tta!"s glob"li! 250"!its
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0assive /mmuni?ation
, !titoi! =tetanus immune globulin> s*o"ld bad#i!istrd i##diatly. T*is )ill i!actiat toi!s i!t* blood.
, Ko"!ds s*o"ld b dbridd to r#o dad tiss" or
$orig! bodis., !tibiotics s*o"ld b gi! to i!*ibit gro)t* o$ C. tetani .
, tta!"s tooid boostr i##"!iatio! s*o"ld b gi!to &ati!ts )*o *a !ot rcid o! )it*i! t* last 5yars.
, $ s&as#s occ"r( a!tis&as#odic dr"gs s*o"ld b "sda!d rs&iratio! #ai!tai!d by a brat*i!g a&&arat"s i$!cssary.
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,Tta!"s tooid )as dlo&d by Dsco#by i!12(
, Tta!"s tooid i##"!iatio!s )r "sdt!sily i! t* ar#d srics d"ri!g Korld
Kar ., lt*o"g* t* rats o$ sroco!rsio! ar
abo"t "al(t* adsorbd tooid is&r$rrd bca"s t* a!titoi! rs&o!s
rac*s *ig*r titrs a!d is lo!gr lasti!g t*a! t*at $ollo)i!g t* $l"id tooid.
TETANUS TOXOID
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Tta!"s tooid
, Tta!"s tooid
co!sists o$ a
$or#ald*yd%tratd
toi!., T*r ar t)o ty&s
o$ tooid aailabl L
adsorbd =al"#i!"#
salt&rci&itatd>tooid
a!d $l"id tooid
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1ctive /mmuni?ation
, 'st dose @th +ee6
, nd dose ')th +ee6
, 3rd
dose '!th
+ee6, 'st booster '#th month
, nd booster @th year
, 3rd booster ')th year
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0assive /mmuni?ation
'. 1TS&eAuine( /g '7)) /B8s.c after
sensitivity test
&or(. 1TS&human( /g 7)7)) /B, no
anaphylactic shoc6, very safe and
costly.
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Treatment of Tetanus patients
, ?os&italiatio!
, Trac*oto#y
, ?"#a! TG 10(000 J
, 4!cilli!( Mtro!idaol
, TB V, Gi acti i##"!iatio!.
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0RV4T/4 % 441T1:
TT14BS
, 2 doss o$ T.T to all &rg!a!t )o#! bt)!17 to 37 )-s o$ &rg!a!cy )it* a! i!tral o$1 to 2 #o!t*s bt)! t* t)o doss.
, T* $irst dos as arly as &ossibl t*
sco!d dos a #o!t* latr &r$rably 3 )-sb$or dliry.
, $ t* &rg!a!t )o#a! is &rio"slyi##"!id( a boostr dos is s"$$ici!t.
, $ t* &rg!a!t )o#a! is !ot i##"!id( t*! t* !)bor! s*o"ld b &rotctd agai!st tta!"s by gii!gtta!"s *"#a! i##"!oglob"li! ;50 J )it* i! 7 *o"rso$ birt*.
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Triple 1ntigen vaccine
, Tri&l !tig! acci!is a co#bi!atio! o$Di&*t*ria( Tta!"s(a!d 4rt"ssis. T*acci! sti#"lats t*&rod"ctio! o$a!tibodis toi##"!i t* body
agai!st t* ca"satiag!ts o$ t* t*rdisass listd abo
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F&id#iology
, F!dos&ors ar $o"!d i! #ost soils a!d i! t*i!tsti!al tract o$ #a!y a!i#als a!d *"#a!s.
, lt*o"g* &os"r to !dos&ors is co##o!(disas is "!co##o! c&t i! co"!tris )it*
&oor #dical car a!d acci!atio! co#&lia!c., t is sti#atd t*at t*r is #or t*a! o! #illio!
cass a yar )orld)id( )it* a #ortality rat o$20N to 50N.
, Most dat*s occ"r i! !o!ats a!d origi!ats$ro# i!$ctio! o$ "#bilical st"#&s i! #ot*rst*at *a !o i##"!ity.
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0 ti i > tt th
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0revention is >etter than
Cure
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, 0rogram Created and Designed by
Dr.T.V.Rao MD for the benefit of
Bniversal ducation on /nfectious
diseases
, F#ail
, doctortrao@g#ail.co#
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