NTA Level 5 • Semester 1 • PST05103

Tetanus

Pharmaceutical Microbiology • Source Session/Topic 15

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Session 15: Tetanus

Total Session Time: 60 minutes

Pre-requisites

• Human anatomy and physiology

Students Learning Tasks

By the end of this session students are expected to be able to:

• Describe Tetanus diseases (causative agents, transmission, signs and

symptoms)

• Describe treatment prevention and control of tetanus

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Cause and Transmission of Tetanus (15 minutes)

• Tetanus is an acute, often fatal disease caused by an exotoxin

produced by the anaerobic bacterium Clostridium tetani. Tetanus can

occur in adults, children and in neonates.

• Tetanus is transmitted through wounds contaminated with spores of the

bacteria.

• Neonatal Tetanus is acquired through the umbilical stump

o Usually occurs through introduction of tetanus spores via the

umbilical cord during delivery through the use of an unclean

instrument to cut the cord, or after velivery by “dressing” the

umbilical stump with substances heavily contaminated with tetanus

spores.

• Tetanus toxin (Tetanospasmin) binds to receptors on the presynaptic

membranes of motor neurons and is transported to the spinal cord and

brainstem where it blocks the release of inhibitory glycine and Gamma

aminoburyric acid (GABA).

• The motor neurons are therefore not inhibited resulting in continuous

stimulation.

• Extremely small amounts of toxin can be lethal for humans.

• Hyperreflexia, muscle spasms, and spastic paralysis result.

STEP 3: Signs and Symptoms of Tetanus (15 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the signs and symptoms of Tetanus? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• The incubation period of Tetanus may range from 4 to 5 days up to 3

weeks.

Signs and symptoms

Signs and symptoms differ depending on the form of tetanus affecting the

patient. There are about three forms of the disease

Generalized tetanus is the most common type of tetanus, representing about

80% of cases. The first sign of generalized form is trismus, or lockjaw,

and the facial spasms called risus sardonicus, followed by stiffness of the

neck, difficulty in swallowing, and rigidity of pectoral and calf muscles.

Other symptoms include elevated temperature, sweating, elevated blood

pressure, and episodic rapid heart rate.

Local tetanus is an uncommon form of the disease, in which patients have

persistent contraction of muscles in the same anatomic area as the injury.

The contractions may persist for many weeks before gradually subsiding.

Local tetanus is generally milder; only about 1% of cases are fatal, but it

may precede the onset of generalized tetanus.

Cephalic tetanus is a rare form of the disease, occasionally occurring with

otitis media (ear infections) in which C. tetani is present in the flora of

the middle ear, or following injuries to the head. There is involvement of

the cranial nerves, especially in the facial area.

Death usually occurs due to exhaustion.

STEP 4: Treatment and Prevention of Tetanus (15 minutes)

Treatment

• Supportive Therapy

o Nursing the patient in the dark, quiet room to avoid unnecessary

external stimuli which can trigger spasms

o Protecting the airway

o Thorough cleaning of the site of entry (wound/umbilicus), leaving it

exposed without dressing

o Pain management with Paracetamol (via NGT) as the spasms can be very

painful

o Maintenance of fluid balance and nutrition (via NGT)

▪ Use of the IV/IM route should be avoided as injections can trigger

spasms

o Sedation

• Medications used

o To prevent further absorption of toxin from the wound

▪ Human tetanus immunoglobulin

▪ Antibiotics

• Amoxycillin

• Metronidazole

o To control spams and contractions

▪ Diazepam

▪ Chlorpromane

▪ Phenobarbitone

Prevention

• Immunization with Tetanus

o Childhood immunization with Tetanus Toxoid (TT)

o Immunize women of reproductive age (in pregnancy or outside pregnancy)

• Hygienic practices when caring for wounds and during delivery

STEP 5: Key Points (5 minutes)

• Tetanus is a very dangerous disease caused by an exotoxin produced by

Clostridium tetani.

• The disease occurs both in adults and neonates. In neonates it is

called neonatal tetanus.

• Transmission of tetanus is through contaminated wounds or umbilical

stumps

• Treatment involves supportive to control muscle contractions and

provision of antibiotics and sedatives

• Tetanus is prevented by vaccination and hygienic practices when caring

for wounds

STEP 6: Evaluation (5 minutes)

• What are the treatment options for Tetanus?

• What is neonatal tetanus?

• Who is at risk of acquiring tetanus?

References

Hugo and Russell (2011), Pharmaceutical Microbiology 8th Edition, Willey-

Blackwel publications

Karen C. Carroll et al (2013); Jawetz, Melnick and Adelberg’s Medical

Microbiology 26th Ed. McGraw Hill Co. Inc.

Greenwood et al (2012); Medical Microbiology, 18th edition Churchill

Livingstone

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