Michael Erick Virtucio Section4-D

Jean Paola Yap 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 outgrowth

Cell lysis occurs

Release of bacterial
endotoxins into
surrounding tissues

Tetanolysin Tetanospasmin (potent

neurotoxin)

Potentiating of
infection

Toxin circulated around Enter Central Nervous System (CNS)

the body through along peripheral nerves
Release of biochemical mediators of
bloodstream and
inflammatory response (histamine,
lymphatic system
bradykinin)
 Michael Erick Virtucio Section4-D
Jean Paola Yap Group 9-b

Inflammatory response initiated Toxin not able to pass

through blood-brain
barrier

Increased capillary WBCs such as

permeability neutrophils and Toxin makes its way to spinal cord
monocytes enter

Increased blood
flow Toxin enters the CNS
Phagocytosis and
removal of debris occur

Toxin taken up by
Swelling Redness
neuromuscular junction
Phagocytes release
endogenous pyrogens
Crosses to synaptic clef

Stimulation of
Irreversibly binds to
hypothalamus to increase
gangliosides at presynaptic
body temperature
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

Generalized tonic muscle spasms

Pain occur

Pharynx Cranial muscle Facial muscle Masseter muscle Glottis GI

(larynx,
Respiratory
abdomi
Aspiration of Rapid firing of Risus Lockjaw Failure to muscles
nal
oral impulses sardonicus speak or wall)
secretions (fixed smile cry out
and
Irritability of elevated
Chest wall Diaphragm
Pneumonia neurons eyebrows)
muscle
Restlessnes
s Chest wall rigidity
Michael Erick Virtucio Section4-D
Jean Paola Yap Group 9-b

Headache
Asphyxiation

Hypoxemia

Cardiac Arrest

DEATH Respiratory failure

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