Qn : You accidentally stepped on a rusty fish hook, while walking along the beach. There is profuse beleeding and you rush to the nearby clinic. The nurse dresses the wound and gives a tetanus injection. Explain the reason for the administration of the injection and the consequences of not administering the tetanus injection.



What is Tetanus?

Tetanus is an infectious disease caused by contamination of wounds from bacteria that live in the soil. The bacteria Clostridium tetani is a hardy organism capable of living many years in the soil in the form of a spore.

The bacterium was first isolated in 1899 by S.Kitasato while he was working with R.Koch in Germany. Kitasato also found the toxin responsible for tetanus and developed the first protective vaccine against the disease.

Where are they found?

Tetanus are usually found throughout the environment, usually in soil, dust and animal waste. They can enter our body via punctured wounds caused by rusty nails, splinters or insect bites, and not transmitted from person to person.


How does it occur?

Tetanus occurs when a wound becomes contaminated with bacterial spores. Infection follows when spores become activated and develop into gram-positive bacteria that multiply and produce a very powerful toxin that affects the muscles.

What will happen when I get infected?

Tetanus results in severe, uncontrollable muscle spasms (shuddder/tremor). The jaw is "locked" by muscle spasms, causing the disease to cometimes be called "lockjaw". In severe cases, the muscles used to breathe can spasm, causing a lack of oxygen to the brain and other organs that may possibly lead to death.

How is the vaccine administered and how does it work?

The DPT (Diphtheria, Pertussis, Tetanus) vaccine is used intramuscularly (injected to the muscle) so as to not let the wound be contaminated. It helps the body to make antibodies so as to fight against tetanus. Its components consists of Diphtheria and Tetanus toxoids, which are inactivated toxins. It is made by growing bacteria in a liquid medium and purifying, thus inactivating the toxin. Since it is not a live vaccine, a person's immunity tends to decline with time, which is why booster doses are recommended. The vaccine works by killing whole cells of organisms that causes Tetanus.

What are the symptoms if I had not followed a Tetanus vaccine to the wound?

Symptoms may appear anywhere from 2 days to 6 weeks after the wound has been infected, but the typical incubation period (time between infection and symptoms) is 5 to 10 days. Symptoms can be mild or severe, which would includes:

• Chills
• Difficulty swallowing
• Headache
• Irritability
• Jaw and neck stiffness
• Low fever
• Restlessness
• Sore throat
• Stiff arms and legs

These symptoms will soon progress to classic tetanus such as:

• Difficulty opening the jaw - which is why it it called 'lockjaw',
• Muscle spasms in the back, neck or abdomen

People with tetanus often develop a fixed expression with a tight, stretched smile and arched eyebrows. They often go into painful whole-body spasms when slightly disturbed, for example fluffing their pillow. They may sweat a great deal during these spasms. They may be unable to speak because of spasms in the chest or throat - these can also make breathing difficult. Rigidity in the bladder and bowels can cause retention of urine and constipation.

The pulse can be fast, but fever is rarely very high. People with tetanus are usually mentally alert. Blue lips or nail beds are a sign of depressed breathing, meaning there's too little oxygen or too much carbon dioxide in the blood.

Sometimes the face is unaffected and the spasms are confined to muscles near the wound. In this case, there is a better chance of full recovery.

Complications of tetanus can include pneumonia, broken bones, skin sores, muscle tears, and low blood pressure.

How can Tetanus be prevented?

The most important way to prevent tetanus is through complete immunization and proper wound care.

• Prevent tetanus through immunization - An effective vaccine against tetanus has been available for many years. It is usually given to children combined with diphtherua and pertussis vaccines in a shot called DTP.
• Prevent tetanus through proper care of wounds - Cleaning all wounds,dead tissue and using antibiotics for contaminated or infected wounds can reduce the likelihood of getting tetanus.

References:

http://www.adacelvaccine.com/index.cfm%...S%3DHOME

http://onesickmother.typepad.com/my_web...cam.html

http://www.immunizebc.ca/ImmVacPrevDis/...anus.htm

http://onesickmother.typepad.com/my_web...cam.html

http://microbiology2009.wikispaces.com/...eatments

http://www.patient.co.uk/health/Tetanus-Immunisation.htm

http://www.allhealth.com.au/html/s02_article/article_view.asp?keyword=tetanus-injection

http://www.emedicinehealth.com/tetanus/article_em.htm#

http://bodyandhealth.canada.com/channel_condition_info_details.asp?channel_id=1020&relation_id=10884&disease_id=125&page_no=1#Symptoms