Tetanus | Tetani |

If you're like most Canadians, you've probably made a checklist of all the chores you have to do around the yard or cottage while the weather is warm. Whether it's cleaning out the garden shed, planting your garden, or making repairs around the yard, it's time to get outside and get dirty.

But are you really ready? Carson Arthur, outdoor living expert and host of HGTV's Green Force and Global TV's Room to Grow, is reminding Canadians that their outdoor chore checklist may be missing one key element – protection against tetanus.

"When preparing for an outdoor project, I find that most people remember to take safety precautions like wearing steel-toed boots, sunscreen or mosquito repellent, but we don't often think to protect ourselves against hidden dangers like tetanus," said Carson. "Tetanus doesn't just lurk on rusty nails – it's in dirt, soil and dust, so you're at risk of exposing yourself even through simple things like kneeling in the garden with a scraped knee."

If you cut or injure yourself while gardening or working on home improvement projects, especially outdoors, there's a chance of being exposed to tetanus bacteria.

The bacteria that cause tetanus are found everywhere in the environment, including in dirt, soil and dust. The disease begins when these bacteria enter the body through a skin injury such as a puncture or laceration, such as the kind you could get from a sharp tool or even a splinter. The first symptom is usually spasm of the jaw muscles, sometimes referred to as "lockjaw," followed by painful spasms of muscles in the face, neck, chest, abdomen, arms and legs, which can last up to a month. It can be fatal in 10 to 20 percent of cases, even with treatment.

Canadians can protect themselves from this potentially fatal disease by receiving the tetanus vaccination and it's recommended that adults receive a free tetanus booster every 10 years to ensure lasting protection. Canadians can contact their doctor or local clinic to check if they're due for a booster.

It is a condition of toxemia due to absorption of soluble toxin from the wound contaminated with clostridium tetani.

Causative organism:

Clostridium tetani is an anerobic gram +ve bacteria with a terminal spore giving a characteristic drum stick appearance. This is mainly found in manure and soil.

It mainly releases mainly two types of exotoxins

1. Tetanospasmin: it is a neurotoxin acts on motor end plates

2. Tetanolysin: it is a oxygen labile haemolytic toxin

Mode of entry:

1. usually through a penetrating wound

2. dirty abrasions

3. chronic ulcers like boils, paronychia, dental extractions

4. subcutaneous injections of irritant drugs

5. contaminated umbilical cord of a neonate

6. post abortal and post puerperal

7. post operative tetanus

Incubation period:

3days to 3weeks on an average 7days

The time interval between 1st symptom and 1st reflex spasm is called period of onset. The less the onset period the condition is more fatal.

Pathology:

The soluble toxin is absorbed from the site of infection.

The spores germinate in the anaerobic condition which is contributed by necrosis and devitalisation of site of injury, Calcium ions derived from soil or hemorrhage.

The toxin reaches the central nervous system either through nervous route, blood stream or by lymphatic channel.

Then it gets fixed to the anterior horn cells of the nerve and causes hyperexitability of motor neurons and inhibits cholinesterase leading to reflex spasms

Clinical features:

1. Trismus (locked jaw)

2. Stiffness of muscles of head, neck, back, abdomen.

3. Risus sardonicus

4. Opisthotonous (bow like bending) of the body. Some times psoas and abdominal muscles may rupture

5. Dysphagia due to spasm of deglutition muscles

6. At early stages the spasms are conditional & later becomes unconditional

7. Constitutional symptoms like fever, cyanosis are present

8. High temperature (fever) of 38C (100.4F), or above

9. Rapid heartbeat (tachycardia)

10. Sore throat

11. Sweating

12. Headache

13. Extreme sensitivity to touch

Main Causes of death

1. Pulmonary infections mainly bronchopneumonia

2. Aspiration of pharyngeal contents leading to Suffocation (asphyxia)

3. Laryngeal spasm

4. Pulmonary embolism due to dislodgement of emboli

5. Anemia & exhaustion due to repeated convulsions

6. Hyperpyrexia

7. Compression fracture of thoracic vertebrae

8. Blood poisoning (septicaemia)

9. Heart attack

10. Kidney failure

Prophylaxis:

1. to give active immunization of alum precipitated tetanus toxoid Im along with diphtheria and pertusis (DPT) In the child hood for every newborn

2. proper surgical wound care is necessary

3. isolation of patient in a quiet, dark room

Homeopathic approach:

Nux vomica:

1.It has tetanic convulsions with opisthotonos, distortion of eyes and face, with dyspnoea excited by any external impression.

2. convulsion of muscles renewed by the slightest external impression,

3. risus sardonicus

4. respiratory spasm

5. blue cyanosed face

6. clear mind..

Hydrocyanic acid:

1. It produces a persistent tonic spasm from its direct action on the spinal cord. It shows itself in the muscles of the face, jaws and back.

2. There is trismus or locked jaw, risus sardonicus and impeded respiration, with lividity and frothing at the mouth; the rigidity is firm

3. The body is bent backwards

4. The attack is sudden

5. There is less reflex excitability.

6. Painful stiffness and stretching of the limbs.

7. The lips are drawn back showing the teeth and the jaws are locked.

Cicuta virosa:

1. Sudden rigidity and jerkings followed by prostration.

2. Great oppression of breathing.

3. Locked jaw.

4. Opisthotonos renewed by touch.

5. There are oesophageal spasms

6. A marked symptom is fixed eyes staring at one point.

Physostigma:

1. The sensory nerves are irritable.

2. There are tetanic spasms stiffness of spine and legs

3. Alternate dilation and contraction of the pupils.

Stramonium:

1. Tetanic convulsions

2. Spasms of glottis and chest worse from light or touch.

Aconite:

1. Tetanus, with fever

2. Numbness and tingling from exposure to cold

3. The face changes color.

4. Great Fear of death

Cuprum:

1. Pale face

2. Jerking

3. Opisthotonos

4. Patient loses consciousness with each spasm.

5. Coldness of extremities.

Hypericum:

1. Trismus from injury to nerves.

2. Useful in spinal injuries

Belladonna:

1. Tetanus of infants.

2. Stiffness of jaws.

Other remedies:

1. Magnesia phosphorica, Carbolic acid,. Phenol, Passiflora, Ignatia