Tetanus Teaching basics by Dr.T.V.Rao MD

8/20/2019 Tetanus Teaching basics by Dr.T.V.Rao MD

1/53

Clostridium tetaniteaching basics

Dr.T.V.Rao MD

08/23/15 Dr.T.V.Rao MD @ Rao's Microbiology 1


2/53

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



3/53

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



4/53

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

08/23/15 Dr.T.V.Rao MD @ Rao's Microbiology


5/53

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

08/23/15 Dr.T.V.Rao MD @ Rao'sMicrobiology

5


6/53

Morphology, Gra# bacilli

, %8 0.5 #icro!s

, Dr"#stic-a&&ara!c

, 6bligatory

a!arob

08/23/15 Dr.T.V.Rao MD @ Rao'sMicrobiology 7


7/53

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

08/23/15 Dr.T.V.Rao MD @ Rao's Microbiology ;


8/53

C. tta!i: -y c*aractristics


9/53

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.



10/53

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



11/53

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


12/53

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(



13/53

Type of Tetanus

, Traumatic tetanus

, 0uerperal tetanus

, togenic tetanus

, /diopathic tetanus

, Tetanus4eonatroum



14/53

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!



15/53

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



16/53

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


17/53

Tetanospasmin

, Mol )t ?ay c*ai! 3(000


18/53

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#.



19/53

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



20/53

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



21/53

Mechanism of Action

of Tetanus Toxin



22/53

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



23/53

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.



24/53

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#.



25/53

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



26/53



27/53

pisthotonus

08/23/15 Dr.T.V.Rao MD @ Rao'sMicrobiology 2;


28/53

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


29/53

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->.



30/53

Risus Sardonicus in Tetanus 0atient



31/53


32/53

: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



33/53

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



34/53

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


35/53

Sho+ing spores and =r+oth on

>lood 1gar plate

08/23/15Dr.T.V.Rao MD @ Rao's

Microbiology 35


36/53

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

08/23/15Dr.T.V.Rao MD @ Rao's Microbiology

37


37/53

Tta!"s bactria gro) i! RCM

Mdi"#

, Aactriagro)! i!

Robrtso!coo-d #at

#di"#

08/23/15Dr.T.V.Rao MD @ Rao's

Microbiology 3;


38/53

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!


38


39/53

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.


3


40/53

4ro&*ylais

, B"rgical att!tio!

, !tibiotics

, ##"!iatio!

, !tibiotics I *o"rs

, Fryt*ro#yci! 5000 #g Aid

, 4!cilli!

,


41/53

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


1


42/53


, !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.


2


43/53

,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


3


44/53

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



45/53

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


5


46/53


'. 1TS&eAuine( /g '7)) /B8s.c after

sensitivity test

&or(. 1TS&human( /g 7)7)) /B, no

anaphylactic shoc6, very safe and

costly.



47/53

Treatment of Tetanus patients

, ?os&italiatio!

, Trac*oto#y

, ?"#a! TG 10(000 J

, 4!cilli!( Mtro!idaol

, TB V, Gi acti i##"!iatio!.

08/23/15 Dr.T.V.Rao MD @ Rao's Microbiology ;


48/53


8


49/53

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*.

08/23/15 Dr.T.V.Rao MD @ Rao's Microbiology


50/53

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


50


51/53

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.


0 ti i > tt th


52/53

0revention is >etter than

Cure


52


53/53

, 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#

08/23/15 Dr T V Rao MD @ Rao's Microbiology 53

Tetanus Teaching basics by Dr.T.V.Rao MD

Documents

Transcript of Tetanus Teaching basics by Dr.T.V.Rao MD