Tetanus

1. Tetanus Anele Mandela

2. Temperament of tetanus and organs involved • Cold and dry • Organs involved are the muscles and it affects the central nervous system

3. Definition • Tetanus is a rare but often fatal disease, it affects the central nervous system by causing painful and often violent muscular contractions. • It begins when the tetanus bacterium (Clostridium tetani ) enters the body, usually through a wound or cut that has come in contact with the spores of the bacterium. Tetanus spores are commonly found in soil, dust, and animal manure. Tetanus is a non-communicable disease, meaning that it cannot be passed directly from one person to another.

4. Tibb definition • tetanus is cold and dry • It is a melancholic imbalance humour • pathway one

5. Signs and symptoms • The disease can show 4 possible types: -Generalized tetanus can affect all skeletal muscles. It is the most common as well as the most severe form of the four types. - Local tetanus manifests with muscle spasms at or near the wound that has been infected with the bacteria.-Cephalic tetanus primarily affects one or several muscles in the face rapidly (in one to two days) after a head injury or ear infection. Trismus ("lockjaw") may occur. The disease can easily progress to generalized tetanus. -Neonatal tetanus is similar to generalized tetanus except that it affects a baby that is less than 1 month old (called a neonate). This condition is rare in developed countries.

7. Signs and symptoms • The time between an injury and the occurrence of the first symptoms is typically less than two weeks but may range from 5 days to 15 weeks. • The presenting symptoms are often jaw or neck stiffness, difficulty swallowing, and irritability, often begins with mild spasms in the jaw muscles (lockjaw). There might be pain or tingling at the site where the tetanus bacteria entered, followed by spasticity of nearby muscles. • Spasms of the respiratory muscles may cause acute asphyxia. Airway obstruction is common. • The patient remains awake and alert throughout the illness.

8. The spasms can also affect the chest, neck, back, and abdominal muscles. Back muscle spasms often cause arching, called opisthotonos. • Sometimes the spasms affect muscles that help with breathing, which can lead to breathing problems. • Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups. This is called tetany. These episodes can cause fractures and muscle tears. • Other symptoms include: • Drooling,excessive sweating,fever,hand or foot spasms, irritability, swallowing difficulty,uncontrolled urination or defecation

10. Diagnosis • Tetanus is diagnosed by the clinical symptoms and a medical history that shows no tetanus immunization. • There are no blood tests that can be used to diagnose tetanus. The diagnosis is based on the presentation of tetanus symptoms and does not depend upon isolation of the bacteria, which is recovered from the wound in only 30% of cases and can be isolated from patients who do not have tetanus. Laboratory identification of C. tetani can only be demonstrated by production of tetanospasmin in mice. • The "spatula test" is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a sterile, soft-tipped instrument, and observing the effect. A positive test result is the involuntary contraction of the jaw (biting down on the "spatula"), and a negative test result would normally be a gag reflex.

11. Treatment and management • Immune globulin, given intramuscularly, is the immediate treatment of unimmunized individuals exposed to material likely to contain the tetanus bacteria. Treatment includes bed rest and quiet conditions. • Sedation, paralysis with certain medications, and mechanical ventilation (i.e.respirator) may be necessary to control the spasms. • Antimicrobial drugs, such as penicillin, are used to eradicate the bacteria. • Keeping wounds and scratches clean is important in preventing infection. SinceC. tetani grows only in the absence of oxygen, the wounds must be adequately cleaned of dead tissue and foreign substances. Run cool water over the wound and wash it with a mild soap. Dry it with a clean cloth or sterile gauze

12. Medication • Drugs used to treat muscle spasm, rigidity, and tetanic seizures include sedative-hypnotic agents, general anesthetics, centrally acting muscle relaxants, and neuromuscular blocking agents. Antibiotics are used to prevent multiplication of C tetani, thus stopping production and release of toxins.

13. Anticonvulsants • Sedative-hypnotic agents are the mainstays of tetanus treatment. Benzodiazepines are the most effective primary agents for muscle spasm prevention and work by enhancing GABA inhibition. Diazepam is the most frequently studied and used drug. Diazepam reduces anxiety, produces sedation, and relaxes muscles. • Phenobarbital is another anticonvulsant that may be used to prolong effects of diazepam. Phenobarbital is also used to treat severe muscle spasms and provide sedation when neuromuscular blocking agents are used. • E.g- phenobarbitol and diazepam (valium)

14. Skeletal muscle relaxants • These agents can inhibit both monosynaptic and polysynaptic reflexes at spinal level, possibly by hyperpolarization of afferent terminals. • E.g. Baclofen (Lioresal), Dantrolene (Dantrium)

15. Antitoxins • These agents are used to neutralize any toxin that has not reached the CNS. • E.g. Tetanus immune globulins (Hyper-Tet, Bay-Tet)- it is used as prophylaxis against tetanus and to treat patients with circulating tetanus toxin. TIG provides passive immunity

16. Antibiotics • Are administer to patients with clinical tetanus. Antibiotics prevent multiplication of C tetani, thus halting production of toxin. Penicillin G is the drug of choice. Metronidazole is considered by some to be a better drug. Tetracycline is an alternative drug for patients who are allergic to penicillin or metronidazole. • E.g. Penicillin G (Pfizerpen), Metronidazole (Flagyl), Doxycycline (Vibramycin, Doxychel),

17. Neuromuscular blocking agents • These agents inhibit the transmission of nerve impulses at neuromuscular junctions of skeletal muscles and/or autonomic ganglia. • E.g.- Vecuronium (Norcuron)

18. Tibb treatment • Treatment (single herb): Acorascalamus; Alliumsativum; Paeoniaemodi; Delphinium denudatum; Castoreum-an anticonvulsant and antispasmodic;Colchicumluteum; Purified ferula foetida; Sarssurealappa. • Medication: CogniumTablets- it is dry and hot and is suitable for phlegmatic,cereberal/nervous system disorders; Tibb-Septogaurd- is dry and hot it has immunomodulatory functions and it helps prevent re-infection. neurotone

19. Diet: avoid cold and dry foods like apples, sour fruits, coffee and mealie meal. • The person must eat foods that fall into the treatment frames which are dry and hot, hot and dry & hot and moist. E.g- chicken, all bran, pungent spices. • Sleep: 8 hours of sleep • Massage: heating oils like ginger and rosemary(h+d) and olive oil (h+m) • Tibb Fast deep breathing exercises • No strenuous exercises

20. Alternative Therapies • Castor oil is a natural remedy that can be used to clean out a wound and prevent tetanus. When a wound is sustained, a cotton ball dunked in castor oil should be placed on the wound, and then fixed on the wound with a bandage. Castor oil has tremendous drawing power and can pull out rust and other infectious agents. The dressing should be changed every 2 hours on the first day of treatment and twice a day for the next three days.

21. Homeopathy is a kind of medicine where the underlying philosophy is based on treating like with like. By introducing a similar treatment to the ailment, it is believed that the body will work to heal itself. Homeopaths will use a variety of methods to treat a whole range of illnesses.

22. NuxVomica • This is one of the leading homeopathic treatments due to its wide range. In terms of treating tetanus, the nux seeds are rich in copper, which can produce cramping, one of the effects of tetanus. Strychnia, which is an alkaloid of nuxvomica, can create a near image of tetanus by creating convulsions and respiratory spasms. CicutaVirosa • This remedy can be effective with tetanus due to the symptoms it creates. It affects the nervous system, creating sometimes violent convulsions similar to what someone experiencing tetanus would undergo. The patient taking this may have fixed eyes and slowed breathing as a result.

23. Physostigma • This remedy is known for affecting the motor abilities of a patient. It stimulates the heart and raises the bloodpressure, all symptoms of tetanus. Physostigma can cause tremors in the body, but can also induce paralysis. The remedy is also effective in dulling the pain of tetanus due to its effect on the nervous system. Aconite • Aconite, also known as aconitum napellus, is used to treat tetanus when a fever is present. The treatment works to calm inflamed nerves, tension in the arteries, and emotional and physical conditions brought on by anxiety. The remedy causes only a functional disturbance in the body and does not alter the tissues. Belladonna • Belladonna is known for its ability to bring on sudden symptoms that mirror anxiety and fear. It affects the nervous system directly and is known to cause twitching, jerks, and even convulsions. It can mimic an epileptic spasm followed by vomiting. It is primarily used in treating tetanus in infants with lock jaw.

24. Traditional medical treatment revolves around drug therapy, traditional Chinese medicine herbal remedies are the most common alternative treatment for tetanus. Herbs that have sedative effects should be given to reduce the frequency of convulsions, along with herbs to fight the bacteria. • Tetanus and convulsions can be treated with a concoction made from the dried body of a long-nosed pit viper, called this drug Qi She in Mandarin. Chan Tui, orcicada slough (the skin the cicada sheds) is also helpful. Also helpful are the dried root of the Saposhnikoviadivaricata, called divaricatesaposhnikovia root, and jack-in-the-pulpit tuber, if it is treated to remove toxins.

25. Prognosis • For patients who survive tetanus, recovery can be long (1 to 2 months) and burdensome. Muscle spasms may begin to decrease after 10 to 14 days and disappear after another week or so. Residual weakness, stiffness, and other complaints may persist for a prolonged period, but complete recovery can occur from uncomplicated tetanus. • Patients with tetanus are hospitalized in an intensive care unit until it is clear that the progression of the disease has stabilized at a level that does not interfere with vital functions, and that therapy can be managed outside the unit.

26. Prognosis • Acute respiratory failure is the leading cause of death in tetanus infections. A short incubation period is associated with a particularly grim prognosis. In individuals under age 50, mortality is nearly 100% if symptoms begin within 1 to 2 days. • Morbidity is reduced to 35% to 40% if the incubation period is greater than 10 days. The overall mortality rate ranges from less than 10% to as high as 50%. High mortality rates are also associated with early onset of convulsions, individuals who require mechanical ventilation, or delay in treatment. • Contaminated wounds located on the head and face are more dangerous than wounds located on other parts of the body. The individual's age and severity of symptoms also affect prognosis. Recovery is complete if the individual survives the infection.

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