TETANUS

Tetanus is a preventable, curable infectious disease, caused by the germ Clostridium Tetani. This microbe exists in soil. A person gets infected due to use of scissors or blades on body contaminated with dust containing spores of C. Tetani. A wound that is contaminated by dust or soil is also a risk factor for development of tetanus. The spores germinate in the contaminated wound and produce toxins. The toxin then spreads to the peripheral nerve cells, affecting them. The symptoms usually develop acutely 3 to 14 days after injury. “Lock jaw”, i.e. the inability to open the mouth is usually the first symptom to develop. As the name suggests, the patient has difficulty to open the mouth wide. This results in difficulty in eating and speaking. Unchecked, later on this rigidity spreads to the trunk and limbs. Involvement of trunk causes arching of the back backwards which is known as ophisthotonus. Increased excitability of the nerve cells leads to convulsions. Any slight stimulus like small sound or light can precipitate and aggravate convulsions. The worst part is that the patient is mentally alert while undergoing all this suffering. In extreme cases there is paralysis of respiratory muscles leading to death. Death can also occur due to aspiration of oral secretions. Tetanus can occur at any age and both genders, when exposed to the risk. Due to use of unsterile instruments by indigenous mid wives for conducting deliveries or cutting the umbilical cord, women and their new born babies develop tetanus. Men are exposed to the germs when they are wounded while working in fields or with machines or tools which may be contaminated by the spores of Clostridium Tetani. Scissors and knives used by barbers if not cleaned and sterilized adequately can also cause tetanus. Commonly tetanus occurs in poor people. Ignorance, living in mud houses, walking bare footed, greater exposure to dust/soil due to nature of work done are the risk factors which are responsible for the continuous prevalence of tetanus, in all parts of the world. Even a rich person can have tetanus if not immunized and exposed to germs through a cut or wound . It exists even in U.S.A. and U.K., though the number is small as compared to the underdeveloped world. After getting injured it is important for any person to take vaccination for tetanus immediately. Tetanus toxoid produces antibodies in the body and helps prevent the disease. It is mandatory to take tetanus toxoid vaccine before any minor or major surgery to prevent tetanus. If somebody has acquired the disease accidentally, he should be given the antitetanic serum within 24 hours, but not later than 72 hours. Thus the release and ascend of the toxin is prevented. This prevents the subsequent damage caused to the nerve cells. Timely taken, suitable antibiotics help in checking and removing the infection. It is very important to keep a patient of tetanus in a quiet, dark room for treatment. Any sound, physical disturbance howsoever mild or even small light should be avoided to avoid occurrence of convulsions. The attendants should be explained very well that no visitor or person except the care taker should be allowed near the patient, till he completely recovers. That is the stage when he is able to open the mouth normally and more than 24 -48 hours pass without convulsions. Stiffness of the limbs takes time to recover and physiotherapy helps in this process. During the period of treatment and recovery, it is important to give attention to the nutrition of the affected person as he is unable to open the mouth. Frequent small liquid meals or intravenous fluids are used for this purpose, depending on the severity of the tetanus. Regular immunization against tetanus in children and pregnant women has helped in bringing down the sickness and deaths due to tetanus. But in this era of extensive medical advancement, deaths due to a totally preventable and curable disease are not acceptable. Extensive public education about tetanus particularly in rural areas and preventive measures will help in total eradication of the disease. E-mail –rachna212002@yahoo.co.uk