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Neonatal tetanus

Neonatal tetanus. DR AUDU LAMIDI CHIEF CONSULTANT PAEDIATRICIAN. Introduction. Acute non contagious infection A non - communicable/infectious disease that causes sustained muscular s pasm ,  contraction as a result of toxins

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Neonatal tetanus

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  1. Neonatal tetanus DR AUDU LAMIDI CHIEF CONSULTANT PAEDIATRICIAN

  2. Introduction • Acute non contagious infection • A non - communicable/infectious disease that causes sustainedmuscular spasm, contraction as a result of toxins • Released by the causative organism Clostridium tetani : a large , Gram positive, rod shaped, spore forming, anaerobic bacteria, • Found in soil, especially heavily manured soils, intestine and faeces of animals (animal dung)

  3. Pathogenesis • Human pathogenicity derives from release of a potent protein toxin from spores; TETANOSPASMIN • Also produces tetanolysin which has no clinical relevance • Spores gain access to wounds, germinate into vegetative forms multiply locally but symptoms appear remote from site of infection • Tetanospasmin is one of 3 known most powerful biologic toxins( Diphtheria and botulism). Estimated lethal human dose is 2.5 ngm/kg

  4. Pathogenesis • Toxin binds to peripheral nerve ending, transported along the axon and across synaptic junctions and ends in the CNS. • Fixes rapidly to gangliosides at the presynaptic inhibitory motor nerve endings and gets transported into the axon by endocytosis • Blocks release of inhibitory neurotransmitters (glycine gama-amiobutyric acid) required to check nervous impulse • Nervous impulses can no longer be checked by normal inhibitory mechanisms resulting in unopposed muscular contractions and spasms.

  5. Transmission • Enters the body through contaminated object: • blades, scissors, knives etc used to ligate umbilical cord as well as for traditional uvulectomy, circumcision and tribal marks, ear piercing ect • cow dung applied on cord, • Affected babies are usually those whose mothers were not immunized against tetanus in pregnacy

  6. Clinical presentation • Incubation period 3-21 days; may be shorter • Onset time: interval between appearance fo first sign and onset of spasm • Usually generalized • Trismus • Risussardonicus • Abdominal rigidity • Generalized spasms: provoked or unprovoked • Inability to feed • Sweating and fever • Neck retraction/retrocolis and opistotonus

  7. Clinical phothograph

  8. Neck retraction

  9. Diagnosis • Usually clinical • History is suggestive • Examination reveals signs listed above • Laboratory investigation not useful as Clostridium is rarely cultured fron site of infection • Investigations are often done to rule out differential diagnosis eg meningitis, strychnine poinsoning

  10. Treatment • Antibiotics to clear residual Clostridium penicillin G:50000IU/kg/day • Tetanus immune globulin to neutralize circulating toxins500 IU im stat • Sedatives to stop and control spasms; phenobarbitone, chlorpromazine, diazepam • Muscle relaxation with Diazepam may be required • Spasm chart should be kept • NGT for feeding • Avoid provoking sounds/noise • May require muscle paralysis, endotracheal intubation and mechanical ventilation. • Immunization following recovery with tetanus toxoid

  11. Complication • Laryngeal spams • Apnea: may be recurrent • Aspiration pneumonitis • Skeletal fractures • Autonomic dysfunction: tachycardia bradycardia • Respiratory failure is the most common cause of death. • Brain damage can occur in infants from recurrent hypoxia (apnoic episodes)

  12. Poor prognostic features • Short incubation period • Short onset time • Delay in treament • Frequent unprovoked spasms • Death is usually due to respiratory or cardiac failure. • Intensive medical care improves the prognosis.

  13. Prevention • Maternal immunization with TT:This protects the mother and – and through a transfer of tetanus antibodies to the fetus – also her baby. • Avoidance of unsterile instrument in the care of cord. • Cord care with chlorhexidine gel only • Discourage unhealthy traditional practices • Health education

  14. Points to note • Neonatal tetanus is a significant problem in developing countries due to poor umbilical stump hygiene and lack of maternal immunization. • Neonatal tetanus requires treatment in a medical facility, often in a referral hospital. • Acute condition requiring intensive care • Prevention is by immunization

  15. End • Thank You

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