physiological tetanus

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2. a highly fatal disease caused by the bacillus Clostridium tetani, characterized by muscle spasms and convulsions. The bacilli are prevalent in rural areas and grow in the intestines of humans and other animals. They are found in soil and dust, and are spread by animal and human feces, entering the body through a break in the skin, particularly a puncture wound, such as one caused by a nail, splinter, insect bite, or gunshot. Occasionally, the original wound appears trivial and heals quickly; more often, there is obvious infection. Because of the characteristic jaw stiffness, it is also known as lockjaw. adj., adj tetan´ic.
Symptoms. Stiffness of the jaw is usually the first definite indication of tetanus. Difficulty in swallowing, stiffness of the neck, restlessness, irritability, headache, chills, fever, and convulsions are also among the early symptoms. Muscles in the abdomen, back, neck, and face may go into spasm. If the infection is severe, convulsions are set off by slight disturbances, such as noises and drafts. During convulsions, there is difficulty in breathing and the possibility of asphyxiation.
Treatment. If there is any suspicion of contamination by tetanus bacilli, emergency treatment should be obtained. This may include an adequate dose of antitoxin or a booster injection of tetanus toxoid (see below) to counteract any possible tetanus infection. Because of the possible danger of hypersensitivity to horse serum antitoxin, tetanus immune globulin (derived from human instead of horse serum) is preferred when available. In any case, the wound area must be carefully cleaned, and all dead tissue and foreign substances removed.

During a tetanus attack, sedatives are often given to reduce the frequency of convulsions. antibiotics may also be used to help combat secondary infection. hyperbaric oxygenation (oxygen under high pressure) has also been used to treat tetanus.
Prevention. The most important weapon against tetanus is adequate immunization. Tetanus toxoid in combination with diphtheria toxoid and pertussis vaccine (DTP) is given at two months of age and repeated at four months, six months, 18 months, and four to six years of age.

At the time of injury tetanus toxoid is given, either as an initial immunizing dose or as a booster for previous immunization, unless the patient has received a booster or completed the initial immunization within the past five years. Patients who have been actively immunized within the past ten years are given a booster unless they have received a booster within the past five years. Patients who have not been previously immunized may require passive immunity with homologous tetanus immune serum as well as active immunization, especially if the wound is severe, neglected, or over 24 hours old.
Patient Care. Because the toxin from Clostridium tetani attacks the central nervous system it is extremely important to provide a nonstimulating environment for patients with tetanus. The room must be kept dark and quiet, and drafts of cold air, noises, and other external stimuli must be avoided because they may precipitate convulsive muscle spasms. As for any patient subject to convulsions, maintenance of a safe environment is essential. Prevention of injury to and assessment of a patient with convulsive seizures are discussed under convulsion.

Fluids and nourishment usually are given intravenously during the acute stage of the disease. The patient's intake and output are carefully measured and recorded. Sedatives and antibiotic drugs are administered as ordered to reduce irritability and to combat secondary bacterial infections.

As long as the patient is acutely ill and likely to suffer from convulsive seizures, someone should be in constant attendance. Signs of respiratory difficulty, changes in pulse and blood pressure, and frequent and prolonged muscle spasms should be reported immediately. A tracheostomy set should be readily available in the event severe dyspnea should develop.
cephalic tetanus (cerebral tetanus) a rare form of infectious tetanus with an extremely poor prognosis; it may occur following an injury to the head or face or in association with otitis media in which Clostridium tetani is a constituent of the flora of the middle ear and it is characterized by isolated or combined dysfunction of the cranial nerves, especially the seventh cranial. It may remain localized or progress to generalized tetanus.
neonatal tetanus (tetanus neonato´rum) a severe form of infectious tetanus occurring during the first few days of life caused by such factors as unhygienic practice in dressing the umbilical stump or in circumcising male infants and the lack of maternal immunization.
physiological tetanus a state of sustained muscular contraction without periods of relaxation caused by repetitive stimulation of the motor nerve trunk at frequencies so high that individual muscle twitches are fused and cannot be distinguished from one another; called also tetanic or tonic contraction and tetanic or tonic spasm.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
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