Bacterial Infections clostridium tetani

TETANUS

• Tetanus is a neurological disease caused by clostridium tetani characterized by increased muscle tone and spasms due to a powerful exotoxin tetano­spasmjnproduced by the bacteria.
• C. tetani is a Gram positive anaerobic rod with a ter­minal spore resembling a tennis~racket.

TETANUS Causes Diagnosis Treatment with Signs and Symptoms

Clinical manifestations TETANUS:

• There is increased muscle tone and generalized spasms.
• It occurs 3 – 13days after an injury such as a punc­ture wound, laceration or abrasion. It is also associ­ated with burns, surgery, abortion, child birth, gan­grene.
• There is increased tone in the masseter muscles (jaw muscles) resulting in tri.smus or lock-jaw.
• Lock-jaw is the first feature of tetanus.
• ~There is dysphagia, stiffness of neck, shoulder and back muscles.
• The abdomen is rigid.
• Hands and feet are spared but proximal limb muscles are involved.
• There is risus sardonicus (sarcastic smile) due to sus­tained contraction of facial muscles.
• There is opisthotonus (arched back). There may be cyanosis and respiratory distress.
• Convulsions are provoked by any stimulation like noise, light etc.
• Patient may have fever.
• Deep tendon reflexes are exaggerated.
• There may be tachycardia, hypertension, arrhythmias, laryngeal spasm, respiratory arrest and cardiac ar­rest.
• Diagnosis is usually clinical.

Treatment OF TETANUS

• General supportive measures. Respiratory support.
• Airway is protected.
• Wound is cleaned and debrided.
• Penicillin 10 – 12 million units daily IV for 10 days.
• Metronidazole 500 mg §…b.r:l¥.
• Clindamycin, Erythromycin.
• V Antitoxin-human tetanus immune globulin is given to neutralize circulating toxin in the wound. Dose is 3000 – 6000 units intra muscular in di­vided doses.
• Equine tetanus antitoxin may be used instead of. human antitoxin.
• Muscle spasms are controlled by Diazepam, Lorazepam, Propofol, Magnesium sulphate.
• Respiratory care – Tracheostomy and Mechani­cal ventilation.

Prevention OF TETANUS :

• Active immunization – consists of 3 doses of teta­nus toxoid – 1^st and 2^nd doses are given 1 -2 months apart, 3^rd dose is given after 6 – 12 months. Booster dose is given every 10 years.

neurotoxins produced by Clostridium botulinum

• Botulism is a paralytic disease caused by neurotoxins produced by Clostridium botulinum.
• There is cranial nerve involvement and the disease progresses downwards to the extremities.
• Botulism may be food-borne, or wound botulism, or intestinal botulism.
• Botulism occurs worldwide.
• Botulinum toxin can be dispersed in an aerosol or mixed with food. Therefore, it is used in biological warfare and terrorism.

Clostridium botulinum

Clinical features BOTULISM:

• There may be a mild ill ess or a severe disease re­sulting in death ithin 24 ho!J.[s.
• Incubation period is 1 – 2 days.
• -There is symmetrical descending paralysis with res­piratory failure and death.
• -There is cranial nerve involvement, diplopia, dysar­thria, dysphagia.
• There is nausia vomiting ,abdominal pain, dizziness, depressed pupillar reflexes, and decreased, deepaondon reflexes.
• Diagnosis is by demonstration of the organism or its toxin in vomitus, gastric fluid or stool.

Treatment  BOTULISM :

• Patients should be monitored and managed for respiratory failure.
• Equine anti-toxin is given as soon as the case is diagnosed.

GAS-GANGRENE disease is caused by Clostridium perfringens

GAS-GANGRENE

• This disease is caused by Clostridium perfringens. They cause food poisoning, enteritis necroticans (ne­crotizing enteritis), suppurative deep tissue infections, skin and soft tissue infections, gangrene (Clostrid ial myonecrosis}.
• reatment is cleaning and debriding the wound, Peni­cillin G 20 units/day or Clindamycin.