Medic School Presentations: Tetanus, Infectious disease process

• What type of organism is involved in spreading this pathogen (bacteria, virus, etc.)?  Identify the name of the organism (if any).  If you have been provided with an organism/pathogen what disease does it cause?

• Clostridium tetani spores
• Anaerobic gram-positive, spore-forming bacteria
• Spores found in soil, animal feces; may persist for months to years
• They can survive autoclaving at 249.8°F (121°C) for 10–15 minutes.
• The spores are also relatively resistant to phenol and other chemical agents.
• Tetanospasmin estimated human lethal dose = 2.5 ng/kg
• Causes Tetanus (Centers for Disease Control and Prevention, 2012, p. 291).
• What is the common route of infection (air, blood, etc.)?  Identify what would be the most likely way a paramedic would be exposed.
• Spores usually enters the body through a wound or breach in the skin. Toxins are produced and disseminated via bloodstream and lymphatic system (Centers for Disease Control and Prevention, 2012, p. 292).
• Paramedic could be susceptible in any environment that could cause a minor or major penetration injury.
• During vehicle extrication. IE: Cutting hand or arm on severed vehicle post.
• Removal of Pt from environment to Ambulance. IE: removal via stairchair and getting cut on rusty nail or removal from woods and getting cut from the undergrowth.
• What personal protective equipment will limit the exposure of healthcare providers to the pathogen?
• wear full length heavy pants, ankle covering leather boots, slash resistant work/turn out gloves, full sleeve shirt/forearm guards, and most importantly, get and maintain vaccination!
• What is the incubation time for the infection?
• The incubation period ranges from 3 to 21 days, usually about 10 days.
• In general, the further the injury site is from the central nervous system, the longer the incubation period.
• A shorter incubation period is associated with more severe disease, complications, and a higher chance of death.
• In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days (Centers for Disease Control and Prevention, 2012, p. 292).
• What are common signs and symptoms seen in a patient with an active infection?  What will occur (signs/symptoms) if the disease is untreated?  Provide stages if applicable.
• The first sign is trismus or lockjaw.  followed by stiffness of the neck
• difficulty in swallowing
• and rigidity of abdominal muscles.
• Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate.
• Spasms may occur frequently and last for several minutes. Spasms continue for 3–4 weeks.
• Complete recovery may take months.
• Tetanus is often fatal if left untreated.- (Centers for Disease Control and Prevention, 2012, p. 292).
• How is this disease treated once a host has become infected?  What medications/treatments are utilized?
• Treatment for Tetanus consist of:
• Antibiotics (primarily Metronidazole or Penicillin G) to eliminate the bacteria
• Tetanus immune globulin (TIG) to neutralize the unbound Toxins.
• This should be immediately followed by a Tetanus Toxoid containing vaccine (Hinfey, 2014).
• Is there a vaccination for this disease?  What is the vaccination (provide the name (s) of the vaccination(s))?  How is the vaccine administered?  How long does it last?
• Tetanus vaccination comes in a couple different forms based on the age you receive it. -(Centers for Disease Control and Prevention, 2012, p. 297-298).
• DTaP (diphtheria and tetanus toxoids and acellular pertussis vaccine) is the vaccine of choice for children 6 weeks through 6 years of age.
• If a child has a valid contraindication to pertussis vaccine, pediatric DT should be used to complete the vaccination series.
• Td is the vaccine of choice for children 7 years and older and for adults.
• A booster dose of Td should be given every 10 years.
• Contracting the illness WILL NOT provide immunity due to the incredibly small amount of the toxin required to cause illness.

references

Centers for Disease Control and Prevention. (2012). Tetanus. In W. Atkinson, C.

    Wolfe, & J. Hamborsky (Eds.), Epidemiology and prevention of

    vaccine-preventable diseases (12th ed., pp. 291-300). Aurthor.

Hinfey, P. B. (2014, March 26). Tetanus medication. Retrieved October 2, 2014,

    from Medscape website: http://emedicine.medscape.com/article/

    229594-medication#8