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Tetanus

TETANUS is an infectious disease caused by contamination of wounds from bacteria that live in the soil. The bacterium Clostridium tetani is a hardy organism capable of living many years in the soil in a form called a spore.

Tetanus occurs when a wound becomes contaminated with bacterial spores. Infection follows when spores become active, multiply, and produce a very powerful poison that affects the muscles. Tetanus spores are found throughout the environment, usually in soil, dust, and animal waste. The favorite locations for the bacteria to enter your body are puncture wounds, such as those caused by nails, splinters, or insect bites. Burns, any break in the skin, and IV drug sites are also potential entryways for the bacteria.

Tetanus results in severe, uncontrollable muscle spasms. The jaw is "locked" by muscle spasms, causing the disease to sometimes be called "lockjaw." In severe cases, the muscles you use to breathe can soasm, causing a lack of oxygen to your brain and other organs and possibly death.

The disease in humans is the result of infection of a wound with the spores of the bacteria. Clostridium tetani. These bacteria produce the toxin (poison), tetanospasmin, which is responsible for causing tetanus. This poisons affects the place where nerves and muscles meet. It increases or intensifies the chemical signal from the nerve to the muscle, causing the muscle to tighten up in a huge continuous contraction or spasm.

The disease can show 4 possible types:

* Generalized tetanus can affect all skeletal muscles. It is the most common as well as the most severe form of the 4 types.

* Local tetanus manifests with muscle spasms at or near the wound that has been infected with the bacteria.

* Cephalic tetanus primarily affects 1 or several muscles in the face. No muscles elsewhere are involved, unless the disease progresses to generalized tetanus.

* Neonatal tetanus is similar to generalized tetanus except that it affects a baby that is less than 1 month old (called a neonate). This condition is rare in developed countries.

Causes

* Clostridium tetani is the bacteria responsible for the disease. The bacteria are found in 2 forms: As a spore (dormant) or as a vegetative cell (active).

* The spores are in soil, dust, and animal waste and can survive there for many years. These spores are resistant to extremes of temperature.

* Contamination of a wound with tetanus spores is rather common. Tetanus, however, can only occur when the spores germinate and turn into the active form.

* The active cells release 3 toxins, and 1 of these toxins is responsible for the disease. This toxin is called tetanospasmin.

* The disease typically follows: As acute injury that results in a break in the skin. Most cases result from a puncture wound, laceration (cut), or an abrasion (scrape).

* Other tetanus-prone injuries include the following:

* Frostbite

* Surgery

* Crush wound

* Abscesses

* Childbirth

* IV drug users (site of needle injection)

* Wounds with devitalized (dead) tissue or foreign bodies (debris in them) are most at risk of developing tetanus (much as burns and crushed injuries).

* Tetanus may develop in people who are not immunized against it or in people who have failed to maintain adequate immunity with active booster doses of vaccine.

Tetanus Symptoms

The hallmark feature of tetanus is muscle rigidity and spasms.

* In generalized tetanus, the initial complaints may include any of the following:

* Irritability, muscle cramps, sore muscles, weakness, or difficulty swallowing are commonly seen.

* Facial muscles are often affected first. Trismus or lockjaw is most common. This condition results from spasms of the jaw muscles that are responsible for chewing. A sardonic smile – medically termed risus

Sardonicus – is a characteristic feature that results from facial muscle spasms.

* Muscle spasm are progressive and may include a characteristic arching of the back known as episthetonus. Muscle spasms may be intense enough to cause your bones to break and your joints to dislocate.

* Severe cases can involve spasms of the vocal cords or muscles involved in breathing. If this happens, death is likely, unless medical help is readily available.

* In cephalic tetanus, in addition to lockjaw, weakness of at least 1 other facial muscle occurs. In two-thirds of these cases, generalized tetanus will develop.

* In localized tetanus, muscle spasms occur at or near the site of your injury. This condition rarely progresses to generalized tetanus.

* Neonatal tetanus is identical be generalized tetanus except that it affects the newborn infant. Your baby may be irritable and have poor sucking ability or difficulty swallowing.

Medical Care

* Call your doctor if you have questions regarding whether your tetanus immunization is current.

* If you have a wound, you should seek medical attention. If you are not immunized or have not kept up your booster every 10 years, any open wound is at risk of developing tetanus.

When to go to the hospital

* Most doctors can care for minor wounds with mild degrees of contamination. In addition, most doctors, maintain tetanus vaccines in their offices and can update anyone who is inadequately immunized. Call your doctor and follow his or her advice regarding whether or not you should seek treatment in a hospital’s emergency department after an injury or wound.

* If the wound is large, crushed, or heavily contaminated, you should go to the nearest hospital’s emergency department for evaluation. Occasionally both a tetanus booster and tetanus antibodies are required if you have any wound that is tetanus-prone. Tetanus antibodies are reserved for people with incomplete immunizations with a tetanus-prone wound.

* If you have a recent injury and are starting to complain of muscle cramps or spasms at or near the injury, you should go to a hospital’s emergency department.

* If you have trouble swallowing or have muscle spasms in the facial muscles, go to the emergency department for treatment.

Self-Care at Home

* Any wound that results in a break in the skin should be cleaned with soap and running water.

* All open wounds are at risk to get tetanus. Wounds from objects outdoors or crush injuries are at higher risk.

* Apply a clean and dry cloth to stop or minimize bleeding.

* Apply direct pressure to the site of bleeding to help minimize blood loss.

Prevention

All partially immunized as well as an immunized adults should receive a tetanus vaccination.

The initial series for adults involves 3 doses:

* The first and second doses are given 4-8 weeks apart.

* The third dose is given 6 months after the second.

* Booster doses are required every 10 years after that.

In children, the immunization schedule calls for 5 doses. Tetanus is included in a combination vaccine (DTP) composed of vaccines against diptheria, tetanus, and pertussis (whooping cough).

* One dose each at 2, 4, 6 and 15 months of age.

* This series is completed with a final dose between 4-6 years.

* Additional boosters are given every 10 years after that.

* People who are not completely immunized who have a tetanus-prone wound should receive a tetanus booster in addition to tetanus antibodies. The tetanus antibodies will provide short-term protection against the disease.

Dr. Gary S. Sy, M.D. is the Medical Director of Life Extension Medical Center located at The Garden Plaza Hotel (formerly Swiss Inn Hotel) 1370 General Luna St. Paco, Manila. He is a Diplomate in Gerontology and Geriatrics, advocate Diet-Nutritional Therapy, and conducts free seminar every Friday about age-related health problems. For more details please call telephone numbers: 400-4205 or 522-4835 local 315.

E-mail Address: This email address is being protected from spambots. You need JavaScript enabled to view it. .

Please tune in at DZRH 666 khz "Operation Tulong" every Wednesday and Friday at 10 p.m.-11 p.m. and DZMM 630 khz "Gabay sa Kalusugan" awarded as "2005 CMMA as Best Educational Radio Program," every Sunday at 10 a.m.-11 a.m.

source: Manila Bulletin
http://www.mb.com.ph/OPED2007080199166.html

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