TETANUS AND LEPROSY

SUBMITTED TO: SUBMITTED BY:

RESPECTED MRS. KRITIKA JYOTI VIRDI

 Introduction
• Tetanus is a Greek word means to stretch
• First described by Hippocrates and
Susruta.
• Tetanus is also known as “lock jaw”
• It is a non-communicable disease
• It is a vaccine preventable disease which
is infectious but not contagious

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 • Tetanus is a neurological disease
which is characterized by increased
muscle tone and spasm caused by
clostridium tetani.
Definition of Or
Tetanus • Tetanus is commonly called “lock
jaw” is a serious acute condition
which is caused by infection with a
bacterium know as clostridium
tetani.
The bacterium is found
Contaminated wounds
through the world in
are site where tetanus
the soil, animals
multiply
intestine
 Causes
Spores of Bacteria C. tetani live in
the soil and are found around the
world which may remain inactive in
the soil but can remain infectious for
more than 40 years
 Risk factors
• Lack of immunization or inadequate
immunization failure to receive
timely booster shots against tetanus
• Sweating around injury
• Animal bites
• Ear infectious

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• Penetrating injury that
results in Tetanus spores
being introduced to the
wound
• Injured tissue
• Infected umbilical stump in
the newborn of
inadequately immunized
mothers
• Puncture wound include
injection drug, tattoos
 Incubation Period

The incubation period for

tetanus infection (the time
The average incubation
between getting infection
time is 10 days
and onset of symptoms is
4 to 21 days.
 Spores of tetanus enter through open
wound
Pathophysiology
They germinate (activation) and
produce toxin called tetanospasmin

Tetanospasmin can spread through

the blood stream

Toxins absorbed by peripheral

nerved and carried to spinal cord
• Block the action of inhibitory
enzyme at spinal synapses
• Interfere with transmission of
neuromuscular impulses
• Uncontrolled muscle spasm
and rigidity (stiffness)
Sign and
symptoms
• Spasm in neck, back chest and
abdominal muscle
• Opisthotonos position (back muscle
spasm often cause arching)
• Lock jaw also called muscle spasm
jaw is locked by spasm
• Asphyxia (due to spasm of
respiratory muscle)
• Drooling
• fever

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• High blood pressure (due to constriction of
nerves )
• Muscle stiffness
• Dysphagia
• Uncontrolled urination or defecation
 Diagnostic evaluation

Physical
History taking
examination CBC Count(to Culture test to
(record of
assessing injury detect WBC) detect bacteria
immunization)
site
 Lumbar puncture
Tetanus antibody
test CSF increased due
to increase of WBC

Electromyelography
Spatula test
(EMG)
 Management of Tetanus

Medical management

Surgical management
 Medical management

Antibiotics: Penicillin is used to treat tetanus

infection. These antibiotic prevent the bacteria from
multiplying and stop tetanospasmin from spreading

Anticonvulsants: “Diazepam” (Valium) to treat

(muscle spasm). It relaxes the muscle and reduces
anxiety. It works as a sedative “phenobarbitone”
Tetanus immunoglobin: TIG is a solution that contains
antibodies “IgG” to control tetanus bacteria. It is given to the
patient through IV injection and provide immediate short-term
protection against tetanus

Neuromuscular blocking agent: it blocks the signal that is

transmitted from nerves to muscle fibres and thus help control
muscle spasm. Vecuronium is neuromuscular blocking agent
sometimes used during surgery as muscle relaxant anaesthesia
Nutrition :consume high number of calories intake of 3500-4000
calories is often required plus 150 gm of protein in a day. If
swallowing is difficult and liquid feed should be given through tube
Muscle relaxant: “baclofen (lioresal), “Dantrolene” (Dantrium).
Two muscle relaxant is being used to ease the symptom of muscle
stiffness and muscle spasm
Breathing assistance may be required
 Surgical management
• Debridement is a procedure used to
remove damaged and contaminated
tissue
• It is a procedure in which cleaning of
open wound by removing foreign
material such as dirt and manure as
well as any dead tissue . It allows the
wound to heal and limit the spread of
Tetanospasmin Toxin
 Prevention
• Proper immunization to provide
protection for 10 years
• Active immunization plays an essential
role
• Protect the skin from being penetrating
by tetanus bacteria
• Use 3C during delivery that is clean
hand, clean surface, clean cord care
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Children should be immunized with DPT which generally
started at the age of 2 months and completed at 5 years of age

Booster dose at 11 years of age

Give health education regarding Tetanus to farmer workers

and armed forces.
LEPROSY
Leprosy is communicable disease that is discovered by G.A Hansen in 1873.
He identified bacterium to causing disease in man
The word leprosy is derived from french word “leper” Greek word “lepros”
means scaly, referring to the scales that form on the skin.
Many countries like Asia , Africa and latin America with significant cases.
Alternate name of leprosy is HANSEN’S DISEASE
DEFINITION
Leprosy is a disease caused by the bacteria “Mycobacterium leprae” which
cause damage to the skin and peripheral nervous system .
It is characterized by disfiguring skin sores , nerve damage and progressive
debilitation . the disease develop slowly from 6 month to the 40 years and
results in skin lesions and deformities most often affecting the eyes ,
nose ,hands and testicles.
CAUSES AND RISK FACTORS
The main cause of leprosy is mycobacterium leprae the organism that cause disease.
It is acid fast , rod shaped bacillus cannot be grown in bacteriological media or cell
culture.
RISK FACTORS:
 Close contact with infected person.
 Low immunity
 Chromosomal mutation
 Armadillo contact
 Age 5 to 35 years
 Family history
TYPES
According to WHO 2 main types are:
Paucibacillary: there are five or fewer lesions and no bacteria detected in skin sample.
Multibacillary :there are more than 5 lesions . The bacteria is detected in skin smear
or sample.

According to HANSEN’S DISEASE 3 types are:

1) Lepromatus :the generalized form lapromatous form attack eyes , peripheral nerves ,
skin , nose , hands , feet and mucous membrane . Its main symptoms are:
chronically stuffy nose and many skin lesions and nodule on front and back of
body.
The loss of sensation at fingers and toes.
In advance cases gangrene may set in with loss of body tissue.
2) Tuberculoid : the tuberculoid form is localized, so its effects are less
widespread across the body
Symptoms usually consist of few well defined skin lesions that are numb.
3) Dismorphous : the third type is known as “BORDERLINE” leprosy and has
characteristics of both form create skin lesions
 PATHOPHYSIOLOGY
M. leprae enters in body through nose, skin etc.

Attack peripheral nerves

Bind schwann cells of axon

 Demylination of nerve

Loss of axonal conductance

Deformity (loss of sensation , loss of pain , touch)

 SIGN AND SYMPTOMS
Symptoms appear after 4-5 years after person become infected with the bacteria
 Skin lesions that are lighter than normal skin colour
 Lesions have decreased sensation to touch heat or pain
 Lesions do not heal after several weeks or months
 Skin rash
 Skin stiffness
 Painless ulcers
 Eye problems (dryness , reduced blinking)
 Muscle weakness
 Absence of sensation in arms , hands , feet and legs
DIAGNOSTIC EVALUATION
History taking
Physical examination
CBC test
LFT test
Nerve biopsy done to determine if other organ system have
been affected
Skin biopsy show characteristics of granuloma (a mass of granulation tissue
typically produced in response to infection , inflammation).
Lepromin skin test to detect distinguish between lepramatous from
tuberculoid leprosy. A lepromin skin test is performed by injecting a small
sample of inactivated M. leprae under your skin. The term “inactivated” means
that the bacterium isn’t able to cause infection. The bacterium is usually
injected into the forearm. A small lump will form at the injection site,
indicating that the correct amount of bacterium has been injected at the correct
depth in the skin for the test to be effective.
You’ll need to be examined three days after the injection to see if you’ve had a
reaction to the bacterium. If no reaction occurs, you’ll need to be examined
again in 28 days. Specific reactions at the injection site indicate certain types of
Hansen’s disease
MANAGEMENT OF LEPROSY
MEDICAL MANAGEMENT
WHO recommend 6-12 months course of MDT(multi drug therapy)
Patient are given cocktail of 3 strong antibiotics (dapsone, rifampicin and
clofazimine) which are tuberculoid form disease within 6 month .
Adult with multibacillary MDT for 12 months
Rifampicin 600mg once a month (2 CAPSULES)
Dapsone 100mg once a month
Clofazimine 500mg once a day and 300mg once a month
Adult with paucibacillary take:
Rifampicin 600mg once a month
Dapsone 100mg once a month.

SURGICAL MANAGEMENT
Amputation
Cosmetic surgery
 Removal of excess skin
 Nasal reconstruction
PHYSIOTHERAPY
PATIENT COUNSELLING
 SUMMARIZATION
 Introduction of tetanus
 Definition
 Causes and risk factors
 Path physiology
 Sign and symptom
 Diagnostic evaluation
 Management of tetanus
 Introduction of leprosy
 Definition of Leprosy
 Causes and risk factors
 Types of leprosy
 pathophysiology
 Sign and symptoms of leprosy
 Diagnostic evaluation of leprosy
 Management of leprosy
RECAPTILIZATION
Define tetanus
Causes of leprosy
Define leprosy
Types of leprosy
 ASSIGNMENT
Write a nursing management of leprosy and tetanus