Clostridium tetani : Diagnosis, treatment and Prevention

Clostridium tetani : Diagnosis, treatment and Prevention

Q. 1

The use of hyperimmune sera such as hepatitis B immune globulin, rabies immunoglobulin, and human tetanus immune globulin for prophylaxis or treatment is an example of what process?

 A

Active immunity

 B

Passive immunity

 C

Humoral immunity

 D

Cellular immunity

Q. 1

The use of hyperimmune sera such as hepatitis B immune globulin, rabies immunoglobulin, and human tetanus immune globulin for prophylaxis or treatment is an example of what process?

 A

Active immunity

 B

Passive immunity

 C

Humoral immunity

 D

Cellular immunity

Ans. B

Explanation:

The use of hyperimmune sera for treatment or prophylaxis is referred to as “passive immunization”. This approach is used when allowing the development of a natural immune response would take too long and directly threaten patient survival.

This type of immunity is of short duration and has no memory component.
 
Ref: Levinson W. (2012). Chapter 57. Immunity. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.

Q. 2

A person is brought to you after an RTA and on examination there is a lacerated wound in the thigh with some tissue damage. The surgery resident has cleaned and debrided the wound and prescribed antibiotics. History of the patient reveals that he has taken a complete course of tetanus toxoid with a booster dose 4 years ago. What is your line of management to prevent tetanus?

 A

Give 1 dose of tetanus toxoid

 B

Give Human tetanus hyper –immunoglobulin

 C

Give ‘a’ and ‘b’

 D

Tell the patient that no tetanus prophylaxis is required

Q. 2

A person is brought to you after an RTA and on examination there is a lacerated wound in the thigh with some tissue damage. The surgery resident has cleaned and debrided the wound and prescribed antibiotics. History of the patient reveals that he has taken a complete course of tetanus toxoid with a booster dose 4 years ago. What is your line of management to prevent tetanus?

 A

Give 1 dose of tetanus toxoid

 B

Give Human tetanus hyper –immunoglobulin

 C

Give ‘a’ and ‘b’

 D

Tell the patient that no tetanus prophylaxis is required

Ans. D

Explanation:

Since he has completed the course of tetanus toxoid and received a booster dose within 5 years nothing more is needed.

If he had taken a booster dose more than 5 years ago and less than 10 years, 1 dose TT should have been given.

If his last booster dose was > 10 years ago he needs both toxoid and immunoglobulin. Same is the case if he has not been vaccinated before.

Note: – In case of a clean non penetrating injury with minimal tissue damage the treatment is only toxoid if no booster is received within 5 years.

Ref: Park, Edition 21, Page 287


Q. 3

Administration of the DPT vaccine (diphtheria toxoid, pertussis products, and tetanus toxoid) would stimulate which of the following types of immunity?

 A

Adoptive

 B

Artificial active

 C

Artificial passive

 D

Natural active

Q. 3

Administration of the DPT vaccine (diphtheria toxoid, pertussis products, and tetanus toxoid) would stimulate which of the following types of immunity?

 A

Adoptive

 B

Artificial active

 C

Artificial passive

 D

Natural active

Ans. B

Explanation:

Administration of the DPT vaccine stimulates the innate immune system to produce antibody and memory cells against this mixture. Active immunity is when we produce our own antibody. Artificial refers to the fact that the stimulus was the vaccination with the antigens in question.

Adoptive immunity involves the patient receiving cells from another host who had been stimulated to produce their products.
Artificial passive immunity refers to the immunity produced by receiving an injection of antibody. An example is the administration of immunoglobulin directed against hepatitis A after an individual had been exposed to it.
Active immunity means that we are stimulated to produce our own antibodies. The term natural active refers to the fact that we received the stimulus (antigen) by a natural means, such as exposure to the organism.
 
Ref:  Levinson W. (2012). Chapter 66. Tolerance & Autoimmune Disease. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.

Quiz In Between


Q. 4

Which of the following is not true about transmission –

 A

Legionella may be transmitted through water aerosols

 B

Listeria may be transmitted through refrigerated food

 C

Leptospirosis may be transmitted through water contaminated with rat urine

 D

Tetanus may be transmitted through dust and droplets

Q. 4

Which of the following is not true about transmission –

 A

Legionella may be transmitted through water aerosols

 B

Listeria may be transmitted through refrigerated food

 C

Leptospirosis may be transmitted through water contaminated with rat urine

 D

Tetanus may be transmitted through dust and droplets

Ans. D

Explanation:

Ans. is. ‘d’i.e., Tetanus may be transmitted through dust and droplets

Transmission of tetanus

.   Tetanus is acquired by contamination of wounds with tetanus spores.

.   It is transmitted through contamination of wounds by tetanus spores in the dust.

.   Transmission may occur through a range of injuries from trivial pin pricks to unsterile surgery and compound fractures.

.   It is not transmitted by droplets.

Transmission of Legionella, listeria and leptospirosis has been explained.


Q. 5

A 37 weeks pregnant woman attends an antenatal clinic at a Primary Health Centre. She has not had any antenatal visit till now. The best approach regarding tetanus immunization in this case would be to-

 A

Give a dose of Tetanus Toxoid (TT) and explain to her that it will not protect the new born and she should take the second dose after four weeks even if she delivers in the meantime

 B

Don not waste the TT vaccine as it would anyhow be of no use in this pregnancy Give one dose of TT and explain that it will not be useful for this pregnancy

 C

Give her anti-tetanus Immunoglobulin along with the TT vaccine

 D

All

Q. 5

A 37 weeks pregnant woman attends an antenatal clinic at a Primary Health Centre. She has not had any antenatal visit till now. The best approach regarding tetanus immunization in this case would be to-

 A

Give a dose of Tetanus Toxoid (TT) and explain to her that it will not protect the new born and she should take the second dose after four weeks even if she delivers in the meantime

 B

Don not waste the TT vaccine as it would anyhow be of no use in this pregnancy Give one dose of TT and explain that it will not be useful for this pregnancy

 C

Give her anti-tetanus Immunoglobulin along with the TT vaccine

 D

All

Ans. A

Explanation:

Ans. is ‘a’ i.e., Give a dose of Tetanus Toxoid (TT) and explain to her that it will not protect the new born and she should take the second dose after four weeks even if she delivers in the meantime 

Guidelines on TT in pregnancy:

        Primigravida: 2 doses 1 month apart, after I trimester

        Duration of Protection with 2 doses : All subsequent pregnancies in next 5 years.

        Multigravida (completely immunized in last 5 years): 1 booster dose is sufficient

        Multigravida (partially immunized in previous pregnancy in last 5 years): 2 doses, 1 month apart, after I trimester.

        Multigravida (unimmunized in previous pregnancy in last 5 years): 2 doses, I month apart, after I trimester

        Multigravida (completely immunized in previous pregnancy earlier than 5 years): 2 doses, I month apart, after I trimester.

        Rule for Delayed immunization of TT in pregnancy (as per Period of gestation — POG): Give 2 doses of TT, 1 month apart, anytime after 1st trimester, of pregnancy, Irrespective of time of delivery (so as to provide protection for atleast next 5 years).


Q. 6

True regarding tetanus toxoid is/are 

 A

Plain toxoid have long duration

 B

Adsorbed toxoid are more beneficial

 C

Should never freeze

 D

b and c

Q. 6

True regarding tetanus toxoid is/are 

 A

Plain toxoid have long duration

 B

Adsorbed toxoid are more beneficial

 C

Should never freeze

 D

b and c

Ans. D

Explanation:

Ans. is ‘b’ i.e., Adsorbed toxoid are more beneficial; ‘c’ i.e., Should never freeze

Quiz In Between


Q. 7

A full course of immunization against, Tetanus with 3 doses of Tetanus toxoid, confers immunity for how many years –

 A

5

 B

10

 C

15

 D

20

Q. 7

A full course of immunization against, Tetanus with 3 doses of Tetanus toxoid, confers immunity for how many years –

 A

5

 B

10

 C

15

 D

20

Ans. A

Explanation:

Ans. is ‘a’ i.e., 5 

o A primary course of immunization consists of two doses of tetanus toxoid at intervals of 1-2 months. o The first booster dose (third in order) should be given a year after the initial two doses.

o Subsequent TT booster are recommended at 5-10 years intervals.

o “The opinion was expressed that no more than one additional booster dose (a total of 4 doses altogether) given 5  years after the third dose is required in adults in developing countries”.


Q. 8

A person has received complete immunization against tetanus 10 years ago. Now he presents with a clean wound without any lacerations from an injury sustained 2.5 hours ago. He should now be given

 A

Full course of tetanus toxoid

 B

Single dose of tetanus toxoid

 C

Human tet globulin

 D

Human tet globulin and single dose of toxoid

Q. 8

A person has received complete immunization against tetanus 10 years ago. Now he presents with a clean wound without any lacerations from an injury sustained 2.5 hours ago. He should now be given

 A

Full course of tetanus toxoid

 B

Single dose of tetanus toxoid

 C

Human tet globulin

 D

Human tet globulin and single dose of toxoid

Ans. B

Explanation:

Ans. is ‘b’ i.e., Single dose of tetanus toxoid 

Prevention of tetanus after injury

o All wounds must be thoroughly cleaned soon after injury – removal of foreign bodies, soil dust, necrotic tissue. This procedure will abolish anaerobic conditions which favour germination of tetanus spore.


Q. 9

The most effective way of preventing tetanus is

 A

Surgical debridement and toilet

 B

Hyperbaric oxygen

 C

Antibiotics

 D

Tetanus toxoid

Q. 9

The most effective way of preventing tetanus is

 A

Surgical debridement and toilet

 B

Hyperbaric oxygen

 C

Antibiotics

 D

Tetanus toxoid

Ans. D

Explanation:

Ans. is ‘d’ i.e., Tetanus toxoid 

o The obvious and most dependable method of prevention is to build up antitoxic immunity by active immunisation (administration of tetanus toxoid) by routine immunization of children and booster doses where appropriate.

  • Tetanus is best prevented by active immunization with tetanus toxoid. – (P.S.M. Park)

Quiz In Between


Q. 10

The active immunity offered by tetanus toxoid is effective in nearly –

 A

25% of the patients 

 B

50% of the patients

 C

75% of the patients 

 D

100% of the patients

Q. 10

The active immunity offered by tetanus toxoid is effective in nearly –

 A

25% of the patients 

 B

50% of the patients

 C

75% of the patients 

 D

100% of the patients

Ans. D

Explanation:

Ans. is ‘d’ i.e., 100% of the patients 

  • Both efficacy and effectiveness of tetanus toxoid are well documented.

o Efficacy of Tetanus toxoid vaccine range from 80-100% in different studies.

o Whereas protection is incomplete after the first vaccine dose, protective concentration of antitoxin are achieved in the majority of vaccinees after completion of 2 doses, a third dose induces immunity in almost 100% of these immunize.

Vaccine                            Protective efficacy

BCG                               0 – 80%

DPT                                Pertussis 85%; Diphtheria 95%; Tetanus 100%

OPV                               80 – 90%

Hepatitis B                      90%

Measles                          95%

MMR                               95%

J.E.                                80 – 90%

Rabies                            90 – 100%


Q. 11

The true statement regarding tetanus is – 

 A

Five dose immunisation provides life long immunity

 B

TT affords no protection in the present injury

 C

TT serves no use once 12 hours have elapsed following injury.

 D

TT and Ig may both be given in suspected tetanus

Q. 11

The true statement regarding tetanus is – 

 A

Five dose immunisation provides life long immunity

 B

TT affords no protection in the present injury

 C

TT serves no use once 12 hours have elapsed following injury.

 D

TT and Ig may both be given in suspected tetanus

Ans. D

Explanation:

Ans. is ‘d’ i.e., Tatanus toxoid and Ig may both be given 

  • Simultaneous active and passive immunization is widely carried out in non-immune persons.

o The patient is given Human Ig (or anti-tetanus serum) in one arm and tetanus toxoid into the other arm or gluteal region.

o This should be followed 6 weeks later by another dose of tetanus toxoid, and a third dose 1 year later.

o The purpose of antitoxin is for immediate temporary protection, and the purpose of tetanus toxoid is for long lasting protection.

About other options

o Life long immunity is not provided by tetanus toxoid immunization. If injury occurs after 5 years of previous immunization, tetanus toxoid should be given (see previous explanations).

o Tetanus toxoid affords long lasting protection in the present injury.

o TT is useful even after 12 hours have elapsed following injury.


Q. 12

What will be the appropriate management of a pt with a clean wound over forearm with slight loss of tissue. He has recieved, Tetanus toxoid 12 years back ‑

 A

Complete course of TT

 B

Only one dose of TT

 C

Full dose of Human tetanus Ig

 D

No T/t needed

Q. 12

What will be the appropriate management of a pt with a clean wound over forearm with slight loss of tissue. He has recieved, Tetanus toxoid 12 years back ‑

 A

Complete course of TT

 B

Only one dose of TT

 C

Full dose of Human tetanus Ig

 D

No T/t needed

Ans. B

Explanation:

Ans is ‘b’ ie only one dose of TT 

Quiz In Between


Q. 13

Injectable tetanus toxoid is an example of:

September 2006

 A

Reactive immunity

 B

Active immunity

 C

Passive immunity

 D

Herd immunity

Q. 13

Injectable tetanus toxoid is an example of:

September 2006

 A

Reactive immunity

 B

Active immunity

 C

Passive immunity

 D

Herd immunity

Ans. B

Explanation:

Ans. B: Active immunity

Passive immunity: Immunity produced by the transfer to one person of antibodies that were produced by another person. Protection from passive immunity diminishes in a relatively short time, usually a few weeks or months. For example, antibodies passed from the mother to the baby before birth confer passive immunity to the baby for the first 4-6 months of life. Passive immunity may be induced by:

  • By administration of an antibody containing preparation (Immunoglobulin or antisera)
  • By transfer of maternal antibodies across the placenta

Active immunity: The production of antibodies against a specific agent by the immune system. Active immunity can be acquired in two ways:

  • By contracting an infectious disease — such as, for example, chickenpox; or
  • By receiving a vaccination which may be a killed vaccine, a live attenuated vaccine or toxoid

Active immunity is permanent. The individual is protected from the disease all their life


Q. 14

True regarding pre-exposure tetanus immunization are all except:     

September 2005

 A

If already immunized, a booster in the last trimester is advocated

 B

Vaccine is given intramuscularly

 C

Tetanus immunoglobulin is injected to the mother

 D

2 doses are recommended

Q. 14

True regarding pre-exposure tetanus immunization are all except:     

September 2005

 A

If already immunized, a booster in the last trimester is advocated

 B

Vaccine is given intramuscularly

 C

Tetanus immunoglobulin is injected to the mother

 D

2 doses are recommended

Ans. C

Explanation:

Ans. C: Tetanus Immunoglobulin is Injected to the Mother

Administration of attenuated virus vaccines are contraindicated during pregnancy, this includes vaccines against measles, mumps, poliomyelitis, rubella, yellow fever, and varicella.

MMR vaccination can be given during lactation and does not affect the baby.

The CDC recommends that non-pregnant women who receive the MMR vaccine or varicella vaccination should wait four weeks before getting pregnant.

In situations where inactivated virus or parts of a virus are administered, in general, there is no contraindication to immunization during pregnancy. Thus influenza vaccination is given to pregnant women at risk, as are vaccinations against hepatitis A and B.

HPV vaccine was introduced in 2006. It is not to be used during pregnancy.

BCG(Live attenuated bacterial) vaccine is used against tuberculosis and is contraindicated in pregnancy

Inactivated bacterial vaccine is used during pregnancy for women who have a specific risk of exposure and disease. Vaccination against pneumococcus or meningococcus infections, or typhoid fever show no confirmed side effects regarding the fetus.

Tetanus toxoids appear safe during pregnancy and are administered intramuscularly.

0.5 ml tetanus toxoid is given at 6 weeks interval for 2 such,the first one to be given between 16-24 weeks..

Immune globulins are used for post exposure prophylaxis. Such agents are considered in pregnant women exposed to hepatitis B, rabies, tetanus, varicella, and hepatitis A

Quiz In Between



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