Under anaerobic conditions

Explain why a booster tetanus injection was given to Mrs Stone. Since Mrs. Stone was gardening, the wound that she sustained could have caught microorganisms from the soil and one of these could be Clostridium tetani, the bacteria which causes Tetanus. Tetanus is a toxigenic infection of anaerobic tissue. Under anaerobic conditions the spores germinate and the organism produces a powerful neurotoxin that prevents release of the inhibitory neurotransmitter in the spinal cord.

The toxin is an A-B type toxin with a domain that binds to target nerve cells at the interneuronal junction in the spinal chord and an active or enzymatic portion which crosses the presynaptic nerve membrane and acts internally to prevent the release of the neurotransmitter. The A or active portion of the toxin has been found to be a zinc dependent metalloprotease which cleaves proteins required for the docking and fusion of the synaptic vesicles so that these vesicles containing the neurotransmitter cannot be released.

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At the inhibitory interneuronal junction this causes a lack of inhibition of contraction of an opposing muscle when one muscle contracts. This causes opposing pairs of muscles to contract at the same time, leading to spastic paralysis. Typically there is a deep puncture wound that becomes contaminated with the tetanus spores that are common inhabitants of soil. In order to prevent tetanus, Mrs. Stone should receive a booster. According to Dr.

Gary Sy (2007), the CDC recommends that adults receive a booster vaccine every ten years, and standard care in many places is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated, or if the patient has had fewer than 3 lifetime doses of the vaccine. In a study by Fatunde & Familusi (2001), they concluded that the current Expanded Programme on Immunization (EPI) recommended by the WHO for developing countries of which three doses of DPT are given during infancy with no provision for booster doses, is inadequate for tetanus prevention during childhood.

It is suggested that a clause be added to the EPI schedule, advising two extra doses of TT between ages four to six years and 11 to 12 years (entry into primary school and secondary school, respectively) for all children. In order to ensure compliance, these booster doses of TT could be made prerequisites for entry prior to schooling. b. ) Describe the physiological basis of her wound observations. Mrs. Stone’s sutured wound, as stated in the case had the ff.

Description: wound edges were slightly red, small amount of hemo-serous ooze, warm to touch, and minimal swelling. The description of her wound tells us that it is inflamed and this is because her wound has started healing. Wound healing starts immediately after damage has occurred, but the mechanism and speed of wound healing, and the eventual nature of the regenerated tissue, depend on the type of the wound. The three main stages of healing are inflammation, repair and maturation.

According to Lee & Bishop (2006), once an injury has occurred, several events takes place, leading to the activation or release of a variety of chemicals. These chemicals are responsible for the physiological events that occur in inflammation and are called the chemical mediators of inflammation. derived from a variety of sources, the most important are histamine, kinins, prostaglandins, leukotrienes, tumor necrosis factor and complement. many of these mediators cause dilation of the arterioles in the area of damage.

This causes more blood to flow into the area, accounting for the redness and warmth of inflamed tissue. Some mediators increase permeability of local capillaries and post capillary venules by causing retraction of the endothelial cells of these vessels. As a result, plasma fluids and proteins, such as clotting factors, complement and antibodies, are able to move from the bloodstream into the tissue spaces. This fluid is called an exudate and its accumulation in tissue causes edema or swelling.


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