TETANUS

definisi
Is

intoxication that results from infection with Clostridium tetani, a gram (+) coccus that enters through a wound.

An exotoxin causes the neuromuscular irritability and the syndrome of tetanus

Clinical features

The mayor presenting feature of generelized tetanus is muscle rigidity and discomfort in the jaw, neck and lower back. The symptms may be mild at the onset, progress over hours or days to state of muscular hyperirritability and spasm that may involve the respiratory and pharyngeal muscles. Convulsive seizures are common

Clinical features

Tetanus may be localized to the area surrounding the wound rather than generalized. Often the jaw is involved the early in both localized and generalized tetanus The prognosis is good in localized tetanus, but mortality reacheas 50 % in patient with generalized disease, despite therapy

TREATMENT

Treatment directed against the toxin. Therapy directed against the bacteria. General measures Prophylaxis

Treatment directed against the toxin

Neutralization of the toxin A. Human hyperimmune globulin. 300010.000 u IM/IV. Toxin already fixed in the neural tissues will not be eliminated by antitoxin, but circulating toxin will be neutralized by it

B. horse serum antitoxin. Can be used, but prior skin tests for sensitivity are rerequired. The ussual dosage is 50.000 u IM followed by 50.000 u in a slow IV infusion. If surgical exicition of the wound is imposible, a small amount of anti toxin may be injected locally.

Therapy directed against the bacteris

A. the area of the wound is surgically excised and drained B. cultures of the wound C. Procaine Penicillin. 1,2 million u IM/IV q6h for 10 days D. Tetracycline (if unable penicillin) 500 mg PO or IV q6h for 10 days, may be substituted

General Measures

A. care of skin, bladder, bowel, fluid management, nutrition, and respiration, preventing aspiration pneumonia and pain is particularly important B. dark and quit room, sedation (diazepam) 2-10 mg IV q4-12 h. my be causes respiratory and cardiac arrest

Prophylaxis

All persons, beginning 2 months of age In acute injury

In fresh, clean wounds. Past 10 years In wounds that are dirty or infected. Past 5 years