Musculosceletal System 1

TETANUS

dr. Fitriah Handayani, M.Kes, Sp.N

Medical Faculty
Tadulako University
2019
 TETANUS

Clinical illness is characterized by

DEFINITION acute onset of hypertonia and/or
painful muscular contractions

• usually the muscles of the

jaw and neck
• generalized muscle spasms
without other apparent medical cause with without other apparent
or without isolation of Clostridium tetani medical cause
(e.g., swabs from wounds and other lesions)
and with or without history of injury
 ➢ 2015 → 34.000 neonatal tetanus DIED 3

➢ 96% reduction → from 1988 estimated 787.000 newborn

babies died of tetanus within their first month of life.
EPIDEMIOLOGY ➢ Afrika → annual mortality rate 28/100.000
➢ ASIA → annual mortality rate 15/100.000
➢ EUROPE → annual mortality rate 0.5/100.000
 TOXIN 4

• This substance is a hemolysin with no

tetanolysin
recognized pathologic activity

• This toxin is responsible for the clinical

manifestations of tetanus ; by weight, it is one of
Tetanospasmin the most potent toxins known, with an estimated
minimum lethal dose of 2.5 ng/kg body weight
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• neurotoxin (tetanospasmin)
produced by anaerobic
bacterium Clostridium tetani
ETIOLOGY • TOXIN absorbed into
bloodstream → reaches the
nervous system→ painful & often
violent muscular contractions
 • neurotoxin (tetanospasmin) produced by
anaerobic bacterium Clostridium tetani
Reservoir and Source
• spore form in soil, dust, •manure and has also
TOXIN absorbed been detected
into bloodstream in the intestines of
→ reaches
animals and humans the nervous system→ painful & often violent
• If not exposed to sunlight, C.muscular
tetani spores can persist in soil for months to years
contractions
• The spores are resistant to boiling and many disinfectants

Transmission
• Soil, dust or fecal → contaminated with C. tetani spores → enter through puncture
wounds or tissue injuries, including unclean deliveries, burns, surgery and dental
extractions
• C. tetani spores → germinate into bacilli in the anaerobic environment present in
the necrotic tissue often associated with blunt trauma or deep puncture wounds.
• However, not all cases of tetanus are preceded by a recognized wound or injury
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Steps tetanospasmin binding, internalization, and activity

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Tetanospasmin diffuses from the site to the alpha motor neuromuscular junction. It
moves via the retrograde transport system to the cell body, from which it diffuses
out into the synapses and extracellular space within the spinal cord or brainstem
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 ANTIBIOTICS 12

• dose is 100 000–200 000 IU/kg/day intramuscularly or intravenously

Penicilin G for 7 to 10 days

• is a safe alternative, and may now be considered as the first line

therapy.
• Adult dose is 400 mg rectally every 6 hours, or 500 mg every 6
hours intravenously for 7–10 days
• Neonatal (< 28 days) weight <1.2 kg : 7.5 mg/kg IV/PO q48hr, age
Metronidazole < 7 days weight 1.2-2 kg: 7.5 mg/kg IV/PO/Day; >2 kg: 15
mg/kg/day IV/PO divided q12hr. Age >7 days, weight 1.2-2 kg: 15
mg/kg/day IV/PO divided q12hr ;
• Infants and children dose : 30 mg/kg/day PO/IV divided q6hr; not
to exceed 4 g/day weight >2 kg: 30 mg/kg/day IV/PO divided
q12hr
 ANTIBIOTICS 13

• Neonates : weight <1.2 kg: 20 mg/kg/day PO divided

q12hr , weight 1.2 kg or more, 0-7 days old: 20 mg/kg/day
Erhytromycin PO divided q12hr. Weight ≥1.2 kg or more, 7 days or older:
30 mg/kg/day PO divided q8hr
• Children : dose 60-100 mg/kg/day PO divided q6-12hr

• Adults : 50mg per kg body weight every six hours, patients

with moderately resistant organisms or severe infections
may require increased dosage up to 100mg/kg body
weight/day
Chloramphenicol • Children : 25mg/kg body weight/ day divided every 6 hours
• Neonates (< 28 days old) : < 7 days old : 25 mg/kg body
weight / day every 24 hours
• > 7 days old : 25 mg/kg body weight / day every 24 hours,
maximal < 2000g every 24 hours
 DRUGS 14

• a coenzyme with glutamate decarboxylase in the

Pyridoxine production of GABA from glutamic acid, and
(vitamin B6) increases GABA concentrations in animal models.
DOSE : 100mg/day

• Prophylaxis: 250 Units IM (single dose)

Human Tetanus • Active tetanus15
Immune Globulin - adult dose : 3000-6000 Units
(HTIG) - >7 years old: 250 Units IM (single dose)
- <7 years old: 4 Unit/kg or 250 Units IM
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ABBLET CLASSIFICATION TETANUS

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