TETANUS

DEFINISI
Penyakit akut spastik paralitik yang disebabkan oleh neurotoksin dari Clostridium tetani

EPIDEMIOLOGI
Neonatal (umbilical) tetanus menyababkan 300,0000 kematian

PATOGENESIS
Luka  potensi reduksi okseigen rendah  germinasi, replikasi, produksi toksin  NMJ 
endocytosis  motor neuron  retrograde axonal  spinal cord  adjacent spinal cord 
prevents inhibitory NT (glycine and gamma-aminobutyric acid)  maximal contraction and
cannot relax

MANIFESTASI KLINIS
1. Masa inkubasi 2-14 hari
1. Generalized tetanus: trismus, headache, restlessness, irritability, sardonic smuile,
opistotonus, disturbance by stimulus, dyusira, urinary retention, forced defecation,
fever upto 40, seizure sudden, severe tonic contractions of the muscles, with fist
clenching, flexion, and adduction of the arms and hyperextension of the legs
2. Neonatal tetanus: 3-12 hari, poor feeding, hunger, crying. Paralysis or diminished
movement, stiffne
3. Localized tetanus: nyeri spasme lokal di samping luka
4. Cephalic tetanus: luka di daerah muka, wajah, hidung. retracted eyelids, deviated
gaze, trismus, risus sardonicus, and spastic paralysis of the tongue and pha- ryngeal
musculature.

DIAGNOSIS
1. Klinis
2. Leukositosis: secondary bacterial infection
3. CSF: normal, peningkatan TIK

TATALAKSANA
1. Eksisi luka bedah dan debridemen
2. TIG 500 unit (3000-6000)
3. Penicillin G (100.000 unit/kg/day dibagi 4-6 jam IV untuk 10-14 hari); metronidazole
(500 mg every 8 hr IV for adult); allergy penicillin  erythromycin dan tetracycline
PERAWATAN SUPORTIF
1. Sedated, avoid stimulus
2. ETT to prevent aspiration
3. Cardiorespiratory monitoring, frequent suctioning, fluid, electrolyte, caloric needs
etc
KOMPLIKASI
1. Seizure  aspirasi, pneumonia, laserasi mulut/lidah, rabdomiolisis
2. Airway patency attempt  pneumothorax dan mediastinal emphysema
3. Venous thrombosis, PE, gastric ulceration, decubitus etc
PROGNOSIS
1. Mortalitas tinggi: sangat muda/tua
2. Favorable: masa inkubasi lama, demam (-), penyakit lokal
3. Poor: trismus < 7 hari, generalized tetanic spasm < 3 hari
4. Gejala sisa hypoxic brain injury  CP, diminished mental abilities, behavioral
difficulties

PENCEGAHAN
Tetanus is an entirely preventable disease. A serum antibody titer of ≥0.01 units/mL is
considered protective. Active immunization should begin in early infancy with combined
diphtheria toxoid–tetanus toxoid–acellular pertussis (DTaP) vaccine at 2, 4, 6 and 15-18 mo
of age, with boosters at 4-6 yr (DTaP) and 11-12 yr (Tdap) of age and at 10 yr intervals
thereafter throughout adult life with tetanus and reduced diphtheria toxoid (Td)