TETANU

S
By :
Reno Waisyah

Preceptor: dr. Amran , Sp. B

CHAPTER I
INTRODUCTI Tetanus is an acute infectious disease
with acute neuromuscular disorders in
ON the form of trismus, stiffness and
muscle spasms.

Tetanus is an infectious disease

caused by contamination of wounds
from the bacteria Clostridium tetani or
the spores they produce that live in the
soil, and animal feces

Greek words -“tetanosand teinein”,

meaning rigid and stretched, which
describe the condition of the muscles
affected by the toxin, tetanospasmin,
produced by Clostridium tetani
CHAPTER II
LITERATURE
REVIEW
Etiology
Tetanus is caused by Clostridium tetani which is a pure anaerobic. Clostridium
tetani is a slender, gram-positive, anaerobic rod that may develop a terminal spore,
giving it a drumstick appearance. Clostridium tetani spores can last for years if its
not exposed to sunlight. These spores are found under the soil or dust, resistant to
antiseptics & heating. From different studies, these spores are usually in human
feces, as well as in horse, dog and cat feces.

Clostridium
spores tetani, with a "drumstick" formation.
The spores of Clostridium tetani are formed on the bacterial part
Pathogenesis
3.
1. 2.
Germinates under
Clostridium tetani enters Stays in sporulated form
anaerobic conditions &
the body from through until anaerobic
begin to multiply &
wound conditions are presented
produce tetanospasmin

6. 4.
Binds to sites 5. Tetanospasmin spreads
responsible for inhibiting Travels along the axons using blood & lymphatic
skeletal muscle to the spinal cord system, and binds to
contaction motor neurons
Pathogenesis

● Initially binds to peripheral nerve

terminals
● Transported within the axon and across
synaptic junctions until it reaches the
central nervous system.
● Becomes rapidly fixed to gangliosides
at the presynaptic inhibitory motor
nerve endings, then taken up into the
axon by endocytosis
4 Types Of Tetanus Lockjaw

1. Generalized
The first sign is trismus or lockjaw,
followed by stiffness of the neck,
difficulty in swallowing, and rigidity of
abdominal muscles.
Other symptoms include elevated
temperature, sweating, elevated blood
pressure, and episodic rapid heart rate
2. Local
Local tetanus is an uncommon form
of the disease, in which patients
have persistent contraction of
muscles in the same anatomic area
as the injury.
4 Types Of Tetanus
3. Cephalic
Facial muscle spasm
Cephalic tetanus occurs with ear
infections or following injuries of the
head, facial muscles spams.
4. Neonatal
Neonatal tetanus is a form of
generalized tetanus that occurs in
newborn infants. Neonatal tetanus
occurs in infants born without
protective passive immunity,
because the mother is not immune.
It usually occurs through infection
of the unhealed umbilical stump,
particularly when the stump is cut
with an unsterile instrument.
Ablett's Tetanus Scoring System
Grade I Mild to moderate trismus, generalized spasticity, no respiratory distress, no spasm
and dysphagia.
Grade II Moderate trismus, visible rigidity, mild to moderate spasm of short duration,
tachypnea ≥ 30 beats / minute, mild dysphagia.
Grade III A Severe trismus, generalized spasticity, prolonged spontaneous spasm, respiratory
distress with tachypnea ≥ 40 beats / minute, apneic spell, severe dysphagia,
tachycardia ≥ 120 beats / minute.
Grade III B Conditions such as grade III plus severe autonomic dysfunction involving the
cardiovascular system. Severe hypertension and tachycardia alternate with relative
hypotension and bradycardia, either of which can be persistent.
Differential Diagnosis
Disease Overview
INFECTION  
Meningoenchepalitis Fever, trismus (-), loss of consciousness, abnormal cerebrospinal fluid.
 Polio Trismus (-) , flasid paralysis, abnormal cerebrospinal fluid.
 Rabies Animal bites, trismus (-), oropharing spasm.
 Orofaring lession Local , rigiditas or spasme all over the body (-).
 Peritonitis Trismus & spasme all over the body (-).

METABOLIC DISORDER
Tetani larynx spasm , hipokalsemia.
Striknin Poisoning Complete relactation among spasm
Fenotiazin Reaction Distonia, showing respons with difenhidramin

CENTRAL NERVE SYSTEM DISORDER

Status epilepticus Loss of consciousness.
SOL Trismus (-) , loss of consciousness
PSHYCIATRIC DISORDER
Hysteria Inconstant Trismus, Complete relactation among spasm

MUSCULOSKELETAL DISORDER
Trauma Local .
Principle of treatment

01
Neutralization of
02
Prevention of further
unbound toxin toxin production
With human tetanus  Wound debridement
immunoglobulin  Antibiotics (metronidazole)

03 04
Control of spasm Supportive care
 Nursing in quiet environment  Adequate hydration
 Avoid unnecessary stimuli  Nutrition
 Protecting the airway  Treatment of secondary infection
 Prevention of bed sores
General treatment
1. Cleaning wounds, wound irrigation, wound debridement (excision of necrotic
tissue), removing foreign objects in the wound and compressing with H202
and ATS injection.
2. Diet enough calories and protein, the form of food depends on the ability to
open your mouth and swallow. If trismus is present, food can be given
personde or parenterally.
3. Isolation to avoid external stimuli such as sound and actions towards
sufferers.
4. Oxygen, artificial respiration and trachcostomy if necessary.
5. Regulate fluid and electrolyte balance.
Medication
Antibiotic
 Given parenteral Peniciline 1.2 million units / day for 10 days, IM.
 These antibiotics are only intended to kill the vegetative form of C. farmer, not the toxins it
produces. If there are complications of giving broad spectrum antibiotics, it can be done

Antitoxin
 Antitoxin can be used Human Tetanus Immunoglobulin (TIG) at a dose of 3000-6000 IU IM
 If TIG is not available, it is recommended to use tetanus antitoxin, of animal origin, at a dose
of 20,000 U
Antikonvulsan
Diazepam. If the patient comes in a seizure, give 0.5 mg / kg i.v. with the optimum dose of 10mg
repeated for each seizure (slowly).
The maximum dose of diazepam is 240 mg / day. If there are still seizures (very severe tetanus),
should be continued with the help of mechanical ventilation. The diazepam dose can be
increased to 480mg / day with the help of mechanical ventilation.

Dose Side effect

/ 4 hrs ( IM ) Stupor, coma

4 hrs ( IM ) (-)
4 hrs ( IM )
Hypotension
4 hrs ( IM ) Respiratory distress
Prognosis
● Overall, about 25%-50% of people with generalized
tetanus will die.
● The disease is more serious when the symptoms come
on quickly.
● Older people and very young children tend to have more
severe cases; those over 65 years are more likely to die
from the infection
● Intensive medical care improves the prognosis in severe
cases.
● Death is usually due to respiratory failure or disturbance
of heart rhythm.
 CHAPTER III - CONCLUSION
Tetanus is a disease with stiffness muscles symptoms, especially on
face and neck. This is caused by the entry of spores from the bacteria
Clostridium tetani which enter through the wound on the body even though the
wound is small. The severity of this disease depends on the incubation period,
the onset period, local or generalized seizures and the presence or absence of
autonomic disorders.
The diagnosis is made based on clinical features, immunization history
and laboratory test result . There are clinical trias of tetanus, rigidity; muscle
spasm ; and severe autonomic dysfunction. Stiff neck, sore throat and
difficulty opening the mouth are often the initial symptoms of tetanus.
Management includes general management, neutralization of toxins,
elimination of bacteria, supportive therapy and consultation if necessary. In
local tetanus, the prognosis is better than general tetanus. The prevention is to
reduce the incidence of tetanus, one of them is offering the immunization.
SOURCES
1. Ismanoe G. Ilmu Penyakit Dalam, Jilid 3. Blai Penerbit FK UI. Jakarta: 2006.
Hal 1799-1807.
2. Sjamsuhidajat R, De Jong. Buku Ajar Ilmu Bedah edisi 3. Jakarta: EGC; 2010.
3. Karakata S. Bedah Minor. Jakarta: Hipokrates; 1996.
4. Todar K. 2007. The Microbiological World: Tetanus. (Online)
http://textbookofbacteriology.net/themicrobialworld/Tetanus.html
5. Mardjono, mahar. NeurologiKlinisDasar. Dian Rakyat, Jakarta:2004.
6. CDC. 2008. Tetanus. http:// www.cdc.gov/ vaccines/ pubs/ pinkbook/
downloads/ tetanus.
 THANKS!

CREDITS: This presentation template was created by Slidesgo, including icons

by Flaticon, infographics & images by Freepik and illustrations by Stories