ODR - Tetanus Flashcards
Causative organism
Clostridium tetani
Two main catergories of features
Skeletal muscle rigidity and spasm
Autonomic instability
What is c.tetani
ANAEROBIC
Gram Positive
Bacterium
Produces a highly potenit toxin
Found in soil and faeces
How does it get in and cause effect
Wound, minor abrasions etc
(25% of cases have no apparent wound)
Tetanus toxin (tetanospasmin) prevents synaptic release from GABA inhib neurones
Therefore increased and uncontrolled motor neurone activity
Increased TONE and SPASM
Increased sympathetic autonomin activity –> instability
Common features
Lock jaw
Muscle stiffness
Back pain
Swallowing difficulty
Look for
Trismus
Risus sardonicus (facial muscle spasm)
Increased abdo rigidity
Airway/resp compromise (laryngeal spasm –> fatal)
Autonomic features –> heart rate, BP temp
Common features
Lock jaw
Muscle stiffness
Back pain
Swallowing difficulty
Look for
Trismus
Risus sardonicus (facial muscle spasm)
Increased abdo rigidity
Airway/resp compromise (laryngeal spasm –> fatal)
Autonomic features –> heart rate, BP temp
Diagnostic test
Isnt one.
Maybe c.tetani cultured from wound, but largely clinical
Evidence of tetanis protection
Antitetanus toxin antibody titres >0.1 IU/lm by ELISA is protective
Natural hx of the disease
Incubation 7-10 days –> asymptomatic.
Period of onset (24-72hours) –> period from first symptom to first spasm
Shorter periods –> more rapid progression and severity
Maximum intensity during week 2
DD of tetanus
Stychnine poisoning
Dystonic to anti-dopaminergic drugs
Surgical acute abdo
Oropharnygeal infection
Hypocalcaemia
Meningoenceph (neonates)
Management
Airway is paramount –> maybe straight to trachy
Specific antitoxin IM
Metronidazole
IVIg
Benzodiazepines, NMBDs for spasm/rigidity
Magnesium
Clean and debride wounds
