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IM INFECTIOUS > TETANUS > Flashcards

TETANUS Flashcards

1
Q
  • acute disease manifested by skeletal muscle spasm and autonomic nervous system disturbance
  • caused by a powerful neurotoxin produced by the bacterium Clostridium tetani and is completely preventable by vaccination
A

Tetanus

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2
Q

“an illness occurring in a child who has the normal ability to suck and cry in the first 2 days of life but who loses this ability between days 3 and 28 of life and becomes rigid and has spasms .”

A

Neonatal tetanus

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3
Q

tetanus occurring during pregnancy or within 6 weeks after the conclusion of pregnancy (whether with birth, miscarriage, or abortion)

A

Maternal tetanus

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4
Q
  • anaerobic, gram-positive, spore-forming rod spores are highly resilient and can survive readily in the environment throughout the world
  • Spores resist boiling and many disinfectants
  • Very low concentrations of this highly potent toxin can result in tetanus (minimal lethal human dose, 2.5 ng/kg)
A

C. tetani

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5
Q
  • Tetanus is a rare disease in the _____
  • Most cases occur in _____
  • Persons ___ years of age are at greater risk of tetanus because antibody levels decrease over time
  • People who inject ____ 15% of all cases (2001-2008)
A
  • developed world
  • incompletely vaccinated or unvaccinated individuals
  • > 60
  • drugs
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6
Q
  • is intra-axonally transported to motor nuclei of the cranial nerves or ventral horns of the spinal cord.
  • This toxin is produced as a single 150-kDa protein that is cleaved to produce heavy (100-kDa) and light (50-kDa) chains linked by a disulfide bond and noncovalent forces.
A

Tetanus toxin

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7
Q

The clinical manifestations of tetanus occur only after tetanus toxin has reached

A

presynaptic inhibitory nerves

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8
Q

If the cranial nerves are involved in localized cephalic tetanus, the ____ may spasm, with consequent aspiration or airway obstruction, and the prognosis may be poor.

A

pharyngeal or laryngeal muscles

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9
Q

ALGORITHM FOR CLINICAL AND PATHOLOGIC PROGRESSION OF TETANUS

  • Before 7-10 days
A

No symptoms

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10
Q

ALGORITHM FOR CLINICAL AND PATHOLOGIC PROGRESSION OF TETANUS

  • 7-10 days
A
  • muscle aches,
  • trismus,
  • myalgia
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11
Q

ALGORITHM FOR CLINICAL AND PATHOLOGIC PROGRESSION OF TETANUS

  • 24-72 hrs ?? (days?)
A
  • Muscle spasm: local and generalized
  • CArdiovascular instability: labile BP, tachy- or bradycardia
  • Pyrexia, increased respiratory and GI secretions
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12
Q

ALGORITHM FOR CLINICAL AND PATHOLOGIC PROGRESSION OF TETANUS

  • 4-6 weeks
A
  • Cessation of spasms, restoration of normal muscle tone

- CArdiovascular and autonomic control

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13
Q

measured in a sample taken before the administration
of antitoxin or immunoglobulin; levels >0.1 U/mL (measured by standard ELISA) are deemed protective and
do not support the diagnosis of tetanus

A

Serum anti-tetanus immunoglobulin G

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14
Q

used for detection of tetanus toxin, but its sensitivity is unknown.

A

Polymerase chain reaction

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15
Q

If possible, the entry wound should be ________ in order to remove anaerobic foci of infection and prevent further toxin production.

A
  • identified,
  • cleaned, and
  • debrided of necrotic material
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16
Q

preferred for antibiotic therapy for tetanus

A

Metronidazole

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17
Q

Alternative drug although this drug theoretically may exacerbate spasms and in one study was associated with increased mortality.

A

penicillin

18
Q

Two preparation of antitoxin

A
  • human tetanus immune globulin (TIG) 2

- equine antitoxin.

19
Q

is the preparation of choice, as it is less likely to be associated nate with anaphylactoid reactions. A single IM dose (3000-5000 IU) is given, with a portion injected around the wound.

A

tetanus immune globulin (TIG)

20
Q

available widely and is used in low-income countries; after hypersensitivity testing, 10,000-20,000 U is administered IM as a single dose or as divided doses.

A

Equine-derived antitoxin

21
Q

Spasms are controlled by heavy sedation with

A

benzodiazepines.

22
Q

used as a muscle relaxant.

A

IV magnesium sulfate

23
Q

are commonly used worldwide tx for tetanus

A

Chlorpromazine and phenobarbital

24
Q

patients should be nursed in _____ because light and noise can trigger spasms.

A

calm, quiet environments

25
Q

_____are increased in tetanus, and ____ due to pharyngeal involvement combined with hyperactivity of laryngeal
muscles makes endotracheal intubation difficult.

A
  • Tracheal secretions

- dysphagia

26
Q

is the usual method of securing the airway in severe tetanus.

A

tracheostomy

27
Q

Cardiovascular stability is improved by increasing sedation with ____ (plasma concentration, 2-4 mmol/L or titrated against disappearance of the patella reflex),

A
  • lV magnesium sulfate
  • morphine,
  • fentanyl,
  • or other sedatives.
28
Q

drugs that allow rapid titration are preferred

A

Short-acting drugs

29
Q

Complications arising from treatment are common and include:

A
  • thrombophlebitis associated with diazepam injection
  • ventilator associated pneumonia
  • central-line infections,
  • septicemia.
30
Q

Recovery from tetanus may take

A

4-6 weeks

31
Q

Factors Associated with a Poor Prognosis in Adult Tetanus

A
  • Age >70 years
  • Incubation period <7 days
  • Short time from first symptom to admission
  • Puerperal, IV, postsurgery, burn entry site
  • Period of onset <48 h
  • Heart rate >140 beats/min
  • Systolic blood pressure >140 mmHg
  • Severe disease or spasms
  • Temp >38.5C
32
Q

Factors Associated with a Poor Prognosis in Neonatal Tetanus

A
  • Younger age, premature birth
  • Incubation period <6 days
  • Delay in hospital admission
  • Grass used to cut cord
  • Low birth weight
  • Fever on admission
33
Q

The WHO guidelines for tetanus vaccination consist of a

primary course of ____ doses in infancy, boosters at ____ years of age, and ____ booster in adulthood.

A
  • three
  • 4- 7 and 12-15
  • one
34
Q

“Catch-up” schedules recommend a ___ primary course with 4 weeks between doses, followed by two boosters 6 months apart.

A

three-dose

35
Q

For persons who have received a complete primary course in childhood but no further boosters, ____ doses at least 4 weeks apart are recommended.

A

two

36
Q

Tetanus Vaccines fpr young children

  • 2, 4 and 6 months
  • 15 through 18 months
  • 4 though 6 yrs
A

DTaP

37
Q

Tetanus Vaccine for preteens

- 11 through 12 yrs

A

Tdap

38
Q

Tetanus Vaccine for adults

  • every 10 yrs
A

Td or Tdap

39
Q

Standard WHO recommendations for prevention of maternal and neonatal tetanus call for administration of ___ doses of tetanus toxoid at least 4 weeks apart to previously
unimmunized pregnant women.

A

2 doses

40
Q

Individuals sustaining tetanus-prone wounds should be ____ if their vaccination status is incomplete or unknown or if their last booster was given >10 years earlier.

A

immunized

41
Q

Patients with an inadequate vaccine status who sustain wounds not classified as clean or minor should also undergo ____ immunization with TIG.

A

passive

42
Q

It is recommended that tetanus toxoid be given in conjunction with ____ in a preparation with or without acellular pertussis: DTaP for children ___ years old, Td for 7- to 9-year-olds, and Tdap for children ___ years old and adults.

A
  • diphtheria toxoid
  • <7
  • > 9

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