Tetanus Flashcards
1
Q
Tetanus
A
Tetanospasmin, clostridium tetanis exotoxin, causes muscle spasms and rigidity, cardinal features of tetanus
2
Q
Pathogenesis
A
- spores of c tetani live in feaces, soil, dust and on instruments
- a tiny breach in skin or mucose may admitt the spores
- diabetics are at increased risk
- spores geminate and make the exotoxin
- this travels up peripheral nerves and interferes with synapses
3
Q
Clinical features
A
- 20% have no evidence of recent woudnds
- signs appear from 1d to severeal months from the injury
- Prodrome - fever, malaise, and headache before classical symmptoms
- trismus (lock jaw, difficulty opening mouth)
- risus sardonicus - (a grin-like posture of hypertonic facial muscels)
- Opisthotonus (arching of body with eck hyperextension)
- spasms (first may be induced movement, njeciton, noise etc then later are spontaenous)
- autonomic dysfuncion (arrhythmia + wide fluctuations in BP)
4
Q
Differential diagnosis
A
- dental abscess (Both cause trismus(
- rabies
- poisioning
5
Q
Investigations
A
Clinical features alone
6
Q
Treatment
A
- Get help on ITY
- ABC (tracheostomy and ventilation posibe)
- debride all wounds
- Monitor ECG + BP + SpO2 (keep >92%)
- HUman tetanus immunoglobulin (HTIG) 150 units/kg IM at multiple sites to neutrolise toxin
- Aim to keep patient asleep but rousable (Diazapam 5-20mg/8h PO to control spasms
- if this fails then paralyse and ventilate
7
Q
Prevention
A
- active immunisation with tetanus toxioid (3-stage vaccine during 1st year of life); booster on starting school and early adulthodd
- once 5 injections have been given, re-vaccinate only at the time of significant injury
- Neonatal and maternal tetanus - unyhygenic methods of delivery, abortion or umbilical cord care
8
Q
Prognosis
A
- Incubation <1 week, trismus leads to spasms in <48h
- neonatesl elderly; post infection; postpartum a big cause of mortality worldwide
