Tetanus Flashcards
It is an anaerobic, gram positive, spore-forming rod that are highly resilient. (Harrison pp 984)
Clostridium tetani
It is defined by WHO as an illness occurring in a child who loses the ability to suck and cry between 3 and 28 days old. (Harrison pp 984)
Neonatal tetanus
It is defined by WHO as tetanus occurring during pregnancy or within 6 weeks after the conclusion of pregnancy whether with birth, abortion or miscarriage. (Harrison pp 984)
Maternal tetanus
What is the minimum lethal human dose? (Harrison pp 984)
2.5 ng/kg
It is the commonest infection sites in adults affected by the Clostridium tetani. (Harrison pp 984)
Superficial abrasions of the limbs
Who are greater risk of having Clostridium tetani? (Harrison pp 984)
Persons > 60 years
Injection drug users (Herion subcutaneously or skin-popping)
Incomplete vaccination
It is the exotoxin caused by tetanus (Harrison pp 984)
tetanospasmin
It is necessary for presynaptic binding and release of neurotransmitter hence effectively blocks inhibitory interneuron discharge. (Harrison pp 985)
VAMP2 - Vesicle associated membrane protein 2
What is the commonest initial symptoms of tetanus? (Harrison pp 985)
Trismus - lockjaw
Muscle pain and stiffness
Back pain
Difficulty swallowing
It is the commonest cause of death among tetanus. (Harrison pp 985)
Respiratory Failure
When is Autonomic disturbance is maximal? (Harrison pp 985)
2nd week
How should be the level of serum anti-tetanus immunoglobulin G to deemed protective? (Harrison pp 985)
> 1.0 IU/mL
What is the antibiotics of choice for tetanus? (Harrison pp 986)
Metronidazole 500mg/IV q6 for 7 days
Alternative: Penicillin 100, 000 to 200, 000 IU/KG per day (exacerbate spasm)
What is the recommended therapy for Human Tetanus Immune Globulin? (Harrison pp 986)
3000 - 5000 IU of TIG as single IM dose
What is the recommended dose if TIG is given intrathecally? (Harrison pp 986)
50 - 1500 IU
Severe spasm are best controlled with what medications? (Harrison pp 986)
Magnesium
Relatively short acting cardiovascular inert, non depolarizing neuromuscular blocking agents
What are the possible complications arising from treatments of tetanus? (Harrison pp 986)
Thrombophlebitis associated with diazepam
VAP
Central line infection
Septicemia
What is the WHO recommendations for prevention of maternal and neonatal tetanus? (Harrison pp 986)
2 doses of tetanus toxoid at least 4 weeks apart to previously unimmunized pregnant women
How should diptheria toxoid be given by recommendation of WHO in conjugate with tetanus toxoid? (Harrison pp 986)
DTap for children < 7 years old
Td for 7 - 9 years old
Tdap for > 9 years old
What are the factors associated with poor prognosis with tetanus among adult? (Harrison pp 986)
> 70 yo Incubation period of < 7 days Heart Beat of > 140 bpm Blood pressure > 140 mmHg Puerperal IV, postsurgery, burn entry Period onset < 48 hrs Severe disease or spasms Temperature > 38.5 C
What are the factors associated with poor prognosis with tetanus among children? (Harrison pp 986)
Younger age, premature birth Incubation period < 6 days Delay in hospital admission Grass used to cut cord Low birth weight Fever on admission
