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Tetanus And Rabies Flashcards

1
Q

Mimics of Tetanus?

A

Strychnine poisoning
Rabies
Hypocalcaemic tetany

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2
Q

What kind of bacteria is tetanus?

A

Clostridium Tetani
Anaerobic gram positive bacilli

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3
Q

What is tetanospasmin?

A

A neurotropic toxin
Travels to spinal cord and disrupts inhibitory neurotransmitters

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4
Q

What is risus sardonicus? Opisthotonus?

A

Lock jaw smile
Extensive back spasm

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5
Q

How does WHO define tetanus?

A

It is a clinical diagnosis

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6
Q

How do you Dx tetanus?

A

Spatula test, they bite down
Clinical diagnosis!!

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7
Q

What is the clinical course?

A

Injury
7 days later get trismus, dysphagia and back pain
Period of onset is time until spasms which occur around day 10
Typically occur in face, nack, back and rigidity
After day 10, CVS, GI/renal and pyrexia

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8
Q

What are the types of tetanus?

A

Cephalic tetanus– most rare, lower cranial nerve muscles
Localised tetanus– spasms around muscle of wound, weakness in that leg
Neonatal tetanus

Both progress to generalised tetanus

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9
Q

Treatment?

A

Minimise light and any stimulus
1st Benzodiazepines , titrate IV benzos such as diazepam and lorazepam
2nd Chlorpromazine
3rd Vecuronium (neuromuscular blockade)

Then use human antitoxin can also use equine
Surgical debridement and metronidazole

Use really short acting beta blockers such as esmolol and morphine, clonidine and magnesium sulphate

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10
Q

Complications of tetanus?

A

Bone fractures
Rhabdomyolysis
PE
Pressure sores
Muscle rigidity

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11
Q

What is the vaccine?

A

Need full course of vaccination
You can Never get natural immunity to tetanus!
3 doses followed by 3 boosters

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12
Q

How do you prevent neonatal tetanus?

A

Clean delivery practice
Vaccinate women of reproductive age
In Jun-immunised pregnant women give them 2 doses of tetanus toxoid one month apart

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13
Q

What is elimination of tetanus defined as?

A

Elimination defined as <1 NNT case per 1000 live births in every district per year

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14
Q

Is there any reduction in GCS during tetanus, if a patient is confused with muscular spasms is it tetanus?

A

No!
There is never a reduction in GCS

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15
Q

What causes nocturnal onset of chest discomfort, breathlessness, abdo pain or early morning paralysis?

A

Caused by Burngarus bites

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16
Q

What are the two main families of snakes?

A

Viperidae: Relatively short, thich body, short tail and strike like lightening
Elapidae: Relatively long thin body, long tail uniformly coloured

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17
Q

What is the vector of African Tryp?

A

Glossina Spp.

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18
Q

What are the two species of African Tryp?

A

T.B. Gambiense is central and West Africa
T.B. Rhodesiense in East Africa

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19
Q

What is the main cause of African sleeping sickness?

A

Gambiense

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20
Q

What is the most endemic Country of T B Gambiense?

A

DRC
Gabon
Congo

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21
Q

Which country has both TB Gambiense and TB Rhodiense?

A

Uganda

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22
Q

Compare clinical features of Rhodesiense with Gambiense

A

Rhodesiense has trypanosomal chancre ++, can be absent in Gambiense
Haemo-lymphatic stage in Gambiense is low grade fever, no neurological symptoms, typically Posterior Cervical lymphadenopathy
The Haemo-lymphatic stage in Rhodesiense is high fever, lymphadenopathy, rash on legs, multi-organ failure
Meningo-encephalitis stage is seen more in Gambiense compared to rhodesiense as rhodesiense is severe and therefore is diagnosed beforehand

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23
Q

What is time between bite and onset of symptoms in rhodesiense?

A

10 days

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24
Q

What is winterbottom sign?

A

Painless poster or Cervical lymphadenopathy in TB Gambiense

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25
What is criteria for diagnosis of Meningo-encephalitis stage?
Presence of tryps in CSF >5 Leukocytes (presence of Mott cells)
26
How do you diagnose gambiense?
CATT (card agglutination test) LFT Then go on to do a blood film, lymph node aspiration and use centrifugation methods
27
Hat in the non endemic setting, who gets rhodesiense vs Gambiense?
Rhodesiense seen almost excludively in tourists from Tanzania, Malawi, Zambia Mostly diagnosed by blood smear and most are in stage 1, diagnosed within 3 weeks of exposure Gambiense mostly in migrants DRC, Gabon and Angola 39% diagnosed by blood smear, 77% diagnosed in stage 2 and diagnostic delay 3-12 months
28
How do you treat Gambiense?
Fexinidazole for stage 1 and 2nd Stage: Fexinidazole Except if advanced disease/presence of >100 WBC in CSF where NECT is preferred Need f/u for 2 years and LP every 6 months if had 2nd Stage Gambiense
29
How do you treat TB Rhodesiense?
First Stage: Suramin (risk of proteninuria, exfoliative dermatitis, Mazotti test if onchocerciasis) Second Stage: Suramin and Melarsoprol (Very toxic causes polyneuropathy, hepatitis, haemolysis and encephalitis)
30
What spreads Ebola?
Pteropodidae fruit bad
31
How does Ebola spread? incubation time?
Contact with bodily fluids, not aersolised Incubate 2-21 days
32
How does Ebola present?
Fever Bleeding Bloody diarrhoea
33
Dx of Ebola?
PCR
34
Clinica stages of Ebola?
Dry followed by wet (diarrhoea, vomiting) and then stage 3 which is coma, hiccups, haemorrage and seizures
35
Type of virus Marburg and main reservoir?
Filo virus
36
Reservoir of lasa virus? Type of virus?
Mastomys natalensis Arena virus
37
Signs of lasa?
High fever, sore throat, vomiting, chest pain sensorineural hearing loss
38
What does hanta virus cause in old world?
Causes haemorrhagic renal failure
39
What does new world hanta virus cause?
Influenza like illness which causes rapidly progressing pulmonary disease
40
How is CCHF transmitted?
Ticks are the main vectors Associated with cattle slaughtering
41
Clinical signs of scorpion sting? How does envenoming work?
Localised agonising pain Ion channels block Na, K and Ca channels Initial parasympathetic signs; vomiting, secretions, sweating, priaprism Neurotoxic signs; fasiculations, tonic-colonic spasms
42
Tx initially of scorpion sting?
Digital block of lidocaine or tetracaine Need ICU tx
43
Brown recluse spiders also known as? Clinical presentation?
Loxoceles spp Initial discomfort, erythema Develops blue/red/white sign Becomes necrotic eschar
44
What is a severe complication of loxoceles?
Fever, hemolytic Anaemia, jaundice and AKI Only 4-19% will develop visceral complications
45
What spiders cause Neurotoxic araneism?
Lactrodectus spiders (brown and black widow) Latin American banana spiders (Phoneutria), and Sydney/Australian funnel-web spiders (Atrax, Hadronyche)
46
What symptoms do Neurotoxic spiders cause?
Local: immediate pain, sweating, gooseflesh/goose bumps • Systemic: rapidly-evolving headache, nausea, vomiting, profuse generalized sweating, fever, priapism, painful muscle spasms, tremors, rigidity that may cause respiratory distress or simulate an acute abdomen
47
Types of fish poisoning?
Ciguatera Scombroid Tetrodotoxic
48
Where is ciguatera fish poisoning and what is it?
Ciguatoxins caused by Typically round tropical countries Caused by psuedomonas bacteria
49
What fish are ciguatoxic?
Grouper Barracuda Parrotfish Moray eel Trigger fish red bass
50
What are the clinical features of ciguatera toxin?
GI symptoms which become parastehsiae, paradoxical dysasthesia, pruritus, numbness and weakness
51
What type of fish have scombroid poisoning?
Mackerel Albacore Yellow fin tuna Bonito
52
What are the immediate symptoms of scombroid?
Immediate peri-oral tingling Histaminic anapylactic reaction Case fatality is low Urticaria like rash with throbbing headache, dizziness and syncope
53
What does Pufferfish poisoning lead to?
Tetrodotoxic poisonings derviced from psuedomonas bacteria
54
What does shellfish poisoning do?
Diarrheal is due to okadaic acid Neurotoxic is due to brevetoxin Paralytic is caused by tetrahydropurine Domoic acid causes amnesia Rapid onset parastehsiae, but no paralysis
55
How do you treat marine poisoning?
Elimante gut contents -ciguatera poisoning need IV mannitol and restore fluids -Scombroid poisoning give adrenaline and histamine H1 and H2 receptor blockers
56
What is important to note seafood toxins?
They are heat and acid resistant! Prevent eating large tropical sea fish and eat only fresh fish to prevent scombroid poisoning
57
Tx of amatoxin mushroom poisoning?
Silibinin N-acetyl cysteine High dose benzyl penicillin
58
What are species of rabies and what predominates? What kind of virus is rabies?
Mainly type 1 rabies Lyssa virus
59
Where is most rabies worldwide?
India
60
Two types of presentations in dogs?
Dumb (60%) and furious (40%)
61
How long does rabies incubate for?
20-90 days Can be years
62
What is the clinica picture of rabies?
Earliest symptom is itching Encephalomyelitis can be furious such as hydrophobic spasms, rapid deterioration into coma, die from cardiac and respiratory arrest Paralytic 'dumb' rabies which is ascending flaccid paralysis. This has a longer survival
63
How does Paralytic rabies present?
Prodromal fever, headache, parastehsiae at bite site Pain, flaccid paralysis, Sensory abnormalities in limb. No hydrophobia, excitation or convulsions. Death from bulbar and resp paralysis or cardiac arrhythmias
64
How do you diagnose rabies?
PCR of bodily fluids such as CSF, tears, skin biopsy. Can immunofluorescence antigen seen in skin biopsy of hairy area Autopsy/post-mortem needle autopsy
65
What is post exposure prophylaxsis?
Throughourly clean the wound Vaccine (x5) and RIG 0, 3, 7, 14 and 28 days is the vaccine regimen Void suturing the wound Abx and tetanus if required
66
What are the categories of rabies post exposure
Cat 1: touching or being licked/intact skin Cat 2: nibbles without breaking skin Cat 3: Bites or scratches with breaking skin causing bleeding, contact of saliva with broken skin/mucous membranes and ANY contact with bats
67
How do you manage CAT 1-3 when not vaccinated?
Cat 1- clean wound and no PEP Cat 2- clean wound, Vaccinate immediately only give RIG if immunocompromised Cat 3- clean wound, Vaccinate immediately and RIG
68
What do you do with immunosuppressed patients for PEP?
Need 5 doses of vaccine irrespective of PREP Need RIG for category 2 and 3 cases
69
How else can you give PEP?
4 doses IM over 21-28 days OR give 3 or 2 dose mutli-site ID over 7 days For those with PrEP either give 2 doses IM over 3 days or give mutli-site ID on 1 day
70
When is it too late to give PEP? Too late to give RIG? When is it too late to give RIG after starting vaccine?
There is no time limit for giving PEP due to long incubation exposure Too late to give RIG if exposure was more than 1 year ago Do not give RIG >7 days after starting vaccination process and do not give RIG to immunocompetent people with PrEP

GORGAS (33 decks)

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