Acute tetanus: Difference between revisions
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==Background== | ==Background== | ||
# C. tetani spores enter skin through wound, make tetanospasmin toxin | # C. tetani spores enter skin through wound, make tetanospasmin toxin | ||
##Lacs, abrasions, puncture wounds | |||
##Preferentially binds GABA and glycinergic neurons and blocks presynaptic release | |||
###Motor neurons undergo sustained excitatory discharge | |||
# Spores found in soil and human feces | # Spores found in soil and human feces | ||
# 2001-2008 in US, 233 cases, 26 deaths | # 2001-2008 in US, 233 cases, 26 deaths | ||
# as high as 45% | # Mortality as high as 45% | ||
# 2 to 56d | # Incubation is 2 to 56d | ||
# | # If the pt survives, no residual sequealae | ||
==Types== | ==Types== | ||
| Line 26: | Line 29: | ||
==Diagnosis== | ==Diagnosis== | ||
# | # Progressive symptoms<ref>Fernandez-Frackelton M: Bacteria, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 127:p 1681-1686</ref> | ||
##Alert and able to communicate | |||
##Trismus - lockjaw (50%-75% of patients) | |||
##Sardonic smile (risus sardonicus) - other facial muscles become involved | |||
##Minor stimuli such as touch or noise start tetanic contractions | |||
##Abd, back, diff swallowing | |||
##Long bone fractures, tendon rupture | |||
##Opisthotonus - contractures that resemble decorticate posturing | |||
# DX = clinical | # DX = clinical | ||
Revision as of 01:04, 26 January 2015
Background
- C. tetani spores enter skin through wound, make tetanospasmin toxin
- Lacs, abrasions, puncture wounds
- Preferentially binds GABA and glycinergic neurons and blocks presynaptic release
- Motor neurons undergo sustained excitatory discharge
- Spores found in soil and human feces
- 2001-2008 in US, 233 cases, 26 deaths
- Mortality as high as 45%
- Incubation is 2 to 56d
- If the pt survives, no residual sequealae
Types
Neonatal
- from umbilical stump infection. Usually protected by passive maternal Abs
- sx- poor suck, irritability, crying, grimacing
- usually with in 10 d of birth
Local
- rigidity of muscles near wound- may progress to generalized
Generalized
- most common form
- pts are conscious and alert
- hypersympathetic state c sweating, HTN, tachycardia, fever
Cephalic
- follow injuries to head or otitis media
- get CN dysfunction- usually CN 7
Diagnosis
- Progressive symptoms[1]
- Alert and able to communicate
- Trismus - lockjaw (50%-75% of patients)
- Sardonic smile (risus sardonicus) - other facial muscles become involved
- Minor stimuli such as touch or noise start tetanic contractions
- Abd, back, diff swallowing
- Long bone fractures, tendon rupture
- Opisthotonus - contractures that resemble decorticate posturing
- DX = clinical
Differential Diagnosis
- Dystonic reaction
- strychnine
- hypocalcemic tetany
- PTA
- teritonitis. SAN
- Meningitis
- Rabies
- TMJ
Treatment
- wound debridement
- TIG- 3000- 10K IM- prevents additional dz but does not reverse toxin already fixed to CNS. Binds circulating toxin
- IVF/ hyperal
- quiet room
- sedation with phenobarb, valium or paralytics
Antibiotics
Metronidizole
- 500 mg IV every 6 hours
Weight and Age Based Dosing
(<1200g)
- 7.5 mg/kg PO/IV q48h
- First Dose: 7.5 mg/kg PO/IV x 1
(>1200g AND <1 Month Old)
- <7 days old
- 7.5-15 mg/kg/day PO/IV q12-24h
- First Dose: 7.5-15 mg/kg PO/IV x 1
- >7 days old
- 15-30 mg/kg/day PO/IV q12h
- First Dose: 7.5-15 mg/kg PO/IV x 1
(>1 Month Old)
- 30 mg/kg/day PO/IV q6h
- First Dose: 7.5 mg/kg PO/IV x 1
- Max: 4 g/day
Penicillin
- Although once the drug of choice it is now no longer recommended since it may potentiate the effect of tetanus toxin by inhibiting the GABA receptors[2]
See Also
Sources
- ↑ Fernandez-Frackelton M: Bacteria, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 127:p 1681-1686
- ↑ Ganesh Kumar AV. Benzathine penicillin, metronidazole and benzyl penicillin in the treatment of tetanus: a randomized, controlled trial .Ann Trop Med Parasitol. 2004 Jan;98(1):59-63 PMID 15000732