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    Tetanus: Oleh: Riz Sanfebrian Adiatma

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    monyet65
    Tetanus is caused by Clostridium tetani bacteria which produces a toxin. The bacteria spores are found in soil and animal feces. The toxin causes muscle rigidity and spasms by interfering with neurotransmitter release in the central nervous system. Tetanus is characterized by lockjaw and muscle spasms. It is diagnosed clinically based on symptoms. Treatment involves wound cleaning, antitoxin administration, benzodiazepines, and supportive care like ventilation for severe cases. Prevention is through routine immunization with tetanus toxoid vaccines.

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    Tetanus: Oleh: Riz Sanfebrian Adiatma

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    monyet65
    50 views16 pages
    Tetanus is caused by Clostridium tetani bacteria which produces a toxin. The bacteria spores are found in soil and animal feces. The toxin causes muscle rigidity and spasms by interfering with neurotransmitter release in the central nervous system. Tetanus is characterized by lockjaw and muscle spasms. It is diagnosed clinically based on symptoms. Treatment involves wound cleaning, antitoxin administration, benzodiazepines, and supportive care like ventilation for severe cases. Prevention is through routine immunization with tetanus toxoid vaccines.

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    Tetanus

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    Tetanus is caused by Clostridium tetani bacteria which produces a toxin. The bacteria spores are found in soil and animal feces. The toxin causes muscle rigidity and spasms by interfering with neurotransmitter release in the central nervous system. Tetanus is characterized by lockjaw and muscle spasms. It is diagnosed clinically based on symptoms. Treatment involves wound cleaning, antitoxin administration, benzodiazepines, and supportive care like ventilation for severe cases. Prevention is through routine immunization with tetanus toxoid vaccines.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    50 views16 pages

    Tetanus: Oleh: Riz Sanfebrian Adiatma

    Uploaded by

    monyet65
    Tetanus is caused by Clostridium tetani bacteria which produces a toxin. The bacteria spores are found in soil and animal feces. The toxin causes muscle rigidity and spasms by interfering with neurotransmitter release in the central nervous system. Tetanus is characterized by lockjaw and muscle spasms. It is diagnosed clinically based on symptoms. Treatment involves wound cleaning, antitoxin administration, benzodiazepines, and supportive care like ventilation for severe cases. Prevention is through routine immunization with tetanus toxoid vaccines.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 16

    Tetanus

    Oleh:
    Riz Sanfebrian Adiatma
    Tetanus
    • Tetanus is an acute, often fatal, disease caused by an exotoxin
    produced by the bacterium Clostridium tetani. It is characterized by
    generalized rigidity and convulsive spasms of skeletal muscles.
    • C. tetani is a slender, gram-positive, anaerobic rod that may develop a
    terminal spore, giving it a drumstick appearance.
    • The spores are widely distributed in soil and in the intestines and
    feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and
    chickens.
    • C. tetani produces two exotoxins, tetanolysin and tetanospasmin.
    Pathogenesis
    • Anaerobic conditions allow germination of
    spores and production of toxins
    • Toxin binds in central nervous system
    • Interferes with neurotransmitter release to
    block inhibitor impulses
    • Leads to unopposed muscle contraction
    and spasm
    Clinical Features

    • Incubation period; 8 days (range, 3-21 days)


    • Three clinical forms: local (uncommon), cephalic (rare),
    generalized (most common)
    • Generalized tetanus: descending pattern of trismus (lockjaw),
    stiffness of the neck, difficulty swallowing, rigidity of abdominal
    muscles
    • spasms continue for 3-4 weeks
    • complete recovery may take months
    Diagnosis
    • Diagnosis tetanus didasarkan pada penemuan klinis yang khas.
    • Pemxan penunjang seperti kultur bakteri tidak diperlukan.
    • Trias tetanus:
    • Rigiditas
    • Spasme otot
    • Disfungsi otonomik

    Gusti Noor Ramadhany, S.Ked./I1A006032 dan Putri Anggraeni F., S.Ked./I1A007040


    Kriteria Patel & Joag (1959)
    • Kriteria 1: Rahang kaku, spasme terbatas, disfagi & kekakuan otot
    tulang belakang.
    • Kriteria 2: Spasme saja tanpa melihat frekuensi & derajatnya.
    • Kriteria 3: Inkubasi ≤ 7 hr.
    • Kirteria 4: Onset ≤ 48 jam.
    • Kriteria 5: Peningkatan suhu rektal hingga 100°F & aksila hingga 99°F
    (37,6°C).

    Gusti Noor Ramadhany, S.Ked./I1A006032 dan Putri Anggraeni F., S.Ked./I1A007040


    Kriteria Patel & Joag (1959)
    • Derajat I: Minimal 1 kriteria (K1/K2)  mortalitas 0%
    • Derajat II: Minimal 2 kriteria (K1 & K2) + inkubasi > 7 hr & onset > 48
    jam  mortalitas 10%
    • Derajat III: Minimal 3 kriteria + inkubasi ≤ 7 hr & onset ≤ 48 jam 
    mortalitas 32%
    • Derajat IV: Minimal ada 4 kriteria  mortalitas 60%
    • Derajat V: Terdiri dari 5 kriteria & termasuk tetanus neonatorum &
    tetanus puerpurium  mortalitas 84%

    Gusti Noor Ramadhany, S.Ked./I1A006032 dan Putri Anggraeni F., S.Ked./I1A007040


    Klasifikasi tetanus menurut Ablett yang
    dimodifikasi oleh Udwadia (1994)
    • Derajat I (ringan): Trismus ringan & sedang dengan kekakuan umum. Kejang (-),
    gangguan respirasi (-) & sedikit/tanpa ggan menelan.
    • Derajat II (sedang): Trismus sedang, kaku disertai kejang ringan-sedang yang
    singkat disertai disfagi ringan & takipnu >30-35 x/mt.
    • Derajat III (berat): Trismus berat, kekakuan umum, kejang spontan yang
    berlangsung lama. Ggan pernapasan dengan takipnu >40 x/mt, kadang apnu,
    disfagi berat & takikardi >120 x/mt. Peningkatan aktivitas saraf otonom yang
    moderat & menetap.
    • Derajat IV (sangat berat): Gbran tingkat III disertai ggan saraf otonom berat: HT
    berat dengan takikardi berselang hipotensi reaktif & bradikardi atau hipertensi
    diastolik yang berat dan menetap (diastolik >110 mmHg) atau hipotensi sistolik
    yang menetap (sistolik <90 mmHg)  autonomic storm.

    Gusti Noor Ramadhany, S.Ked./I1A006032 dan Putri Anggraeni F., S.Ked./I1A007040


    PENCEGAHAN
    • Tetanus dapat dicegah dengan vaccinasi toxoid tetanus
    • CDC Merekomendasikan :
    • Dewasa mendapat booster tetanus tiap 10 th
    • Booster diberikan pada saat ada luka bila terakhir di vaccine tidak diketahui
    atau telah divacinne tapi kurang dari 3 kali.
    • Anak kurang dari 7 tahun mendapat DPT
    PEGANGAN PROFILAKSIS TETANUS
    Riwayat imunisasi Luka bersih Luka lain
    Tetanus (Dosis)
    TD TIG TD TIG

    Tidak pasti, atau kurang Y N Y Y


    dari 3 kali
    3 kali atau lebih N N N N

    Lebih dari 5 tahun N N Y N

    Lebih dari 10 th Y N Y N

    Luka lain : luka lebih dari 6 jam, bentuk irreguler, kedalaman lebih
    dari 1 cm, luka tembak, luka bakar, frostbite, crush injury, terdapat
    jaringan mati, sangat kotor
    Penatalaksanaan

    1. Suportif & perawatan intensif.


    • Tetanus > derajat III sebaiknya dilakukan trakeostomi. Oksigenasi untuk
    ventilasi & cegah hipoksia. Diit & kebutuhan cairan!
    • Tetanus > derajat II sebaiknya dirawat dalam rg intensif. Ruangan intensif
    harus bersih, cukup sejuk dgn ventilasi baik. Rgan gelap bukan keharusan,
    namun stimulasi cahaya berlebihan harus dihindari. Stimulasi taktil sebaiknya
    dihindari.

    Gusti Noor Ramadhany, S.Ked./I1A006032 dan Putri Anggraeni F., S.Ked./I1A007040


    Penatalaksanaan
    2. Pemberian ATS & TT.
    • Setiap pasien dengan tetanus harus diberi ATS 10.000 U & TT 0,5 cc
    pada lokasi injeksi yang berbeda. Pemberian antitoksin dosis
    terapetik selama 2 – 5 hari berturut – turut.
    • ATS berhubungan dengan kejadian anafilaksis, shg bila mungkin,
    berikan HTIG dosis 3000-5000 IU i.v /i.m.

    3. Penanganan luka & pemberian AB.


    • Luka harus didebridemen & higiene  cegah infeksi sekunder.
    • AB: penisilin prokain dosis 2 juta U/4 jam i.v, namun obat ini
    merupakan antagonis GABA & dapat mencetuskan kejang.
    • Alternatif: metronidazol 3 x 500 mg i.v + tetrasiklin 4 x 500 mg
    p.o. Obat lain: eritromisin 4 x 500 mg p.o. Lama pemberian AB: 14
    hari.
    Gusti Noor Ramadhany, S.Ked./I1A006032 dan Putri Anggraeni F., S.Ked./I1A007040
    Penatalaksanaan
    • Benzodiazepin  terapi utama. Diazepam digunakan
    sesuai kebutuhan hingga dosis maksimal 240 mg/ 24
    jam.
    • Bila sedasi tetap tidak memadai  muscle relaxant
    untuk induksi paralisis dengan pankuronium 2-4 mg
    i.v & ventilator.

    Gusti Noor Ramadhany, S.Ked./I1A006032 dan Putri Anggraeni F., S.Ked./I1A007040


    Penatalaksanaan
    5. Penanganan disotonomik.
    • Non-farmakologis: cairan salin hingga 4000 cc/hr utk
    instabilitas otonom.
    • Medikamentosa utama: benzodiazepin utk me↓an
    aktivitas otonom & histamin. Penyekat beta (propranolol)
    utk tatalaksana HT, takikardi & miokarditis. Dosis maks.
    240 mg/hr.

    Gusti Noor Ramadhany, S.Ked./I1A006032 dan Putri Anggraeni F., S.Ked./I1A007040


    Tetanus Complications
    • Laryngospasm
    • Fractures
    • Hypertension and/or abnormal heart rhythm
    • Nosocomial infections
    • Pulmonary embolism
    • Aspiration pneumonia
    • Death
    Terimakasih

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