「Tetanus」の版間の差分

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==treatment==
 
==treatment==
 
*tetanus immunoglobulin 500 - 1000 IU intramuscular
 
*tetanus immunoglobulin 500 - 1000 IU intramuscular
 +
**only once is needed, to neutralize residual toxins
 
*penicillin or metronidazole
 
*penicillin or metronidazole
 
*spasm management
 
*spasm management
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**muscle relaxants
 
**muscle relaxants
 
*tracheostomy and respiratory support
 
*tracheostomy and respiratory support
 +
**just to wait washing out of toxin effects
 +
 +
*death occurs due to:
 +
**secondary infection by long-term ventilator support
 +
**overwhelming autonomic instability, i.e., cardiovascular death
  
 
==prevention==
 
==prevention==
 
*wound debridement is crucial
 
*wound debridement is crucial
 
**''C. tetani'' is anaerobe which grows in closed wound area
 
**''C. tetani'' is anaerobe which grows in closed wound area

2021年6月7日 (月) 17:36時点における最新版

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pathogen

  • Clostridium tetani
  • gram positive terminal round shape (drumstick like) bacilli
  • spore-forming
    • drumstick looking is from spore
    • means long term sustainability in soil
  • strict anaerobe
  • incubation 3-21 days (average 10 days)
  • AB toxin
    • blockade of releasing GABA in synapus
    • convulsive contraction of voluntary muscles
    • toxin binding is irreversible

epidmiology

clinical picture

  • opisthotonus
    • muscle spasm in opisthotonus is very painful
  • trismus (lockjaw)
    • difficulty opening mouth
  • respiratory difficulties
  • cardiovascular instability
    • sympathetic nervous system
    • drastic rise and fall of blood pressure
  • localized (not generalized) tetanus also may occur
  • increased muscle tones lasts more than 2 months
  • muscle spasm emerges after increased muscle tones and lasts > 1 month
    • needs long term ventilator support

diagnosis

  • culture
    • difficult and tricky
  • PCR - toxin gene

treatment

  • tetanus immunoglobulin 500 - 1000 IU intramuscular
    • only once is needed, to neutralize residual toxins
  • penicillin or metronidazole
  • spasm management
    • diazepam, midazolam, paraldehyde
    • sedatives
    • muscle relaxants
  • tracheostomy and respiratory support
    • just to wait washing out of toxin effects
  • death occurs due to:
    • secondary infection by long-term ventilator support
    • overwhelming autonomic instability, i.e., cardiovascular death

prevention

  • wound debridement is crucial
    • C. tetani is anaerobe which grows in closed wound area