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    Case Presentation Tetanus

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    ukhtianita
    A 23-month old female presented with inability to open her mouth and difficulty walking and eating for the past 5 days. On examination, she had trismus and spasms. Differential diagnoses included tetanus. She was given anti-tetanus serum, diazepam, and penicillin. Tetanus is caused by Clostridium tetani spores entering through wounds. It causes muscle spasms by inhibiting inhibitory neurons in the spinal cord and brain. Prognosis depends on severity of symptoms, with mild cases having less than 10% mortality. Prevention includes routine childhood vaccinations and booster shots.

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    Case Presentation Tetanus

    Uploaded by

    ukhtianita
    481 views15 pages
    A 23-month old female presented with inability to open her mouth and difficulty walking and eating for the past 5 days. On examination, she had trismus and spasms. Differential diagnoses included tetanus. She was given anti-tetanus serum, diazepam, and penicillin. Tetanus is caused by Clostridium tetani spores entering through wounds. It causes muscle spasms by inhibiting inhibitory neurons in the spinal cord and brain. Prognosis depends on severity of symptoms, with mild cases having less than 10% mortality. Prevention includes routine childhood vaccinations and booster shots.

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    presented by ella de vries

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    A 23-month old female presented with inability to open her mouth and difficulty walking and eating for the past 5 days. On examination, she had trismus and spasms. Differential diagnoses included tetanus. She was given anti-tetanus serum, diazepam, and penicillin. Tetanus is caused by Clostridium tetani spores entering through wounds. It causes muscle spasms by inhibiting inhibitory neurons in the spinal cord and brain. Prognosis depends on severity of symptoms, with mild cases having less than 10% mortality. Prevention includes routine childhood vaccinations and booster shots.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    481 views15 pages

    Case Presentation Tetanus

    Uploaded by

    ukhtianita
    A 23-month old female presented with inability to open her mouth and difficulty walking and eating for the past 5 days. On examination, she had trismus and spasms. Differential diagnoses included tetanus. She was given anti-tetanus serum, diazepam, and penicillin. Tetanus is caused by Clostridium tetani spores entering through wounds. It causes muscle spasms by inhibiting inhibitory neurons in the spinal cord and brain. Prognosis depends on severity of symptoms, with mild cases having less than 10% mortality. Prevention includes routine childhood vaccinations and booster shots.

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    Case Presentation

    Tetanus
    Ella de Vries

    Identification
    Name: Cinta Age: 23 months Gender: female

    History
    Chief complaint: Inability to open mouth History of present illness: 5 days before arrival in the hospital, patient started having difficulty opening mouth, difficulty walking, eating. History of past illness: none Pregnancy and delivery: normal Development: normal Immunization: complete History of family illness: none

    Physical examination on admission


    General Full consciousness, responding Temp: 36.7 C pulse 120 bpm Resp. rate: 28/min 82 cm, 10 kg
    BW/age: 0--1 Length/age: 0--1 BW/length: 0--1

    Physical Examination on Admission


    Specific Head: nasal flare -, anemia -, ict. , trismus + Thorax: symmetric, retraction Pulm: vesicular, wheezing -, rhonchi + Cor: normal S1S2, murmur -, gallop Abdomen: flat, no visible masses, bowel sounds heard, variable tympanic, soft, no liver/spleen palpable Extremity: warm, crt < 2 sec

    Neurological examination
    Right arm Movements Strength Tonus Klonus Fysiological reflexes Good 5/5 Eutonic + Normal Left arm Good 5/5 Eutonic + Normal Right leg Good 5/5 Eutonic + Normal Left leg Good 5/5 Eutonic + Normal

    Differential Diagnosis
    Tetanus (generalized) Mandible dislocation Peritonsillar abces Meningitis Encephalitis

    Management
    CBC 20.000 IU anti tetanus serum Diazepam Penicillin procain Good prognosis

    Tetanus
    C. tetani (anaerobic, gram-positive) Spore survive heat, dessication, disenfectants Anearobic spores germinate tetanolysin + tetanospasmin enters motorneuron travels to spinal cord enters central inhibitory neurons cleaves synaptobrevin that binds neurotransmittervesicles to cell membrane GABA and glycine vesicles are not releases loss of inhibitory function

    Etiology
    Wound (65%) Skin ulcer (5%) No obvious source Complication of abcess, burns, frostbite, otitis media, surgery, abortion, childbirth, IV or subcutaneous drug use, foreign bodies, corneal abrasions

    Signs and symptoms


    Trismus (75%), risus sardonic Dysphagia Stiffness Neck rigidity Head ache Restlessness Reflex spasms (noise, light, touch) Elevated temperature (no fever) Sweating Elevated blood pressure Rapid heart rate Severe: opisthotonus, flexion arms, extension legs Autonomic dysfunction Seizures with consciousness

    Spatula test
    Stimulate posterior pharyngeal wall with spatula Normal: gag reflex, try to expell spatula Pathological for tetanus: bite down on spatula Sensitivity 94% Specificity 100%

    Treatment
    Neutralization unbound toxin
    Tetanus immune globulin 3000-6000 units Anti tetanus serum

    Wound debrided Antibiotics


    Penicillin, antagonist of GABA Metronidazole 0,5 mg 4dd clindamycine, erythromycin, tetracycline, vancomycin

    Tetanus toxoid-containing vaccin Benzodiazepine for symptoms


    Diazepam 10-40 mg 1-8 hrly: reduces anxiety, sedates, relaxes muscles, prevents spasms

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    Prognosis
    Incubation period < 7 days Onset <48 hours Acquired from burns, surgical wounds, compound fractures, septic abortion, umbilical stump, IM injection Narcotic addiction Generalized tetanus Temperature > 40 C Tachycardia > 120 bpm

    0-1 = mild tetanus mortality <10% 2-3 = moderate tetanus mortality 10-20% 4 = severe tetanus mortality 20-40% 5 -6 = severe tetanus mortality >50%

    Prevention
    Vaccination (DTP)
    3x infancy

    TT booster
    4-7 years 12-15 years 20-23 years

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