111 0211 066 Definisi Gangguan neurologis yang ditandai dengan meningkatnya tonus otot dan spasme, yang disebabkan tetanospasmin
Etiologi: Identifikasi Be: batang, oval, spt raket tenis atau paha ayam S: tunggal Wa: ungu Si: Gram positif M: pewarnaan Gram Etiologi Bersifat anaerob obligat, motil, dan menghasilkan spora Habitat: tanah, kotoran hewan Bakteri sangat sensitif terhadap panas, tidak tahan pada lingkungan aerob Spora resisten terhadap panas Menghasilkan eksotoksin tetanospasmin, yg merupakan salah satu toksin paling kuat. Lethal dose: 10 -5 mg/kg Transmisi: luka akut, luka kronis, luka yang terkontaminasi Epidemiologi Negara beriklim tropis dan negara berkembang Daerah pertanian, pedesaan Insiden puncak pada musim panas dan musim hujan Pria > wanita Resiko >> pada usia tua Klasifikasi Berdasarkan derajat keparahannya Derajat I (ringan) Derajat II (sedang) Derajat III (berat) Derajat IV (sangat berat) Berdasarkan manifestasi klinisnya Tetanus generalisata Tetanus lokal Tetanus cephalica Tetanus neonatorum Manifestasi Klinis Tetanus generalisata Trias klinis: rigiditas, spasme otot, disfungsi otonom (berat) Gambaran khas tetanic seizure: characterized by sudden, severe tonic contractions of the muscles, with fist clenching, flexion, and adduction of the arms and hyperextension of the legs Tetanus lokal Tetanus cephalica Tetanus neonatorum
Perjalanan Klinis Masa inkubasi: 3-21 hari, rata-rata 7-8 hari Onset: 1-7 hari Disfungsi otonom terjadi beberapa hari setelah timbulnya spasme otot, dapat bertahan sampai 1-2 minggu Spasme dapat bertahan 3-4 minggu Pemulihan butuh berbulan-bulan Tetanus Neonatorum Epidemiologi: kills approximately 500,000 infants each year, with about 80% of deaths in just 12 tropical Asian and African countries Manifestasi Klinis: manifests within 314 days of birth progressive difficulty in feeding (sucking and swallowing), associated hunger, and crying Stiffness and rigidity to the touch, and spasms, trimus, with or without opisthotonos, are characteristic umbilical stump may hold remnants of dirt Prognosis: 90% meninggal, jika bertahan: retardasi mental
Derajat Keparahan Derajat I (ringan) Derajat II (sedang) Derajat III (berat) Derajat IV (sangat berat) Diagnosis Berdasarkan gambaran klinis Lab: leukositosis, CSF normal EMG
Penatalaksanaan Goals of therapy are: to eliminate the source of toxin, neutralize unbound toxin, and prevent muscle spasms monitoring General treatment: monitoring the patients condition observation and cardiopulmonary monitoring protection of airway wound management Penatalaksanaan Antibiotic therapy: First line Metronidazole (10-14 days): Adult dose: 500 mg PO/6h or 1g IV/12h, max 4g/d; Pediatric dose: 15-30 mg/Kg/d IV divided dose 2- 3x/d, max 2g/d Penicillin G (10-14 days): Adult dose: 10-24 million U/d IV divided in 4 doses; Pediatric dose: 100.000- 250.000 U/Kg/d IV/IM divided in 4 doses Penatalaksanaan Antitoxin: Human Tetanus Immunoglobulin (TIG) should be given promptly. Dose: 3000 to 6000 U IM, in divided dose (@ 500 U). Control of muscle spasm: Diazepam Adult dose: Mild spasm: 5-10 mg PO/ 4-6h Moderate spasm: 5-10 mg IV Severe spasm: 50-100 mg in 500ml D5, IV 40mg/h Pediatric dose: Mild spasm: 0,1-0,8 mg/Kg/d, in 3-4 divided doses Moderate-severe spasm: 0,1-0,3 mg/Kg/d IV every 4-8h Penatalaksanaan Respiratory Care: Intubation or tracheostomy, with or without mechanical ventilation
Komplikasi Jalan nafas: aspirasi, laringospasme/obstruksi Respirasi: apnea, hipoksia, gagal napas, komplikasi bantuan ventilasi berkepanjangan, komplikasi trakeostomi CVS: takikardia, hipertensi, hipotensi, bradikardia Ginjal: gagal ginjal Prognosis
Pencegahan Active Immunization All partially immunized and unimmunized adults should receive vaccine, as should those recovering from tetanus. For adults consists of three doses: the first and second doses are given 4 to 8 weeks apart, and the third dose is given 6 to 12 months after the second. A booster dose is required every 10 years and may be given at mid-decade ages35, 45, and so on. Adsorbed vaccine is preferred because it produces more persistent antibody titers than fluid vaccine. Pencegahan Wound Management Proper wound management requires consideration of the need for : passive immunization with TIG, dose: 250 U IM active immunization with vaccine, preferably Td in persons over age 7 Neonatal Tetanus maternal vaccination, even during pregnancy; efforts to increase the proportion of births that take place in the hospital; and the provision of training for nonmedical birth attendants
