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TETANUS

Anumillah Arini Zidna


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

Diagnosis Banding
Meningitis
Encephalitis
Rabies
Inflamasi abdomen akut (rigid abdomen)

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