Textbook Reading

TETANUS

Oleh :
INDIRA WAHYU SUKMA S (21804101040)

Pembimbing :
dr. Nurike Setiyari Mudjari, Sp.PD
PENDAHULUAN
 Latar Belakang

mortalitas tetanus melebihi 50%

Dicegah dengan imunisasi
dengan perkiraan jumlah
booster
kematian 800.000-1.000.000
orang per tahun
masalah kesehatan
Tetanus merupakan masyarakat signifikan
penyakit infeksi akut pada negara
akibat eksotoksin berkembang termasuk
spesifik kuman anaerob Indonesia
Clostridium tetani
TINJAUAN PUSTAKA
 Definisi & Etiologi

• Definisi
Tetanus merupakan penyakit akut, yang ditandai dengan gejala spasme otot tubuh dan
gangguan sistem syaraf otonom (gangguan neuromuscular akut berupa trismus, kekakuan, dan
kejang otot).

• Etiologi
Disebabkan oleh eksotoksin yang diproduksi oleh bakteri Clostridium tetani.
Produksi dua eksotoksin yaitu tetanolysin (belum diketahui) dan tetanospasmin (menyebabkan
efek klinis)
 Clostridium tetani

• bersifat anaerob murni.

• Gram positif

• Spora C.tetani dapat bertahan sampai bertahun-tahun bila

tidak kena sinar matahari.

• Spora ini terdapat di tanah atau debu, tahan terhadap

antiseptik, pemanasan 100˚C, dan bahkan pada otoklaf
120˚C selama 15-20 menit

Gambar 2.1 Clostridium tetani, dengan
bentukan khas “drumstick” pada bagian
bakteri yang berbentuk bulat tersebut spora
dari Clostridium tetani dibentuk. (dengan
pembesaran mikroskop 3000x).
• Perkiraan dosis tetanospasmin mematikan manusia
minimum adalah 2,5 nanogram per kilogram berat badan
manusia
• Tetanospasmin adalah rantai polipeptida tunggal yang
terbelah menjadi dua, rantai berat : memediasi
pengikatannya dengan reseptor sel saraf dan masuknya
ke dalam sel dan rantai ringan : memblokade pelepasan
neurotransmitter.
 Otitis media
PATOFISIOLOGI dan karies
Umbilicus :
pada bayi
gigi

spora C. tetani yang

Port d’entre pada 60%
pasein tetanus terdapat
didaerah kaki, terutama
pada luka tusuk
Berbagai jenis Luka
gangguan pada pernafasan,
metabolisme, hemodinamika, Saraf otonom
hormonal, saluran cerna, saluran
kemih
Eksitasi terus-menerus
dan spasme  tempat
luka atau otot masseter
(trismus) atau cerebri
(kejang umum spontan)
ada didalam feses
binatang atau berada di
tanah masuk kedalam
tubuh manusia melalui
luka anaerob (pada
jaringan yang mati)
maka spora akan
berkembang menjadi
bakteri C. tetani
Masuk ke aliran darah
dan menghambat
kemudian berkembang
pengeluaran biak dan memproduksi
neurotransmitter
toksin
inhibisi; GABA dan spesifik(tetanospasmin)
glisin
 Manifestasi Klinis

Masa inkubasi tetanus umumnya antara 3-21 hari, dan umumnya terjadi dalam 8 hari.
Masa inkubasi yang lebih pendek terkait dengan kemungkinan kematian yang lebih tinggi

Berdasarkan Gambaran klinis, tetanus terbagi atas 3 :

1. Tetanus lokal :
• kontraksi otot yang terus-menerus di daerah anatomis yang sama dengan cedera
• Kontraksi ini dapat bertahan selama beberapa minggu dan secara bertahap mereda

2. Tetanus cephalic :
• luka mengenai daerah mata, kulit kepala, muka, telinga, otitis media kronis dan jarang
akibat tonsilektomi
• disfungsi saraf kranial antara lain n. III, IV, VII, IX, X, XI dan menyebabkan gangguan
motorik dari serabut saraf tersebut
 Manifestasi Klinis
3. Tetanus Umum
• Gejala yang pertama terlihat dan dirasakan
• Kejang  lengan fleksi dan adduksi serta
pasien adalah kaku otot masseter yang
tangan mengepal kuat
mengakibatkan gangguan membuka mulut
• Kesadaran tetap baik
(trismus)  lock jaw
• Retensi urine sering terjadi karena spasme
• Risus sardonikus (alis tertarik ke atas, sudut
sfincter kandung kemih.
mulut tertarik ke luar dan ke bawah, bibir
• Tidak ada kenaikan suhu  jika ada curigai
tertekan kuat pada gigi)
komplikasi ke pusat pengatur suhu
• Kekakuan leher : sulit fleksi pada leher dan
• Kasus berat : mudah terjadi overaktivitas
tubuh  gejala kaku kuduk hingga
simpatis (takikardi, hipertensi yang labil,
opisthotonus
banyak berkeringat, dan aritmia)
• Kesulitan menelan akibat spasme otot laring
• Spasme dapat berlangsung selama beberapa
dan otot pernapasan
menit, spasme berlanjut 3-4 minggu
• Kekakuan otot perut
 Manifestasi Klinis

4. Tetanus Neonatal
• Kehilangan kemampuan normal menyusu dan menangis antara hari ke-3 sampai hari
ke-28 serta menjadi kaku dan spasme.
• Ditandai dengan kelemahan dan ketidakmampuan untuk menyusu
• Kadang opistotonus
Penegakan Diagnosa
Murni Diagnosis Klinis :
 Riwayat penyakit
 Temuan pemeriksaan fisik uji spatula : (+) jika
menggigit spatula, (-) jika refleks muntah
 Riwayat imunisasi

Menurut WHO :
 trismus atau
 risus sardonicus atau
 spasme otot yang nyeri dan didahului riwayat luka

Pemeriksaan darah & CSF  normal

Kultur C.tetani dari luka sulit (30% positif) dan hasil
positif hanya mendukung diagnosa dan bukan
mengkonfirmasi
1. Vaksinasi atau imunisasi tetanus
2. Penanganan luka dengan baik, pada luka-luka yang kotor dan berisiko timbulnya tetanus maka
pemberian human tetanus immunoglobulin (HTIG) diperlukan dengan dosis 250 IU secara IM
3. Bila luka terkontaminasi tanah atau kotoran hewan yang sulit dibersihkan dosis HTIG bisa
dinaikkan menjadi 500 IU dan 4 minggu kemudian bisa diulang 500 IU bila luka belum sembuh
4. Indika pemberian antitetanus serum atau toksoid
Imunisasi sebelumnya Luka Bersih Luka Kotor
Toksoid ATS Toksoid ATS

Tidak ada/tidak pasti Ya* Tidak Ya* Ya

1 x DT atau DTP Ya* Tidak Ya* Ya
2 x DT atau DTP Ya* Tidak Ya* Ya
3 x DT/DTP atau lebih Tidak + Tidak Tidak ++ Tidak

* : Seri imunisasinya harus dilengkapi

+ : kecuali booster terakhir sudah 10 tahun yang lalu atau lebih
++ : kecuali booster terakhir sudah 5 tahun yang lalu atau lebih
Cara pemberian melalui intramuskular (ATS 1.500 IU/ Imunoglobulin 250 IU)
DT : vaksinasi difteri-tetanus
DTP : vaksinasi difteri- tetanus- pertusis
 1. Antibiotik pilihan untuk bakteri ini adalah
metronidazole dosis 500 mg iv setiap 6 jam
diberikan selama 7 hari  mencegah
pengeluaran toksin
2. ATS 10.000-20.000 U selama 5 hari atau HTIG

Tatalaksana (human tetanus imunoglobulin) 3000-6000 IU

single dose (3,5-4,5 minggu) menetralisir
toksin yg belum berikatan dengan sel saraf
3. Benzodiazepin (ringan sampai moderat) atau
diazepam (berat) dengan dosis 0,1-0,3
mg/kgBB/kali setiap 2-4 jam hingga 200
mg/hari
4. Propofol dan midazolam untuk sedasi dan
relaksasi otot (tambahan)
01 UMUM 5. Semua penderita tetanus memerlukan
pemberian tetanus toxoid mencegah
rekurens

1. Merawat dan membersihkan luka sebaik-baiknya

2.Diet cukup kalori dan protein, bentuk makanan
KHUSUS 02
tergantung kemampuan membuka mulut dan
menelan. Bila ada trismus, makanan dapat
diberikan personde atau parenteral
3. Isolasi untuk menghindari rangsang luar seperti
suara, cahaya dan tindakan terhadap penderita
4. Oksigen
5. Mengatur keseimbangan cairan dan elektrolit
 KOMPLIKASI
Hipertensi dan atau
abnormalitas ritme
jantung
Larigospasme Hiperaktivasi dari sistem saraf Infeksi nosokomial
otonom
Spasme dari pita suara atau Lama di Rumah Sakit
otot pernafasan

Infeksi Sekunder termasuk

sepsis
Fraktur
Akibat kateter, hospital acquired
Kontraksi dan kejang pneumonia, ulkus dekubitus

Pneumonia aspirasi Kematian

Ditemukan pada 50%-70%
kasus pada tetanus sebagai
common late complication
 Prognosis
Sistem penilaian tetanus, klasifikasi menurut : cole dan spooner, dakar score, Ablett skor, severity
score dan Philips skor You can simply impress your audience and
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1. Klasifikasi Prognostik Cole-Spooner. 2. Dakar scorePresentations. Easy to change colors,
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III Tidak diketahui Tidak diketahui

Berdasarkan tabel di atas dapat ditentukan

bahwa angka kematian pasien termasuk dalam
kelompok prognostik I lebih tinggi daripada
kelompok II dan III

Interpretasi :
0-1 : severitas ringan, mortalitas 10 %
2-3 : severitas sedang, mortalitas 10-20 %
4 : severitas berat, mortalitas 20-40 %
5-6 : severitas sangat berat, mortalitas >50 %
3. Ablett score 3. Philips score

Phillips score <9, severitas ringan;

9-18, severitas sedang; dan >18, severitas berat
3. Tetanus Severity Score (TTS)

Total Score TSS ada 2:

1. ≥8  resiko tinggi
2. <8 resiko rendah

TSS memiliki sensitivitas 77% dan spesifisitas 82% 

lebih unggul dibanding Dakar score dan Philip score
karena menggunakan metode statistik yang lebih baik
KESIMPULAN
Tetanus merupakan penyakit akut, yang ditandai dengan gejala spasme otot tubuh
dan gangguan sistem syaraf otonom. Penyakit ini disebabkan oleh eksotoksin yang
diproduksi oleh bakteri Clostridium tetani

Gejala klinisnya berupa trismus, kaku leher, epistotonus, risus sardonicus, perut kaku
seperti papan, dan apnea secara periodik atau obsruksi saluran nafas atas oleh
karena kontraksi otot-otot pernapasan

Pencegahannya dapat diberikan vaksinasi atau imunisasi tetanus serta penanganan

luka dengan baik, pada luka-luka yang kotor dan berisiko timbulnya tetanus maka
pemberian human tetanus immunoglobulin (HTIG). Prognosisnya tergantung dari
faktor resiko dan penanganannya
 Penegakan Diagnosis

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Riwayat penyaki
Diagnosis
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add a unique zing and appeal to your Presentations.

Contents Title
Contents Title
You can simply impress your audience
and add a unique zing and appeal to your
Presentations.

You can simply impress your audience

and add a unique zing and appeal to your Contents Title
Presentations.
You can simply impress your audience
and add a unique zing and appeal to
your Presentations.

Contents Title You can simply impress your audience

and add a unique zing and appeal to
your Presentations.
One Columns
Columns You can simply impress your audience and add a unique zing and appeal to
Infographic your Presentations. I hope and I believe that this Template will your Time,
Simple Money and Reputation. You can simply impress your audience and add a
Portfolio unique zing and appeal to your Presentations. Easy to change colors,
photos and Text.
Designed

You can simply impress your audience and add a unique zing and appeal to your
Presentations. Easy to change colors, photos and Text. I hope and I believe that this
Template will your Time, Money and Reputation. You can simply impress your audience
and add a unique zing and appeal to your Presentations. Easy to change colors, photos
and Text. You can simply impress your audience and add a unique zing and appeal to
your Presentations. Easy to change colors, photos and Text. I hope and I believe that this
Template will your Time, Money and Reputation.

I hope and I believe that this Template will your Time, Money and Reputation. Easy to
change colors, photos and Text. You can simply impress your audience and add a unique
zing and appeal to your Presentations.

You can simply impress your audience and add a unique zing and appeal to your
Presentations. Easy to change colors, photos and Text.
 Two Columns
You can simply impress your audience
and add a unique zing and appeal to
your Presentations. I hope and I believe
that this Template will your Time, Money
and Reputation. Easy to change colors,
photos and Text. Get a modern
PowerPoint Presentation that is
beautifully designed. You can simply
impress your audience and add a unique
zing and appeal to your Presentations.
Easy to change colors, photos and Text.
You can simply impress your audience
and add a unique zing and appeal to
your Presentations. I hope and I believe
that this Template will your Time, Money
and Reputation. Easy to change colors,
photos and Text. Get a modern
PowerPoint Presentation that is
beautifully designed. You can simply
impress your audience and add a unique
zing and appeal to your Presentations.
Easy to change colors, photos and Text.

Get a modern PowerPoint Presentation Get a modern PowerPoint Presentation

that is beautifully designed. that is beautifully designed.

You can simply impress your audience and add a unique zing and appeal to
Columns
your Presentations. I hope and I believe that this Template will your Time, Infographic
Money and Reputation. You can simply impress your audience and add a Simple
unique zing and appeal to your Presentations. Easy to change colors, Portfolio
photos and Text.
Designed
 Thank You
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Fully Editable Shapes
 Fully Editable Icon Sets: A
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

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 Fully Editable Icon Sets: B
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com
 Fully Editable Icon Sets: C
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com