TETANUS

O Rizky Putri Sabilla Yahya 6130014005

O Devi Afiana Putri 6130014010
O Elsa Kusumawati 6130014015
O Aanisah Ikbaar Sayyidah 6130014020
O Aisyah Imas Setiawati 6130014025
O Dana Madya Puspita 6130014030
O Anastastiastuti Anissa 6130014035
O Fithrotun Nisak 6130014040
O Aldania Fajrin 6130014045
O Nurlidya Rizki Latifah 6130014050
 Scenario
A man already 3 days is treated in ICU RSIJS due to
spasms throughout the body. A man should be
intubated and injected with anti-seizure medication.
These seizures arise if there is a noise. His wife told that
2 weeks earlier, A man exposed spikes while working
devoted and treated with herbs to treat wounds. The
wound did not heal, even coupled with convulsions with
difficulty breathing. The mouth becomes stiff, difficult to
open and difficult to eat, although. A man is still
conscious.
 Keywords
1. Full body seizure
2. Seizure with arises noises
3. 2 weeks ago exposed nails
4. Consume herbal medicine
5. Breathing difficulties
6. Trismus
7. Conscious
 A man

Hospital

History (now): History (past):

looks toxic, History of spikes, wound cross
tetanus, trismus incision right foot

seizure hypocalsemia, DD epileptic, meningitis,

tetanus distonia
Opistotonus next examination Meningeal Sign (+)

Dx: Tetanus

management

Complication and prognose

Hypothesis
Patients on the scenario suspected of tetanus
LEARNING OBJECTIVE
O 1. Diagnose and Differential Diagnose
O 2. Etiology
O 3. Clinical Manifestation
O 4. Patofisiology
O 5. Treatment
O 6. Complication and Prognose
O 7. Examination of Meningeal Sign
O 8. Supporting Examination of Tetanus
 1. Diagnose and Differential Diagnose
Disease Clinical Manfestation
Tetanus Seizures Tetanic, Trismus, Dysphagia, Risus
Sardonicus, A history of forgotten injuries

Meningoencephalitis Fever, No Trismus, Sensorium depression,

abnormal CSF

Rabies There is a history of animal bites, no trismus,

only oropharyngeal spasm

Polio No Trismus, Paralize flaccid type, abnormal

CSF

Peritonitis Trismus or spasm of the whole body does not

exist

Status Epilepticus Sensorium Depression

Hemorrhage No trismus, Sensorium Depression
 2. Etiology

O Tetanus is caused by gram-positive bacteria;

Cloastridium tetani This bacterium berspora, found in
animal feces, especially horses, can also be on humans
and also on soil contaminated with animal feces. This
spore can last several months or even years, if it infects
a person's wounds or along with other meat or bacterial
objects, it enters the body of the sufferer, then releases
a toxin called tetanospasmin (Hamid, 1985).
O In underdeveloped countries, tetanus is common in
neonates, bacteria enter through the umbilical cord
during poor labor, this tetanus is known as tetanus
neonatorum (Hamid, 1985).
 3. Clinical Manifestation

Incubation period:
1. In non-neonatal tetanus varies between 3 and
21 days after infection.
2. In neonatal tetanus, symptoms usually present
3 to 14 days, averaging 7 days, after birth in
90% of cases.
3. Characteristic features of the disease are
muscular spasms.
4. Ricus Sardonikus, trismus, opistotonus
5. Hipertoni
4. Patofisiology
 5. Management
O A. GENERAL
The purpose of this therapy is to eliminate tetani bacteria, neutralize circulation
of toxins, prevent muscle spasms and provide relief to recovery.
O B. Drugs
O B.1. Antibiotics:
Given parenteral Peniciline 1.2 million units / day for 10 days, IM. While tetanus
in children can be given Peniciline dose 50.000 Units / KgBW / 12 hours IM is
given for 7-10 days.
O B.2. Antitoxin
Antitoxin can be used Human Tetanus Immunoglobulin (TIG) with a dose of 3000-
6000 U, one-time administration, IM should not be given intravenously
O B.3.Tetanus Toksoid
The provision of the first Tetanus Toxoid (TT) is performed simultaneously with the
administration of antitoxin but on the different side with different syringes.
O B.4. Anticonvulsants
The main cause of death in tetanus neonatorum is a severe clonic seizure,
muscular and laryngeal spasm and its complications. With the use of sedation
drugs / muscle relaxans (diazepam), it is expected that the seizures can be
overcome
 6. Complication and Prognose

Complication : Prognose :
O Laryngospasm The prognosis is depend upon the
O Hypertension Severity Of The Disease
O Nosocomial infection Age Of The Patient
O Pulmonary embolism Facilities for the intensive care
O Aspiration pneumonia The high mortality is in neonatal
tetanus
O Death
Over 60% mortality is lowest
between 10 – 20 years age
group (I.e.less than 20%)
 7. Examination of Meningeal Sign

O Nuchal rigidity
O Lasegue sign
O Kernig sign
O Brudzinski I (Brudzinski’s
neck sign)
O Brudzinski II
(Brudzinski’s
contralateral leg sign)
 8. Supporting Examination of Tetanus

O Laboratory examination
O Blood tests: normal / increased
O Cerebrospinal fluid examination: normal /
elevated
O Microbiological examination
O Pus culture: C. tetani
O Radiological Examination
O Ultrasound / CT scan / MRI: normal
O Other Checks
O EEG when seizure: abnormalLaboratory
examination