TETANUS

Question 1

• acute disease manifested by skeletal muscle spasm and autonomic nervous system disturbance
• caused by a powerful neurotoxin produced by the bacterium Clostridium tetani and is completely preventable by vaccination

Answer 1

Tetanus

Question 2

“an illness occurring in a child who has the normal ability to suck and cry in the first 2 days of life but who loses this ability between days 3 and 28 of life and becomes rigid and has spasms .”

Answer 2

Neonatal tetanus

Question 3

tetanus occurring during pregnancy or within 6 weeks after the conclusion of pregnancy (whether with birth, miscarriage, or abortion)

Answer 3

Maternal tetanus

Question 4

• anaerobic, gram-positive, spore-forming rod spores are highly resilient and can survive readily in the environment throughout the world
• Spores resist boiling and many disinfectants
• Very low concentrations of this highly potent toxin can result in tetanus (minimal lethal human dose, 2.5 ng/kg)

Answer 4

C. tetani

Question 5

• Tetanus is a rare disease in the _____
• Most cases occur in _____
• Persons ___ years of age are at greater risk of tetanus because antibody levels decrease over time
• People who inject ____ 15% of all cases (2001-2008)

Answer 5

• developed world
• incompletely vaccinated or unvaccinated individuals
• > 60
• drugs

Question 6

• is intra-axonally transported to motor nuclei of the cranial nerves or ventral horns of the spinal cord.
• This toxin is produced as a single 150-kDa protein that is cleaved to produce heavy (100-kDa) and light (50-kDa) chains linked by a disulfide bond and noncovalent forces.

Answer 6

Tetanus toxin

Question 7

The clinical manifestations of tetanus occur only after tetanus toxin has reached

Answer 7

presynaptic inhibitory nerves

Question 8

If the cranial nerves are involved in localized cephalic tetanus, the ____ may spasm, with consequent aspiration or airway obstruction, and the prognosis may be poor.

Answer 8

pharyngeal or laryngeal muscles

Question 9

ALGORITHM FOR CLINICAL AND PATHOLOGIC PROGRESSION OF TETANUS

• Before 7-10 days

Answer 9

No symptoms

Question 10

ALGORITHM FOR CLINICAL AND PATHOLOGIC PROGRESSION OF TETANUS

• 7-10 days

Answer 10

• muscle aches,
• trismus,
• myalgia

Question 11

ALGORITHM FOR CLINICAL AND PATHOLOGIC PROGRESSION OF TETANUS

• 24-72 hrs ?? (days?)

Answer 11

• Muscle spasm: local and generalized
• CArdiovascular instability: labile BP, tachy- or bradycardia
• Pyrexia, increased respiratory and GI secretions

Question 12

ALGORITHM FOR CLINICAL AND PATHOLOGIC PROGRESSION OF TETANUS

• 4-6 weeks

Answer 12

• Cessation of spasms, restoration of normal muscle tone

- CArdiovascular and autonomic control

Question 13

measured in a sample taken before the administration
of antitoxin or immunoglobulin; levels >0.1 U/mL (measured by standard ELISA) are deemed protective and
do not support the diagnosis of tetanus

Answer 13

Serum anti-tetanus immunoglobulin G

Question 14

used for detection of tetanus toxin, but its sensitivity is unknown.

Answer 14

Polymerase chain reaction

Question 15

If possible, the entry wound should be ________ in order to remove anaerobic foci of infection and prevent further toxin production.

Answer 15

• identified,
• cleaned, and
• debrided of necrotic material

Question 16

preferred for antibiotic therapy for tetanus

Answer 16

Metronidazole

Question 17

Alternative drug although this drug theoretically may exacerbate spasms and in one study was associated with increased mortality.

Answer 17

penicillin

Question 18

Two preparation of antitoxin

Answer 18

• human tetanus immune globulin (TIG) 2

- equine antitoxin.

Question 19

is the preparation of choice, as it is less likely to be associated nate with anaphylactoid reactions. A single IM dose (3000-5000 IU) is given, with a portion injected around the wound.

Answer 19

tetanus immune globulin (TIG)

Question 20

available widely and is used in low-income countries; after hypersensitivity testing, 10,000-20,000 U is administered IM as a single dose or as divided doses.

Answer 20

Equine-derived antitoxin

Question 21

Spasms are controlled by heavy sedation with

Answer 21

benzodiazepines.

Question 22

used as a muscle relaxant.

Answer 22

IV magnesium sulfate

Question 23

are commonly used worldwide tx for tetanus

Answer 23

Chlorpromazine and phenobarbital

Question 24

patients should be nursed in _____ because light and noise can trigger spasms.

Answer 24

calm, quiet environments

Question 25

_____are increased in tetanus, and ____ due to pharyngeal involvement combined with hyperactivity of laryngeal muscles makes endotracheal intubation difficult.

Answer 25

- Tracheal secretions | - dysphagia

Question 26

is the usual method of securing the airway in severe tetanus.

Answer 26

tracheostomy

Question 27

Cardiovascular stability is improved by increasing sedation with ____ (plasma concentration, 2-4 mmol/L or titrated against disappearance of the patella reflex),

Answer 27

- lV magnesium sulfate - morphine, - fentanyl, - or other sedatives.

Question 28

drugs that allow rapid titration are preferred

Answer 28

Short-acting drugs

Question 29

Complications arising from treatment are common and include:

Answer 29

- thrombophlebitis associated with diazepam injection - ventilator associated pneumonia - central-line infections, - septicemia.

Question 30

Recovery from tetanus may take

Answer 30

4-6 weeks

Question 31

Factors Associated with a Poor Prognosis in Adult Tetanus

Answer 31

- Age >70 years - Incubation period <7 days - Short time from first symptom to admission - Puerperal, IV, postsurgery, burn entry site - Period of onset <48 h - Heart rate >140 beats/min - Systolic blood pressure >140 mmHg - Severe disease or spasms - Temp >38.5C

Question 32

Factors Associated with a Poor Prognosis in Neonatal Tetanus

Answer 32

- Younger age, premature birth - Incubation period <6 days - Delay in hospital admission - Grass used to cut cord - Low birth weight - Fever on admission

Question 33

The WHO guidelines for tetanus vaccination consist of a | primary course of ____ doses in infancy, boosters at ____ years of age, and ____ booster in adulthood.

Answer 33

- three - 4- 7 and 12-15 - one

Question 34

“Catch-up” schedules recommend a ___ primary course with 4 weeks between doses, followed by two boosters 6 months apart.

Answer 34

three-dose

Question 35

For persons who have received a complete primary course in childhood but no further boosters, ____ doses at least 4 weeks apart are recommended.

Answer 35

two

Question 36

Tetanus Vaccines fpr young children - 2, 4 and 6 months - 15 through 18 months - 4 though 6 yrs

Answer 36

DTaP

Question 37

Tetanus Vaccine for preteens | - 11 through 12 yrs

Answer 37

Tdap

Question 38

Tetanus Vaccine for adults - every 10 yrs

Answer 38

Td or Tdap

Question 39

Standard WHO recommendations for prevention of maternal and neonatal tetanus call for administration of ___ doses of tetanus toxoid at least 4 weeks apart to previously unimmunized pregnant women.

Answer 39

2 doses

Question 40

Individuals sustaining tetanus-prone wounds should be ____ if their vaccination status is incomplete or unknown or if their last booster was given >10 years earlier.

Answer 40

immunized

Question 41

Patients with an inadequate vaccine status who sustain wounds not classified as clean or minor should also undergo ____ immunization with TIG.

Answer 41

passive

Question 42

It is recommended that tetanus toxoid be given in conjunction with ____ in a preparation with or without acellular pertussis: DTaP for children ___ years old, Td for 7- to 9-year-olds, and Tdap for children ___ years old and adults.

Answer 42

- diphtheria toxoid - <7 - >9