[UKMPPD - SKDI REVIEW] Tetanus & Tetanus Neonatorum - Antibiotik DOC? | Sistem Saraf #15, 17

Summary

This educational video explains the general concept of tetanus and neonatal tetanus, focusing on its causes, symptoms, and treatment. It covers the pathogenesis of tetanus, how Clostridium tetani bacteria and its toxin cause spasms and paralysis, and highlights the different types, such as local, cephalic, and general tetanus. The video emphasizes the importance of early intervention and proper management, including vaccination schedules, antibiotic treatments, and supportive care. It also provides insights into managing tetanus in emergency situations, with a focus on how to prevent, diagnose, and treat this potentially life-threatening disease.

Takeaways

• 😀 Tetanus is a disease caused by the toxin tetanospasmin produced by the bacteria Clostridium tetani. It results in sustained muscle spasms.
• 😀 Tetanus neonatorum (neonatal tetanus) has a higher incidence in babies born to mothers who did not receive complete tetanus vaccination or proper hygienic childbirth practices.
• 😀 Older adults are more susceptible to tetanus due to a decline in immune function, even if they were vaccinated earlier in life.
• 😀 The bacteria Clostridium tetani can enter the body through open wounds, where its spores germinate and proliferate, especially in anaerobic conditions.
• 😀 Tetanospasmin blocks neurotransmitter release at the neuromuscular junction, leading to overstimulation of muscles and causing spasms.
• 😀 Symptoms of tetanus include trismus (lockjaw), risus sardonicus (facial grimacing), dysphagia (difficulty swallowing), and opistotonus (arching of the body due to muscle spasms).
• 😀 Tetanus can lead to autonomic dysfunction, including tachycardia, hypertension, and potentially respiratory failure, which can be fatal.
• 😀 The treatment for tetanus includes immediate stabilization of the patient (ABCs), neutralizing the tetanus toxin with immunoglobulins, and managing spasms with antispasmodics and anticonvulsants.
• 😀 Antibiotics like metronidazole are used to eradicate the Clostridium tetani bacteria, and debridement of the wound is necessary to prevent continuous toxin production.
• 😀 Vaccination plays a crucial role in preventing tetanus, with routine tetanus vaccinations administered as part of the DTP (diphtheria, tetanus, and pertussis) vaccine for children and booster doses throughout life, particularly every 10 years.

Q & A

What is tetanus, and how does it affect the nervous system?

Tetanus is a disease of the nervous system caused by the toxin tetanospasmin, produced by the bacterium *Clostridium tetani*. The toxin affects the neuromuscular junction by inhibiting the release of neurotransmitters, leading to persistent tonic muscle spasms. This causes the muscles to contract rigidly, similar to the stiffness of a board, and can progress to paralysis and respiratory failure.

What is the difference between tetanus and tetanus neonatorum?

Tetanus refers to the general disease caused by *Clostridium tetani* infection, whereas tetanus neonatorum specifically affects newborns, often due to umbilical cord infections caused by unhygienic birth practices. Tetanus neonatorum is more common in infants whose mothers did not receive complete tetanus vaccinations or who gave birth under unsanitary conditions.

How does *Clostridium tetani* cause tetanus?

When *Clostridium tetani* spores enter a wound, they germinate and proliferate in anaerobic conditions, releasing the tetanospasmin toxin. The toxin travels through the nervous system, first affecting the peripheral nervous system and then spreading to the central nervous system, disrupting inhibitory neural signals, leading to muscle overstimulation and spasms.

What are the primary symptoms of tetanus?

The primary symptoms of tetanus include trismus (lockjaw), risus sardonicus (a grinning facial expression due to spasms), dysphagia (difficulty swallowing), and muscle rigidity. In severe cases, generalized muscle spasms, especially in the back (opisthotonus), and autonomic instability, such as tachycardia and hypertension, can occur. Death is often caused by respiratory failure due to paralysis of respiratory muscles.

What is risus sardonicus, and how is it related to tetanus?

Risus sardonicus is a facial spasm that causes a grin-like expression, which is a common symptom of tetanus. It occurs due to spasms in the muscles controlling facial expressions, particularly the muscles involved in smiling and other mimetic movements.

How is tetanus classified based on its manifestations?

Tetanus can be classified into four types: local tetanus (affecting muscles near the wound), cephalic tetanus (limited to the head, causing symptoms like trismus and risus sardonicus), generalized tetanus (systemic involvement with severe spasms), and neonatal tetanus (tetanus neonatorum), which typically results from umbilical infections in newborns.

What are the main steps in managing tetanus?

Tetanus management includes stabilizing the patient's airway, breathing, and circulation (ABC), neutralizing the circulating tetanus toxin with tetanus immunoglobulin, preventing further spasms with antispasmodics and anticonvulsants, eradicating the *Clostridium tetani* bacteria with antibiotics, providing supportive care, and administering tetanus vaccination to prevent future infections.

What is the role of human tetanus immunoglobulin (HTIG) in treating tetanus?

HTIG is used to neutralize the tetanus toxin circulating in the body before it binds to the central nervous system. It contains antibodies against tetanospasmin and is most effective when given early. It is important to administer HTIG promptly, as it can only neutralize toxins not yet bound to the nervous system.

How is tetanus diagnosed?

Tetanus is diagnosed based on clinical presentation, including symptoms like trismus, risus sardonicus, dysphagia, and spasms. Provocative tests, such as gently tapping the back of the throat with a tongue depressor, can trigger muscle spasms in tetanus patients but not in healthy individuals.

What is the vaccination schedule for tetanus, and how often should booster doses be given?

The tetanus vaccine is included in the DTP vaccine for children, typically administered at 2, 3, and 4 months of age. A booster is given at 18 months, with subsequent boosters at ages 5-7, and every 10 years thereafter. Additionally, schoolchildren often receive a booster dose around age 5 and again at age 10. Adults should continue receiving tetanus boosters every 10 years to maintain immunity.