Downloaded 27 times
Uploaded byThe CRUDEM Foundation
Tetanus in Haiti Symposia - The CRUDEM Foundation
The document discusses the epidemiology, pathology, diagnosis, and management of tetanus, highlighting its annual global incidence and mortality rates. It details clinical presentations of various forms of tetanus, including neonatal and cephalic types, and emphasizes the importance of proper wound care and immunization. A clinical case in Haiti illustrates the severe implications of untreated tetanus, ultimately resulting in the patient's death.
More Related Content
Similar to Tetanus in Haiti Symposia - The CRUDEM Foundation
Tetanus in Haiti Symposia - The CRUDEM Foundation
- 1.
- 2. Epidemiology ~ 1 million cases per year worldwide 200,ooo to 300,000 deaths annually Neonatal tetanus was targeted for elimination by the WHO in ‘95 Neonatal tetanus still causes 5-‐7% of neonatal deaths
- 3. Pathology Spores of Clostridium tetani are found widely in soil Innoculated into wounds Transforms into active bacterium, produces tetanus toxin Toxin binds to neuroreceptors Disinhibits excitatory impulses Causes increased muscle tone, painful spasms and autonomic instability
- 4. Clinical scenario Generalized tetanus Local tetanus Cephalic tetanus Neonatal tetanus
- 5. Generalized tetanus Autonomic overactivity: -‐ irritability -‐ diaphoresis -‐ tachycardia -‐ labile BP -‐ fever
- 6. Generalized tetanus Tonic contraction of skeletal muscles Intermittent, painful muscle spasms These cause classic signs/symptoms: -‐ trismus -‐ apnea -‐ risus sardonicus -‐ abdominal rigidity -‐ opisthotonus
- 7. Localized tetanus Rare Tonic and spastic muscle contractions in one extremity or body region Usually evolves into generalized tetanus
- 8. Cephalic tetanus Due to injuries of head, neck Involves only cranial nerves Usually evolves into generalized tetanus
- 9. Neonatal tetanus Due to umbilical stump infection (eg application of cow dung to stump) versus non-‐sterile delivery Manifests as: -‐ inability to suck -‐ seizures -‐ rigidity -‐ spasms
- 10. Diagnosis Clinical: -‐ tetanus prone wound -‐ inadequate vaccination -‐ consistent signs/symptoms
- 11. Management Wound care Antibiotics Neutralize toxin Control spasms Immunize
- 12. Wound care Aggressive wound debridement to: -‐ remove spores -‐ remove necrotic tissue necessary for spore germination
- 13. An>bio>cs Play minor role Penicillin traditional drug of choice Metronidazole now preferred Given likelihood of mixed infection: -‐ ceftriaxone for 5-‐7 days
- 14. Toxin neutraliza>on Symptom causing tetanus toxin is irreversibly bound Can only neutralize unbound toxin HTIG 3000 to 6000 units IM ETIG 1500 to 3000 units IM
- 15. Symptom control Spasms are life threatening Put pt in a quiet room Drugs: -‐ Benzodiazepines -‐ Vecuronium -‐ Propofol -‐ Baclofen
- 16. Symptom control Autonomic dysfunction: -‐ magnesium -‐ labetolol -‐ morphine
- 17. Immuniza>on Disease does NOT confer immunity If primary immunization series in doubt: 3 doses of tetanus toxoid Booster every 10 years
- 18. Other care Bound tetanus toxin cannot be displaced Recovery requires re-‐growth of nerve terminals (4-‐6 weeks) Severe tetanus means a prolonged hospital course Consider: -‐ nutritional support -‐ ventilatory support -‐ early PT
- 19. Prognosis Neonatal: -‐ 10-‐60% fatality -‐ may have long term neurologic deficits Non-‐neonatal: -‐ 8-‐50% fatality
- 20.
- 21. Tetanus in Hai> 4 yr old female brought to triage area 1-‐17-‐10 Found under ruble in Port au Prince Presenting for evaluation of L LE injury
- 22. Tetanus in Hai> AF 90 BP unavailable General: Crying Heart: RRR Lungs: CTA Abd: NT, ND Extrems: large lacerations deep to muscle involving the R lateral calf and L shin
- 23. Tetanus in Hai> Wounds cleaned and bandaged Tetanus prophylaxis given Empiric abx (IM ceftriaxone) Plans for further debridement in OR
- 24. Tetanus in Hai> Following day, Febrile to 39.1, nuchal rigidity and intermittent arching of the back Consult re ? meningitis
- 25. Tetanus in Hai> General: Awake, alert, crying HEENT: Teeth clenched, neck stiff Heart: RRR Lungs: CTA Abd: NT, ND Wound: unchanged Neuro: Globally increased muscle tone
- 26. Tetanus in Hai> Clinical tetanus diagnosed Management: High dose tetanus IgG Continue Ceftriaxone To OR for wound debridement Diazepam prn
- 27. Tetanus in Hai> Following day: Decreased muscle rigidity Decreased spasms Increased BP lability Mg ggt added
- 28. Tetanus in Hai> That night: IV loss Benzos not given Mg ggt not given Intractable spasms, trismus Vecuronium given, ventilation support started
- 29. Tetanus in Hai> Next AM: Navy helicopter transfer to USS Comfort Informed child coded and died shortly after arrival