TETANUS ANAK

Dr Hj Rahmini Shabariah SpA

Bagian Ilmu Kesehatan Anak FK UMJ

TETANUS
Acute toxic disease
Caused by exotoxin
(tetanospasmin
Clostridium tetani
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Etiology
Clostridium tetani: bacillus, anaerob,

gram positive, spora

Non-invasive
Produce toxin
Tetanospasmin tetani
Tetanolysin
hemolysis (in vitro)

Pathogenesis
Spora anaerob wound vegetative

exotoxin tetanus
Susceptible wound: deep wound,
necrotic wound, perforated otitis media

 Tetanospasmin: absorbed by motor

end plate nerve cornu anterior

Lymphatic system blood CNS

 Tetanospasmin motor end plate

Medulla spinalis
Brain
Sympathetic nerve system

 Tetanospasmin: inhibit choline esterase

Sympathetic nerve system

tachycardia, hypertention, arythmia,

peripheral constriction, sweating
Bound toxin couldnt be neutralized by
antitoxin

Symptom
Incubation periode: 3-14 days

(1-several months)
Tetanus:
Local
Cephalic
Generalized

 Tetanus
Mild
Moderate
Severe

: without spasm
: with spasm
: spontaneous spasm

Local tetanus
Terderness & muscle spasm

Around the wound:

healing/generalized

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Generalized tetanus
Trismus, neck stiffness, dysphagia,

irritable, headache
Rhisus sardonicus, tonic spasm,
back spasm, abdominal muscle
spasm, opistotonus
Early spasm: mild severe
The patient remain consious/alert
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 Stimulation (eye, ear, skin) spasm

Laryngospasm + respiratory muscles

spasms asphyxia
Vesica urinary sphincter spasm
dysuria & urine retention.

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 Usually moderate fever

High fever: terminal stadium

Terminal stadium:
Hyperpirexia, tachycardia,

hypertention, hyperhydrosis, cardiac

abnormalities
Muscle paralysis death

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 Symptoms change in 3-7 days

Consistent in 2nd week

Healing: 2-6 weeks
Periode of onset: time interval from

first symptoms appearance till

spasm
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Cephalic tetanus
Incubation time: 1-2 days

Acute otitis media/ wound on the head

Usually with N II, IV, VII, IX, X, XI

impairment.
N VII: the most common involved
Cephalic tetanus generalized tetanus

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Diagnosis
Clinical symptoms & signs

Laboratory examination: might be

only mild leucocytosis

Elevated intracranial pressure

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Differential diagnosis
Trismus:
Tooth abcess, retropharingeal or

pharingeal abcess
Seizure/spasm:
Encephalitis, meningitis, rabies,
strichnine intaxication, tetani
Nuchal rigidity
Torticolis, cephalic spondilytis, lobar
pneumonia, meningitis
Abdominal spasm:
Peritonitis, acute abdomen
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Complication
Aspiration pneumonia, atelectasis,

asphyxia
Tongue and buccal mucosa laseration
Musle bleeding
Vertebral fracture
dehydration

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Treatment
Eradication of tetanospasmin

sources
Toxin neutralization
Supportif treatment: intensive

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Eradication of tetanospasmin
sources
Clostridium tetani eradication

Wound debridement
Corpus alienum elimination
Antibiotic: metronidazol dan penisilin

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prokain
Penicillin: 50.000-100.000 IU/kgBW/day
I.M
Metronidazole: 30 mg/kgBW/day;
divided in 4
Tetrasiklin : 50 mg/kgBB/ day

Toxin neutralization
Anti tetanus serum (ATS)/Tetanus

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immune globulin (TIG)

ATS: horse serum skin test & eye
test. Bedreska dilution.
ATS : 100.000 IU IM/day; 50.000 IU
iv dan 50.000 IU im
HTIG : 3000-6000 Unit IM; once
only
eye & skin test: not necessary

Supportive treatment
Nursing

Nutrition
Muscle relaxans

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Muscle relaxans
Combinations:
Phenobarbital: Initial dose: 60-100 mg IM
Following doses: 6 x 30 mg/day orally
Diazepam: initial dose 0,5-1 mg/kgBW IV

slowly
Following dose: 1,5-4 mg/kg/day div in 4-6
doses p.o
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Neonatal tetanus
Similar with tetanus in children but

more severe and usually generalized

Entry site: umbilical cord due to

contaminated delivery on susceptible

mother.
Labour process mostly helped by

traditional healer
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Clinical symptoms
Usually occurred on 3-10 days old

Breastfeed problem
Fever.

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Treatment
Similar with tetanus in children
Intravenous fluid drips:
Glucose 5-10%:NaCl 0,9% 4:1 for 48-72 hours
ATS: 10.000 units/days; 2 days
Anticonvulsants/muscle relaxans
In the past:
Diazepam: 4-5 mg/kg/day I.V divided in 4 doses
Phenobarbital: initial dose: 30-60 mg I.M 6 x 15
mg/day

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 Cefotaksim100 mg/kg/day in 4 doses

OR combination with
Gentamycin /amikasin 5 mg/kg/day
in 2 doses
Oxygen, mucus suction, tracheostomi if
necessary
Umbilical cord nursing.

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Prevention
Immunization

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 Patient with no history of immunization:

Penicillin
ATS 750-1500 IU OR TIG 250-500 U
Tetanus toxoid

Immunization (+): ATS/TT (-)

Risky wound, TT last longer than 5 yr:
Tetanus toxoid

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