BLOCK TROPICAL MEDICINE

GROUP 11
Leader : Hendra Admah Jaya
Secretary : Anthony Suranta S.
Notulen : Martha Napiria
Members : Eureka Laoli Prayitna Susant
Edward Valentno Agum Gumelar
Anggraini J Esmeralda
Theresia Jonathan Joseph S.
Tiara Dwi P.M. Stevenie
Cindy Prajna Friska SR
Irfan J.
 SCENARIO
Adi 8 years old came to a hospital because
of seizure since 5 days ago. One month ago
he punctured by a nail. He has been brought
to public health care centre and the wound
has recovered. From the examinaton found;
sens: compos mets, T: 36,5oC ; Trismus
2cm ; opisthotonus ; abdominal rigidity ;
and excitatory seizure (+). What happened
to this kid and what should we done?
 CLARIFICATION OF TERMS
1. Opisthotonus : Hyperextenton of head
and heel ,
2. Trismus : Disrupton of N.Trigeminus
3. Trismus 2cm : Patent can only open
his/her mouth up to 2cm.
IDENTIFICATION OF PROBLEMS
Adi 8 years old came to a hospital because
of seizure since 5 days ago. One month ago
he punctured by a nail. He has been brought
to public health care centre and the wound
has recovered.
From the examinaton found; sens: compos
mets, T: 36,5oC ; Trismus 2cm ; opisthotonus
; abdominal rigidity ; and excitatory seizure
(+).
 ANALYSIS OF PROBLEMS
Maybe the first aid and debridement for
his wound wasnt treated well .
Maybe thats the complicaton
symptoms from his wound
 HYPOTESIS
Adi , 8 years old , was diagnosed
with tetanus
 Definition of Seizures
Seizures are sudden changes in brain
functon and temporarily as a result of
abnormal neuronal actvity and as a
cerebral excessive electrical discharges.
This actvity can be partal or vocal from
specific regions of the cerebral cortex,
or generalized, involving both
hemispheres of the brain.
 Types of Seizures
PARTIAL
Awareness intact although it may be changed; focus on one
part but can spread to other parts

Simple Partal
At the motor (unilateral abnormal movements), sensory (taste, smell, hear
something abnormal), autonomic (tachycardia, bradycardia, tachypnea,
redness, discomfort in the epigastric), psychic (dysphagia, memory loss).
Usually lasts less than 1 minute.

Complex Partal
Started as a simple partal seizures; developed into a change of
consciousness, accompanied by motor symptoms, sensory symptoms,
automatsm (taste-ngecapkan lips, chewing, tugging at clothes).Some
complex partal seizures may develop into generalized seizures. Usually lasts
1-3 minutes.
Generalized
Absence
Blank stare, head slightly limp, quivering eyelids, or blinking rapidly; postural
tone is not lost. Lasts a few seconds.
Myoclonic
Sudden shock-like contractons were limited in some muscle or limb; tend to be
brief.
Atonic
A sudden loss of muscle tone accompanied by the disappearance of posture
(drop attacks)
Clonic
Repettve movements, sharp, slow, and single or multple in the arm, leg or
torso.
Tonic
The sudden increase in muscle tone (becomes stff, contracton) the face and
upper body; arm flexion and extension legs.
Tonic-Clonic
Tonic-clonic muscle spasm; urinary incontnence, tongue bitng; phase postctus
 Definition, etiology and
epidemiology tetanus
DEFINITION
Tetanus defined as an acute disease,
marked by muscle stiffness and spasm.

GREEK
tetanos = contraction

ETIOLOGY
Clostridium tetani is a rod-shaped, anaerobic bacteria of the
genus species Clostridium. It is Gram-positive, and its
appearance on a gram stain resembles tennis rackets or
drumsticks. C. tetani is found as spores in soil or in the
gastrointestinal tract of animals. C. tetani produces potent
EPIDEMIOLOGY
On most developing countries, tetanus remains
to be the biggest public health problem, with 1
million cases per year around the world,
18/100.000 citizens per year and mortality
rate 300.000-500.000 per year. The amount of
cases in Indonesia was 1.6-1.8 per 10.000 birth
within the period of 1997-2000, with mortality
rate for neonatal tetanus had reached 7.9%.
Patophysiology and Clinical Manifestation of tetanus
Clinical Symptoms
Muscle stffness slowly, especially the neck and jaw muscles.
dysphagia
The body stff as a board
Head of interested, back arched (opisthotonus)
Limbs and feet in a state of extension, hands clenched and thumb
adducton.
Facial expression stff (Risus Sardonikus)
Eyebrow lif
palpebral fissure narrowing
Angle of mouth attracted down and out
The upper lip firmly on the clenched teeth
Sometmes there is spasm of the sphincter and cause urinary
retenton
Sweatng more (Hyperhidrosis)
Diagnosis and Differential Diagnosis
Tetanus
1. Diagnosis Tetanus
Tetanus absolute diagnosis is based on clinical symptoms and
anamnesis. No special investigations required to diagnose
tetanus as a fairly typical clinical symptoms, but some checks
to support the diagnosis of tetanus.
A. Anamnesis
- Ask the patient's identity?
- Ask the main complaint?
- Asks additional complaints?
- Ask the history of present illness?
- Asked past medical history?
- Asks social history?
B. Physical Examination
Can be found: local muscle stiffness, trismus to strong
spasms.

1. On local tetanus found stiffness and spasms were settled.

2. On the cephalic tetanus found trismus, rhisus sardonikus and
cranial nerve dysfunction.
3. On common tetanus trismus, neck stiffness, rigidity of the
chest and abdomen.
4. On neonatal tetanus found stiffness and spasms and body
position classic: trismus, stiffness in the back muscles causes
severe opisthotonus with lumbar lordosis
 C. Investigations
Examination limited support in the diagnosis and usually normal.

2. Deferential Diagnosis
1. Bacterial Meningitis
2. Poliomyelitis
3. Rabies
4. Poisoning Strichine
5. Tetany
6. Abscess retrofariengal
7. Tonsillitis Heavy
8. Side Effects Fenotiasin
9. Mastoiditis, upper lobar Pneumonia, Myositis neck and neck
Spondylitis
 Management
Ant convulsant and sedatve
a. Diazepam
when the patent come with seizure state, First will be
given 0,5mg/kgBB

b. Fenobarbital
First dose : <1 years old will be given 50mg IM
>1 years old will be given 75mg IM
And will be follow with Oral dose 5-9mg/kgBB/each day.
c. Antbiotc
- Penicilin Procain
With dose 50.000U/kgBB/each day IM
for 10 days.

- Eritromisin
With dose 50mg/kgBB/each day for 10
days
 PREVENTION
Treat the wound properly
Especially for stab wound &
contaminated wound
Passive Immunisaton
1. ATS from horse serum
2.Tetanus immunoglobulin Human ( TIGH)
Actve immunisaton
DPT, DT , TT
 Complication and Prognosis of
tetanus
Complicatons of tetanus
1. The respiratory tract
cause : asphyxia,aspiraton pneumoni,telektasis,
pneumotorax and mediastnal emfisiema.
2. Cardiovascular
cause : tachycardia,hypertensions,peripheral
vasoconstricton and stmulaton of the myocardium.
3. The bones and muscle
bleeding in the muscle and columna vertebral
fracture.
4. laceraton of the tongue due to convulsions
Prognosis of tetanus influenced by factors :
a. Period of the incubaton
b. The age
c. Period of onset
d. Treatment
e. presence or absence of complicatons
f. The frequency of seizures
 FINAL CONCLUSION
Adi 8 years old came to a hospital because of seizure since 5 days
ago. One month ago he punctured by a nail. He has been brought to
public health care centre and the wound has recovered. From the
examinaton found; sens: compos mets, T: 36,5oC ; Trismus 2cm ;
opisthotonus ; abdominal rigidity ; and excitatory seizure (+). He was
diagnosed with tetanus . The treatments that we recommend are :
Non-Pharmacologic :isolaton for the patent
Pharmacologic :
Diazepam 0,5 mg/kgBB per rectal , if patent doesnt seizure : 0,5mg /kgBB PO
6 tmes a day
Penicillin procain 50.000 unit /kgBB IM
Ant Serum Tetanus 50.000-100.000 unit IV , IM . For IV , mix it with 100-
200 ml glucose 5 % for 1-2 hours
If the patent has recovered , we recommend the patent for TT vaccine
 Pada skenario ini, adi berumur 8 thn menderita kejang sejak
5 hari yg lalu dgn riwayat tertusuk paku 1 bulan yg
lalu.berdasarkan pemeriksaan fisik didapatkan trias tetanus
yaitu trismus 2 cm, epistotonus, abdominal rigidity sehingga
adi didiagnosa menderita tetanus. Penatalaksanaan yg hrs
dilakukan adalah melakukan isolasi kpd pasien utk
menghindari rangsangan lalu diberikan diazepam 0,5
mg/kgbb diberikan secara rectal,serta pemberian antbiotka
yaitu penicilin procain 50.000 unit/kgbb Im dan diberikan
ant serum tetanus dengan dosis 50.000-100.000 unit 1/2 IV
dan 1/2 IM dan setelah sembuh pasien dianjurkan untuk
imunisasi TT