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DEFINITION
ORGANISMS
Anaerobic - Gram-positive - Spore-forming bacillus
Genus Clostridium
C. perfringens - Most common etiologic agent
Other common clostridial species
Clostridium bifermentans
Clostridium septicum
Clostridium sporogenes
Clostridium novyi
Clostridium fallax
Clostridium histolyticum
Clostridium tertium
C perfringens - 20 exotoxins.
Alpha toxin-lecithinase,necrotizing,hemolytic,cardiotoxic
ALPHA-TOXIN
PREDISPOSING FACTORS
Injury
Dead tissue, blood clots, foreign matter aerobic organisms
CLASSIFICATION
POST-TRAUMATIC
POST-OPERATIVE
SPONTANEOUS
POSTTRAUMATIC
POSTOPERATIVE
clostridial infections
colon resection
ruptured appendix
bowel perforation
biliary or other GI surgery, including laparoscopic
cholecystectomy and colonoscopy.
Septic back-street abortions - uterine gas gangrene.
SPONTANEOUS
SYMPTOMS
SIGNS
SUMMARY C/P
Laboratory Studies
Hemolytic anemia
Increased lactate dehydrogenase (LDH)
White blood cell No leukocytosis.
Toxic shock syndrome - C sordellii or C septicum
Hemoconcentration & leukocytosis.
Gram stain - exudate or infected tissues
Box-car & large gram-positive bacilli without neutrophils
LecithinaseC- toxaemia
Nagler reaction
Colonies withhaloes
Colonies without
haloes
Incorporatedwith
Antitoxins
C Perfringens
C histolyticum
C septicum
C novyii
C Perfringens
Alpha toxin
(lecithinase)
IMAGING STUDIES
Radiograph
Delineate the typical feathering pattern of gas in
soft tissue
Gas may not be present in patients
Gas in soft tissue does not confirm diagnosis
CT SCAN
Abdominal cases
OTHER TESTS
PROCEDURES
HISTOLOGIC FINDING
ANTIBIOTIC THERAPY
INTENSIVE CARE
End-organ failure
Other concomitant serious medical conditions that
require intensive supportive care.
ADJUVANT THERAPY
SURGICAL CARE
Hemipelvectomy
SUMMARY
COMPLICATIONS
TETANUS
EPIDEMOLOGY
History
History
1897,
Edmond Nocard - tetanus antitoxin induced
passive immunity in humans
could be used for prophylaxis and treatment.
1924
P. Descombey - Tetanus toxoid vaccine was
developed
used to prevent tetanus induced by battle
wounds during World War II
INTRODUCTION
INTRODUCTION
Skeletal muscle
Cardiac or heart muscle cannot be tetanized - Intrinsic
electrical properties.
Mortality rates - 48% to 73%.
Highest mortality rates - Unvaccinated & > 60 years
Shorter the incubation period -More severe symptoms
Neonatal tetanus,
symptoms usually appear from 4 to 14 days after
birth
averaging about 7 days
Types
Basis of clinical findings, four different forms of tetanus
Generalized tetanus
Neonatal tetanus
Local tetanus
Cephalic tetanus
GENERALIZED TETANUS
NEONATAL TETANUS
Generalized tetanus that occurs in newborns.
Infants - Not acquired passive immunity mother has never been immunized - risk.
Infection of the unhealed umbilical stump stump is cut with a non-sterile instrument.
Neonatal tetanus - developing countries
-Responsible for about 14% neonatal deaths,
-Very rare in developed countries
LOCAL TETANUS
Uncommon
Persistent contraction of muscles - same anatomic
area as the injury.
Contractions may persist for many weeks before
gradually subsiding.
Local tetanus is generally milder- 1% fatal
Generalized tetanus.
CEPHALIC TETANUS
Rare form
Otitis media (ear infections) in which C. tetani is
present in the flora of the middle ear,
Injuries to the head.
Cranial nerves -Facial area.
ETIOLOGY
PATHOPHYSIOLOGY
Clostridium tetani,
obligate nonencapsulated anaerobic gram-positive bacillus
Rod-shaped bacteria
spores
neurotoxin
causes the clinical manifestations of tetanus.
Tetanospasmin
Toxin is inactive inside the bacteria, - Bacteria dies Released and activated by proteases
Active tetanospasmin - Retrograde axonal transport to
the spinal cord and brain stem
Lymphatic & vascular circulations - End plates of all nerves.
Enters nervous system peripherally - Myoneural jn.
Transported centripetally into neurons of the CNS
Tetanospasmin
SYMPTOMS
SYMPTOMS
Restlessness,
Reflex spasms
Other symptoms
Elevated temperature, sweating, elevated blood pressure,
and episodic rapid heart rate.
RISUS SARDONICUS.
SIGNS
SIGNS
& experiences severe pain.
No LOC
Seizures - muscle groups
Opisthotonos, flexion and abduction of the arms
Clenching of the fists against the thorax
Extension of the lower extremities
Localized tetanus
Painful spasms muscles in close proximity to the site of
injury.
Disorder may persist for several weeks but is usually selflimiting.
Cephalic tetanus
Characterized by variable cranial nerve (CN) palsies
CN VII is most frequently involved
Untreated progress to generalized tetanus
Ophthalmoplegic tetanus - variant
Develops after penetrating eye injuries
Results in CN III palsies and ptosis
SIGNS
TESTS
PREVENTION
PREVENTION
Booster
not prevent a potentially fatal case of tetanus from the
current wound
It take up to two weeks for tetanus antibodies to form
TREATMENT
MILD TETANUS
SEVERE TETANUS
SURGICAL THERAPY
DRUGS
ANTICONVULSANTS
OTHER AGENTS
Spasm control
baclofen,
Dantrolene,
Short-acting barbiturates
Chlorpromazine.
COMPLICATIONS
PROGNOSIS
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