Tetanus

Abstract

Tetanus is a potentially lethal disease that is preventable with appropriate vaccination. The diagnosis is made exclusively on clinical criteria, and early recognition and treatment are essential for positive outcome. Patients should be monitored in the intensive care unit immediately on diagnosis. Early intubation and mechanical ventilation have drastically reduced the mortality from tetanus. Autonomic instability is associated with a high fatality rate and therefore must be aggressively treated. Metronidazole, human tetanus immunoglobulin, and active immunization should also be initiated on presentation. Because of extremely high metabolic demands in patients with tetanus, care must be taken to provide adequate nutrition and fluids. Prevention of sequelae of long-term critical illness, such as nosocomial pneumonia and deep venous thrombosis, are also important for achieving good outcomes.

Infecção por Clostridium tetani no recém-nascido: revisão sobre o tétano neonatorum

“…Vaccination of potential childbearing or pregnant women (during their prenatal care) is the best preventive strategy against tetanus neonatorum. (1,(6)(7)(8) In light of these considerations, the aims of this manuscript are to revise the ethiopathogenic, clinical, therapeutic and epidemiological aspects of the disease and to improve the control of neonatal tetanus.…”

“…The therapeutic targets should include the following: a) neutralization of circulating (i.e., not bound to receptors) toxins; b) the elimination of the toxin-producing source (i.e., the vegetative C. tetani forms); and in particular, c) management of clinical features using ventilation, nutrition and hemodynamic support in addition to treatment of muscle spasms. (6,(10)(11)(12)(13) Neutralizing toxin activity Unbound tetanus toxin can be found in organ fluids, in particular, in blood and tissues surrounding the wound. For neutralization purposes, heterologous anti-tetanus serum (ATS) or hyperimmune human tetanus immunoglobulin (TIG) should be administered as soon as possible, ideally before the tetanus toxin has begun its axonal migration toward the spinal cord, after which neutralization is no longer possible.…”

Diretrizes para o manejo do tétano acidental em pacientes adultos

“…(1,2,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) In the ICU, appropriate monitoring and quick detection of complications can be performed by a trained multidisciplinary team. (12)(13)(14)17,19,20) We highlight five studies that showed reduced mortality after ICU admission in tetanus patients. In Japan, a decrease in mortality from 40-50% for patients treated between 1940 and 1970, to 20% for patients treated between 1971and 1980, and 10% for patients treated between 1981 and 1982 was shown.…”

“…(12,19) 2. Is a clinical strategy of grading the severity of disease relevant to the management of tetanus patients?…”

Tetanus seroepidemiology and factors influencing immunity status among farmers of advanced age

“…Tetanus remains a significant health concern in developing countries with predominantly agricultural economy [1]. It afflicts approximately one million people per year, with a mortality of 20-50% [2].…”