TETANUS

Dr. Msy Rita Dewi A SpAK

Divisi Neurologi Anak
Bagian IKA RSMH/FK UNSRI

Tetanus
Tetanus is an acute disease muscle
paralitic spasm caused by Clostridium
tetani exotoxin
Mortality rate : 5-60/ 1000 live birth
RSMH (2006) : 3 cases, 1 death.

Definition
Neonatal Tetanus is an acute disease,
muscle paralytic spasms, caused by
Clostridium tetani exotoxin

Epidemiology
In the world : 500.000 case/year
Indonesia : 6-7/1000 live birth in urban
11-23/1000 live birth in rural
Male: Female between 1:1 and 1:3

Clostridium Tetani
Gram positive bacteria, Obligate anaerobe,
exotoxin tetanolysin and tetanospasmin
Tetanospasmin neurotoxin, 150kDa

Patogenesis
Spora in anaerobe conditions
Vegetative, produce toxin
Tetanospasmin
Motor end plate & axis cilinder peripher nerve
Cornu anterior, alpha motor neuron

CNS

Patogenesis
toxin in motoric nerve
neuromuscularjunction
block releasing inhibitory neurotransmitter (glysin &GABA)

close inhibitory impulses

increase tonic of muscle

spasms

Clinical Manifestation
1.
2.
3.
4.
5.
6.

trismus, (lock jaw), rigid of lips impede

feeding trismus: spasme otot masseter
Risus sardonicus spasme meluas ke otot muka penampakan khusus
Opistotonus kekakuan otot rangka
Rigidity of abdominal muscles
Autonomic symptom
Tetanic spasms initiated by light and noise

Classification
1.
2.
3.
4.

Localized tetanus
Generalized tetanus
Cephalic tetanus
Neonatal Tetanus

Tetanus Neonatorum
By Chandra criteria:
No criteria
1
Ages : < 6 days
6-10 days
> 10 days

Score
4
2
1

Seizure : Spontaneous
Stimulated

2
1

3
4
5

Cyanosis
Body Temp 380C or more
Trimus /rhisus sardonikus

2
1
1

If score 2-5 : grade I

If score 6-7 : grade II
If score 8-10 : grade III

Tetanus

No

1
2
3
4
5
6

By Cole and Youngman

criteria

Incubation
Periode of onset
Trismus
Disfagia
Spasm
General seizure

Grade

II

III

14
6
mild
Local
mild

10-14
3-6
Moderate
mild
Early spasm
>>

< 10
<3
Severe
Severe
Stiffness, asfiksia
Respiratory failure
Laryngeal spasm

Classification of severity of tetanus

Classification of severity of tetanus:
1. Mild : only trismus/ spasm
2. Moderate : spasms, without spontaneous
seizure, stimulated siezure
3. Severe : spasms, frequently spontaneous
seizure

Differential Diagnosis

Meningitis
Hypocalcemic tetany
Rabies

Complication
1.
2.
3.
4.
5.
6.
7.

BP
Laryngospasms
Pneumonia aspiration
Nosocomial infection
Hipertensi
Fracture of vertebrae
Death

Treatment
A.

General :
a. supportive
b. airways & O2
c. control of rigidity & spasms
d. patient isolation
e. wound care

Treatment
Diazepam dose :
0,04mg - 0,2 mg/kgbw/times per oral.
rectal : age < 3years : 5 mg can be give the
second after 5-10 minute.
parenteral : 0,2mg - 0,3mg/kgbw /times.
Maximum dose : 40mg/kgbw/d.

Treatment
B. Special:

a. Antiserum
ATS : 10.000 IU neonatus
ATS : 20.000 IU child
b. Antibiotic
Penicillin G : 50.000 IU/kg BW/days

Treatment
Diazepam dose :
0,04mg - 0,2 mg/kgbw/times per oral.
rectal : age < 3years : 5 mg can be give the
second after 5-10 minute.
parenteral : 0,2mg - 0,3mg/kgbw /times.
Maximum dose : 40mg/kgbw/d.

Prognosis
incubation

period
onset periode
immunization

status.