Tetanus

Question 1

It is an anaerobic, gram positive, spore-forming rod that are highly resilient. (Harrison pp 984)

Answer 1

Clostridium tetani

Question 2

It is defined by WHO as an illness occurring in a child who loses the ability to suck and cry between 3 and 28 days old. (Harrison pp 984)

Answer 2

Neonatal tetanus

Question 3

It is defined by WHO as tetanus occurring during pregnancy or within 6 weeks after the conclusion of pregnancy whether with birth, abortion or miscarriage. (Harrison pp 984)

Answer 3

Maternal tetanus

Question 4

What is the minimum lethal human dose? (Harrison pp 984)

Answer 4

2.5 ng/kg

Question 5

It is the commonest infection sites in adults affected by the Clostridium tetani. (Harrison pp 984)

Answer 5

Superficial abrasions of the limbs

Question 6

Who are greater risk of having Clostridium tetani? (Harrison pp 984)

Answer 6

Persons > 60 years
Injection drug users (Herion subcutaneously or skin-popping)
Incomplete vaccination

Question 7

It is the exotoxin caused by tetanus (Harrison pp 984)

Answer 7

tetanospasmin

Question 8

It is necessary for presynaptic binding and release of neurotransmitter hence effectively blocks inhibitory interneuron discharge. (Harrison pp 985)

Answer 8

VAMP2 - Vesicle associated membrane protein 2

Question 9

What is the commonest initial symptoms of tetanus? (Harrison pp 985)

Answer 9

Trismus - lockjaw
Muscle pain and stiffness
Back pain
Difficulty swallowing

Question 10

It is the commonest cause of death among tetanus. (Harrison pp 985)

Answer 10

Respiratory Failure

Question 11

When is Autonomic disturbance is maximal? (Harrison pp 985)

Answer 11

2nd week

Question 12

How should be the level of serum anti-tetanus immunoglobulin G to deemed protective? (Harrison pp 985)

Answer 12

> 1.0 IU/mL

Question 13

What is the antibiotics of choice for tetanus? (Harrison pp 986)

Answer 13

Metronidazole 500mg/IV q6 for 7 days

Alternative: Penicillin 100, 000 to 200, 000 IU/KG per day (exacerbate spasm)

Question 14

What is the recommended therapy for Human Tetanus Immune Globulin? (Harrison pp 986)

Answer 14

3000 - 5000 IU of TIG as single IM dose

Question 15

What is the recommended dose if TIG is given intrathecally? (Harrison pp 986)

Answer 15

50 - 1500 IU

Question 16

Severe spasm are best controlled with what medications? (Harrison pp 986)

Answer 16

Magnesium

Relatively short acting cardiovascular inert, non depolarizing neuromuscular blocking agents

Question 17

What are the possible complications arising from treatments of tetanus? (Harrison pp 986)

Answer 17

Thrombophlebitis associated with diazepam
VAP
Central line infection
Septicemia

Question 18

What is the WHO recommendations for prevention of maternal and neonatal tetanus? (Harrison pp 986)

Answer 18

2 doses of tetanus toxoid at least 4 weeks apart to previously unimmunized pregnant women

Question 19

How should diptheria toxoid be given by recommendation of WHO in conjugate with tetanus toxoid? (Harrison pp 986)

Answer 19

DTap for children < 7 years old
Td for 7 - 9 years old
Tdap for > 9 years old

Question 20

What are the factors associated with poor prognosis with tetanus among adult? (Harrison pp 986)

Answer 20

> 70 yo
Incubation period of < 7 days
Heart Beat of > 140 bpm
Blood pressure > 140 mmHg
Puerperal IV, postsurgery, burn entry
Period onset < 48 hrs
Severe disease or spasms
Temperature > 38.5 C

Question 21

What are the factors associated with poor prognosis with tetanus among children? (Harrison pp 986)

Answer 21

Younger age, premature birth 
Incubation period < 6 days
Delay in hospital admission 
Grass used to cut cord
Low birth weight
Fever on admission