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VOLUME 25 , ISSUE S2 ( May, 2021 ) > List of Articles

INVITED ARTICLE

Intensive Care Management of Severe Tetanus

Dilip R Karnad, Vishal Gupta

Keywords : Autonomic dysfunction, Benzodiazepine, Immunization, Intensive care unit, Laryngospasm, Muscle spasm, Rhabdomyolysis, Severe tetanus,Tracheostomy, Tropical infections

Citation Information :

DOI: 10.5005/jp-journals-10071-23829

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

• Tetanus is caused by an exotoxin, tetanospasmin, produced by Clostridium tetani, an anaerobic gram-positive bacillus. • Tetanospasmin prevents the release of inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the spinal cord, brainstem motor nuclei, and the brain, producing muscle rigidity and tonic spasms. • Trismus (lockjaw), dysphagia, laryngeal spasms, rigidity of limbs and paraspinal muscles, and opisthotonic posture are common. • Frequent severe spasms triggered by touch, pain, bright light, or sounds may produce apnea and rhabdomyolysis. • Autonomic overactivity occurs in severe tetanus causing labile hypertension, tachycardia, increased secretions, sweating, and urinary retention. Dysautonomia is difficult to manage and is a common cause of mortality; magnesium sulfate infusion is often used. • Antibiotics (penicillin or metronidazole) and wound care reduce toxin production and human tetanus immune globulin neutralizes the circulating toxin. • Nasogastric tube placement for feeding and medications is needed. • Early elective tracheostomy is performed in moderate or severe tetanus to prevent aspiration and laryngeal stridor. • Benzodiazepines help reduce rigidity, spasms, and autonomic dysfunction. Large doses of diazepam (0.2–1 mg/kg/h) are administered via nasogastric tube. • Neuromuscular blocking agents and mechanical ventilation are used for refractory spasms. • Mortality ranges from 5% to 50%.


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