Abstract:Latar belakang.Insiden dan angka kematian tetanus anak masih cukup tinggi di Indonesia. Di Bagian Ilmu Kesehatan Anak RSCM Jakarta, dari tahun 1990 sampai 1993 dirawat rata-rata 20,3 kasus tetanus anak per tahun dengan case fatality rate(CFR) berkisar antara 12,9 sampai 27,4%. Laporan penelitian di Manado belum ada, maka diperlukan mengetahui profil penyakit tetanus anak yang dirawat di RS Prof. Dr. R.D. Kandou, Manado.Tujuan. Mengetahui profil tetanus pada anak yang dirawat di RSUP Prof. Dr. R.D. Kandou Manad… Show more
“…Three doses were given before the first year after birth, boostered at 4–7 and 15 years old. Vaccination and good wound care are the mainstays to prevent tetanus [ 5 , 22 ]. Fig.…”
Background
Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low–middle-income countries, tetanus still occurs (mostly in adults) due to the lack of immunization related to religious tenets, cultural belief, or inaccessibility to medical care. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group.
Case presentation
We report a case of a 7-year-old girl presented to our institution with a history of falling 10 days prior to admission, with only skin laceration on her forehead. For 1 day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed her as an unimmunized child with an open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw.” Perioperative management of this rare case is reported and discussed.
Conclusion
The pediatric intensive care of such patients requires halting further toxin production, neutralization of circulating toxin, and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery.
“…Three doses were given before the first year after birth, boostered at 4–7 and 15 years old. Vaccination and good wound care are the mainstays to prevent tetanus [ 5 , 22 ]. Fig.…”
Background
Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low–middle-income countries, tetanus still occurs (mostly in adults) due to the lack of immunization related to religious tenets, cultural belief, or inaccessibility to medical care. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group.
Case presentation
We report a case of a 7-year-old girl presented to our institution with a history of falling 10 days prior to admission, with only skin laceration on her forehead. For 1 day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed her as an unimmunized child with an open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw.” Perioperative management of this rare case is reported and discussed.
Conclusion
The pediatric intensive care of such patients requires halting further toxin production, neutralization of circulating toxin, and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery.
“…Vaccination and good wound care are the main feature to prevent tetanus. 4,21 The treatment of tetanus involves providing supportive care for symptoms of muscle spasms and potential respiratory compromise, neutralizing the remaining tetanus toxin, and good wound care for eradicating bacteria at the wound site. The de ning factor that contribute to therapeutic success was time for immunoglobulin administration to neutralize the toxin and/or tetanus toxoid vaccination as we can se in table 2.…”
Background: Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low-middle income countries, tetanus still occurs (mostly in adult) due to the lack of immunization related to religious tenets, cultural belief or inaccesibility to medical care. In addition, tetanus in pediatric population shows features which are quite distinct from the adult group. Case Description: We reported a 7 year old girl that presented to our institution with a history of falling 10 days prior the admission, with only skin laceration of her forehead. Since one day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed as unimmunized child with open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw”. Perioperative management of that rare case is reported and discussed. Conclusion: This case is so exceptional, since the infected open depressed skull fracture complicated with trismus in an unimmunized child occurrence in our center is extremely rare; the pediatric intensive care of such patients requires halting further toxin production, neutralisation of circulating toxin and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tents of anaesthetic care in such case had to well managed and planned prior the surgery.
“…Gejala awal tetanus ditandai dengan trismus, kejang, panas, opistotonus, dan kaku pada leher yang dijumpai pada kebanyakan pasien. 2 Faktor -faktor yang menyebabkan kematian pada pasien tetanus meningkat yaitu usia diatas 40 tahun, masa inkubasi < 7 hari, dan masa hospitalisasi yang singkat. 7 Terdapat hubungan korelasi yang signifikan antara komplikasi dengan mortalitas tetanus, pada hasil analisis multivariat menunjukan komplikasi kardiovaskular dan sistem pernafasan merupakan salah satu faktor kematian pada tetanus.…”
Section: Faktor -Faktor Yang Berhubungan Dengan Luaran Klinis Pasien ...unclassified
“…Hal ini sesuai dengan penelitian di Manado yang mendapatkan hasil tertinggi yaitu sebesar 31 orang (77,5%) pada kelompok masa inkubasi > 7 hari. 2 Hal ini dapat terjadi karena sebagian besar penderita tetanus memiliki riwayat luka yang jaraknya cukup jauh dari sistem saraf pusat seperti luka di daerah kaki. 13 Berdasarkan data distribusi frekuensi karakteristik pasien tetanus menurut derajat tetanus yaitu kelompok dengan jumlah terbanyak adalah kelompok dengan derajat tetanus II atau sedang yaitu sebanyak 18 orang (54,5%).…”
Introduction: Tetanuseis anwacute diseasedthat attacks thewperipheral nervousgsystem, causedebyfthe tetanospamin toxinvproducedbbymthe bacterium Clostridiumbtetani. Tetanusfcan be lifecthreatening andgis stillra healthgproblem forxdevelopingvcountries, includingvIndonesia. Thisfstudy aimsbto determinekthe characteristicskand relationships of age, incubation period, tetanus degree, and complications of the clinical outcome of tetanus patients in Sanglah Hospital Denpasar in January 2018 - October22019.Method: Thissstudy is accross-sectionall studyeof 333samples thatfwere takenxfrom secondaryddata infthe formvof medicalbrecords atvSanglah HospitalcDenpasar.rDatalwerekanalyzeduusing SPSS software version 23.Result: Tetanusfpatients with age <60 years found in 19 people, >60 years found in 14 people. The incubation period <7 days was found in 7 people, >7 days was found in 26 people. TetanussAblett I / mild scores was found in 1 person, II/moderate in 18 people, III/severe in 9 people, IV/very severe in 5 people. Cardiovascular complications was found in 16 people, respiratory system in 11 people, no complications in 6 people. Good clinical outcomes (survive) in 19 people, death in 14 people.Conclusion: There is no relationship between age and incubation period on clinical outcomes Theregis afstrong relationshiptbetween thebdegree of tetanusvand complicationsvwith clinicalboutcomes with significantgvalues respectively of p=0.008i (correlationbcoefficient = 0.443) and p=0.004 (correlationfcoefficient = 0.487). Latar Belakang: Tetanusrrmerupakant tpenyakit akutr yangr menyerangr susunany sarafhtepi, disebabkanlloleh toxin tetanospamin yangfdihasilkan oleh bakteri Clostridiummtetani. Penyakitrtetanus dapatbmengancam nyawabdan masihbmerupakan masalahxkesehatan bagiz negara-negara berkembang, termasukkkIndonesia. Penelitiannnini bertujuanf funtuktt mengetahui karakteristike dan hubunganefaktorrusia, masa inkubasi, derajat tetanus, dan komplikasi terhadap luaran klinis pasien tetanus di RSUP Sanglah Denpasar pada bulan januari 2018 – Oktoberr2019.Metode: Penelitiangini merupakanvpenelitian potongslintang pada233 sampeltyang diambilhdari datacsekunder berupazrekam medisddi RSUPCSanglahcDenpasar.wData dianalisisjmenggunakanrsoftware SPSSsversi 23.Hasil: Pasien tetanus dengan usia < 60 tahun dijumpai 19 orang, > 60 tahun sebanyak 14 orang. Masa inkubasi < 7 hari dijumpai pada 7 orang, > 7 hari dijumpai pada 26 orang. Tetanus skoreAblett I/ringan dijumpai 1 orang, II/sedang sebanyak 18 orang, III/berat sebanyak 9 orang, IV/sangat berat sebanyak 5 orang. Komplikasi kardiovaskular dijumpai 16 orang, sistem pernafasan 11 orang, tidak ada komplikasi pada 6 orang. Luaran klinis yang bertahan hidup = 19 orang, meninggal = 14 orang.Simpulan: Tidak terdapat hubungan antara faktor usia dan masa inkubasi terhadap luaran klinis. Terdapat hubungan yang kuat antara derajat tetanus dan komplikasi dengan luaran klinis dengan nilai signifikan berturut-turut sebesar p=0,008 (koefisienckorelasi 0,443) dan p=0,004 (koefisientkorelasi 0,487).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
