TATALAKSANA TETANUS GENERALISATA GRADE III YANG DISERTAI DENGAN COMMUNITY ACQUIRED PNEUMONIA DI RUANG PERAWATAN INTENSIF (LAPORAN KASUS)

Authors

  • Nur Intan Nasution Rumah Sakit Umum Daerah Cibabat Cimahi
  • Sobaryati Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran Rumah Sakit Hasan Sadikin Bandung

Keywords:

tetanus, management of tetanus, intensive care unit

Abstract

Tetanus is an acute toxemia due to neurotoxins produced by Clostridium tetani characterized by periodic and severe muscle rigidity and spasme, which threatens life and is world health problem. Goals of tetanus management include: (1) neutralization of unbound toxin; (2) eradication of tetanospasmin source; (3) muscle spasm control and treatment of autonomic dysfunction; and (4) general supportive management. The purpose of this paper is to report and describe the successful management of tetanus with complications due to muscle spasm, autonomic dysfunction and respiratory failure in intensive care unit. The method used is case report with retrospective approach and analyzed descriptively. Male, 34 years old, was admitted with complaints of wholebody rigidity 1 day before admission accompanied with trismus, dysphagia, hypertension, tachycardia, risus sardonikus, opistotonus and spasm of all muscles. Patient was diagnosed with tetanus generalisata grade 3 and admitted for 18 days in intensive care unit using mechanical ventilation. Tracheostomy was performed on the sixth day. The patient was fully recovered and discharged after 35 days of hospitalization. It can be concluded that tetanus mortality rate remains high because of its complications and longterm care for critical illness. Immediate diagnosis, identification of complications, complication management, and quality of supportive management are keys in determining outcome.

References

Adam RD, Victor M. Tetanus in Principles Of Neurology. 7th Edition. Mc Graw-Hill International edition. Singapore. 2001.

Barlas UK, Kihtir HS, Yesilbas O, Petmezci MT, Akcay N, Petmezci E, Hatipoglu N, ┼×evketoglu E. Tetanus; a forgotten infection disease: a report of two cases. Turk J Pediatr. 2020.

Cook TM, Protheroe RT, Handel JM. Tetanus: A review of the literature. Br J Anaesth. 2001.

Espinosa W, Vinco V. Timing of Tracheostomy and Outcomes in Adults with Moderate and Severe Tetanus. Philipp J Otolaryngol Head Neck Surg. 2019.

Farrar_JJ,_Yen_LM,_Cook_T, et al, Tetanus, Journal of Neurology, Neurosurgery & Psychiatry_2000

Hannah Behrens, Sophie Ochmann, Bernadeta Dadonaite. "Tetanus". Published online at OurWorldInData.org. Retrieved from: 'https://ourworldindata.org/tetanus' [Online Resource]. 2019.

Lisboa T, Ho YL, Henriques Filho GT, Brauner JS, Valiatti JL, Verdeal JC, Machado FR. Guidelines for the management of accidental tetanus in adult patients. Rev Bras Ter Intensiva. 2011.

Prajogi P, Hartawan I. Magnesium sulfat pada tatalaksana tetanus generalisata di ruang terapi intensif. Medicina, 2019.

Rodrigo C, Fernando D, Rajapakse S. Pharmacological management of tetanus: an evidence-based review. Crit Care. 2014.

Saeed A, Muazzam M, Mansoor SA, Iqbal J. Impact of Early Tracheostomy on Outcome in Tetanus Patients. JSZMC. 2013.

Somia IKA. Management of tetanus complication. IOP Conf. Ser.Earth Environ. Sci. 2018.

Taylor AM, Tetanus,_Continuing Education in Anaesthesia Critical Care & Pain, 2006.

WHO Communicable Diseases Working Group on Emergencies. Current recommendations for treatment of tetanus during humanitarian emergencies, WHO Technical Note. Commun Dis Surveill Response, WHO Reg Off Am. 2010.

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Published

2021-01-14

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