Fukutake Toshio, Miyamoto Ryosuke
Department of Neurology, Kameda Medical Center, Japan.
Brain Nerve. 2011 Oct;63(10):1101-10.
Tetanus is a CNS disorder characterized by muscle spasms that is caused by the exotoxin of an anaerobic bacterium, Clostridium tetani. This disease is killing tens of thousands of neonates in developing countries. Although the incidence and mortality of tetanus has dramatically dropped in developed countries due to effective vaccination, appropriate wound management, and recent advances in intensive care, treatments remain difficult. From among developed countries, Japan has had a relatively high incidence of tetanus, and prevention is the problem especially in the elderly. We analyzed the data from 12 patients admitted to our hospital during 1997-2010. Their age ranged from 50-82 years; median 72 years with male to female ratio 5: 7, and all patients lacked a reliable history of toxoid immunization. Five patients out of 12 had history of cancer and one each had diabetes mellitus, pulmonary emphysema and Sjogren syndrome. In some cases, the patients had been initially misdiagnosed with ENT disorders, dental problems, or psychosis. Therefore to date, observation of clinical symptoms such as difficulty in mouth opening is considered the most crucial for diagnosis. The shorter was a period from onset to generalized convulsion (onset time), the longer was a duration of hospital stay. A notable complication was intramuscular hemorrhage in the lumbar muscles, which occurred in 2 patients. No patients died due to ICU managements, in which the most useful were propofol for spasm control and sedation, and magnesium sulfate for autonomic overactivity. Retrospectively, the Tetanus Severity Score (TSS) for mortality proposed by Thwaites et al (2006) is considered a useful tool also for predicting the clinical outcome at discharge. Although tetanus has been traditionally classified into the generalized, local, and cephalic types, a simpler severity-based classification into "severe", "moderate", and "mild" types may be more practical with regard to disease management.
破伤风是一种中枢神经系统疾病，其特征为肌肉痉挛，由厌氧细菌破伤风梭菌的外毒素引起。这种疾病正在发展中国家导致数以万计的新生儿死亡。尽管由于有效的疫苗接种、恰当的伤口处理以及重症监护方面的最新进展，破伤风在发达国家的发病率和死亡率已大幅下降，但治疗仍然困难。在发达国家中，日本的破伤风发病率相对较高，预防尤其是老年人群中的问题。我们分析了1997年至2010年期间我院收治的12例患者的数据。他们的年龄在50至82岁之间；中位数为72岁，男女比例为5:7，所有患者均缺乏可靠的类毒素免疫史。12例患者中有5例有癌症病史，各有1例患有糖尿病、肺气肿和干燥综合征。在某些情况下，患者最初被误诊为耳鼻喉疾病、牙科问题或精神病。因此，迄今为止，观察诸如张口困难等临床症状被认为对诊断最为关键。从发病到全身惊厥的时间（发病时间）越短，住院时间越长。一个显著的并发症是腰大肌内出血，发生在2例患者中。没有患者因重症监护室的管理而死亡，其中最有效的是使用丙泊酚控制痉挛和镇静，以及使用硫酸镁治疗自主神经功能亢进。回顾性来看，Thwaites等人（2006年）提出的用于预测死亡率的破伤风严重程度评分（TSS）也被认为是预测出院时临床结局的有用工具。尽管破伤风传统上分为全身型、局部型和头型，但就疾病管理而言，基于严重程度的更简单分类为“重度”、“中度”和“轻度”类型可能更实用。
