George Elizabeth K., De Jesus Orlando, Tobin Ellis H., Vivekanandan Renuga
Creighton University
University of Puerto Rico, Medical Sciences Campus, Neurosurgery Section
is the causative organism for the disease known as tetanus. This bacillus and its spores are ubiquitous in the environment, and infection by plasmid-containing neurotoxin-producing strains has been a scourge since antiquity. Fortunately, the advent of highly protective vaccines has nearly eliminated tetanus worldwide. However, tetanus remains a significant infectious disease in resource-poor areas where public health outreach may be lacking. Conversely, in resource-rich areas with easily accessible vaccines, tetanus is a rare occurrence for most clinicians. Its rarity in the latter setting can lead to delays in diagnosis and optimal therapy when patients with tetanus seek medical attention. Thus, it is important to identify risk factors, recognize typical clinical presentations, and understand the immediate management and treatment of infection. Tetanus is a life-threatening disorder characterized by painful muscular spasms, hypertonia, and autonomic nervous system dysfunction. Despite widespread vaccination efforts in the US, the disorder still arises. Tetanus is classified into 4 categories: Generalized. Localized. Cephalic. Neonatal . Mortality rates are highest at the extremes of age, where a combination of diminished immunity and the presence of comorbidities is common. Ideally, individuals with tetanus should receive care from a multispecialty team within a critical care setting. Unfortunately, this optimal care environment is frequently unavailable in regions where it is most urgently needed for treating patients with tetanus. Furthermore, in resource-poor areas, neonatal tetanus is associated with high mortality. The management of tetanus relies on experience gained and reported in many case studies. Due to the relatively low incidence of infection and the potentially lethal nature of tetanus, there are no large randomized, placebo-controlled studies for a comprehensive comparison of best practices. Nevertheless, the management approach has been well established through anecdotal reports, case series, and small-scale randomized clinical studies.
是被称为破伤风的疾病的致病微生物。这种杆菌及其芽孢在环境中普遍存在，自古以来，含有产生神经毒素质粒的菌株感染一直是一大祸害。幸运的是，高度保护性疫苗的出现几乎已在全球范围内消除了破伤风。然而，在缺乏公共卫生推广服务的资源匮乏地区，破伤风仍是一种重要的传染病。相反，在疫苗易于获取的资源丰富地区，破伤风对大多数临床医生来说是罕见的。在后者这种情况下其罕见性可能导致破伤风患者就医时诊断和最佳治疗的延迟。因此，识别危险因素、认识典型临床表现并了解感染的即时管理和治疗很重要。破伤风是一种危及生命的疾病，其特征为痛苦的肌肉痉挛、肌张力亢进和自主神经系统功能障碍。尽管美国广泛开展了疫苗接种工作，但这种疾病仍会出现。破伤风分为4类：全身性、局限性、头部型、新生儿型。死亡率在年龄两端最高，在这些年龄段免疫力下降和合并症的存在很常见。理想情况下，破伤风患者应在重症监护环境中接受多专业团队的护理。不幸的是，在最急需治疗破伤风患者的地区，这种最佳护理环境往往无法提供。此外，在资源匮乏地区，新生儿破伤风与高死亡率相关。破伤风的管理依赖于许多病例研究中获得和报告的经验。由于感染发生率相对较低以及破伤风潜在的致命性质，没有大型随机、安慰剂对照研究来全面比较最佳实践。尽管如此，通过轶事报告、病例系列和小规模随机临床研究，管理方法已得到充分确立。
