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Quiz: How Much Do You Know About Tetanus?

Michael Stuart Bronze, MD

September 08, 2016


Tetanus is characterized by an acute onset of hypertonia, painful muscular contractions (usually of the muscles of the jaw and neck), and generalized muscle spasms without other apparent medical causes. Despite widespread immunization of infants and children since the 1940s, tetanus still occurs in the United States. Currently, tetanus primarily affects older adults because of their higher rate of nonvaccination or inadequate vaccination. What do you know about this condition? Test yourself with our quick quiz.




问题1:Which is currently the most common source of infection that leads to tetanus? 目前,引起破伤风最常见的感染来源是什么?


868516-figure1The source of infection usually is a wound (approximately 65% of cases), which often is minor (eg, from wood or metal splinters or thorns). Frequently, no initial medical treatment is sought. Chronic skin ulcers are the source in approximately 5% of cases. In the remainder of cases, no obvious source can be identified.


Tetanus can also develop as a complication of chronic conditions such as abscesses and gangrene. It may infect tissue damaged by burns, frostbite, middle ear infections, dental or surgical procedures, abortion, childbirth, and intravenous or subcutaneous drug use. Possible sources not usually associated with tetanus include intranasal and other foreign bodies and corneal abrasions.


For more on the etiology of tetanus, read here.


问题2:In the United States during the current vaccination era, which is the most common form of tetanus? 在美国目前疫苗接种的情况下,哪种类型的破伤风最为常见?


Illustration of a human hand with tophi, or swelling, at the joints of the fingers, due to gout. Gout is caused by elevated levels of uric acid in the blood, which crystallizes and deposits in joints and tendons.

Generalized tetanus is the most commonly found form of tetanus in the United States, accounting for 85%-90% of cases. The extent of the trauma varies from trivial injury to contaminated crush injury. The incubation period is 7-21 days, largely depending on the distance of the injury site from the central nervous system.


Localized tetanus involves an extremity with a contaminated wound and is highly variable in severity. It is an unusual form of tetanus, but the prognosis for survival is excellent. Cephalic tetanus may remain localized or may progress to generalized tetanus. It is an unusual form of tetanus with an incubation period of 1-2 days. The prognosis for survival is usually poor. Neonatal tetanus (tetanus neonatorum) occurs primarily in underdeveloped countries.


For more on the presentation of tetanus, read here.


问题3:Which is the leading cause of death associated with tetanus? 以下哪个是破伤风患者的首要死因?


868516-figure3Before 1954, asphyxia from tetanic spasms was the usual cause of death in patients with tetanus. However, with the advent of neuromuscular blockers, mechanical ventilation, and pharmacologic control of spasms, sudden cardiac death has become the leading cause of death. Sudden cardiac death has been attributed to excessive catecholamine production or the direct action of tetanospasmin or tetanolysin on the myocardium.


For more on the complications of tetanus, read here.


问题4:Which statement about the workup of tetanus is accurate? 有关破伤风检查的哪种说法是正确的?


868516-figure4No specific laboratory tests are indicated for determining the diagnosis of tetanus. The diagnosis is clinically based on the presence of trismus, dysphagia, generalized muscular rigidity, spasm, or combinations thereof. Although the laboratory findings are not diagnostically valuable, they may help exclude strychnine poisoning. A lumbar puncture is not necessary for diagnosis. Blood counts and blood chemical findings are unremarkable. Imaging studies of the head and spine reveal no abnormalities.


For more on the workup for tetanus, read here.

有关破伤风诊断的更多内容,请参见 here

问题5:Which is true regarding the treatment of tetanus? 有关破伤风治疗的哪种说法是正确的?


fig5_DT_13365948 [Converted]The goals of treatment should include stopping the production of toxin and its neutralization, airway management, and control of muscle spasm and dysautonomia. Prophylactic intubation should be seriously considered in all patients with moderate to severe clinical manifestations. Intubation and ventilation are required in 67% of patients. Attempting endotracheal intubation may induce severe reflex laryngospasm; preparations must be made for emergency surgical airway control. Rapid-sequence intubation techniques (eg, with succinylcholine) are recommended to avoid this complication. Tracheostomy should be performed in patients requiring intubation for more than 10 days. Tracheostomy has also been recommended after onset of the first generalized seizure.


Antimicrobials are used to decrease the number of vegetative forms of Clostridium tetani (the toxin source) in the wound. For years, penicillin G was used widely for this purpose, but it is not currently the drug of choice. Metronidazole (eg, 0.5 g every 6 hours) has comparable or better antimicrobial activity, and penicillin is a known antagonist of gamma-aminobutyric acid (GABA), as is tetanus toxin. Metronidazole is also associated with lower mortality. Human immune tetanus globulin is administered to neutralize the toxin.

抗生素用于减少伤口中破伤风梭状芽孢杆菌的繁殖体(毒素来源)数目。多年以来,青霉素得到广泛使用,但是目前并非首选药物。甲硝唑(0.5 g q6h)的具有相似或更佳的抗生素活性,而青霉素与破伤风毒素相似,均为gamma-氨基丁酸(GABA)的拮抗剂。甲硝唑治疗病死率较低。人破伤风免疫球蛋白可用于中和毒素。

In many cases, the wound responsible for tetanus is clear at presentation, in which case surgical debridement offers no significant benefit. If debridement is indicated, it should be undertaken only after the patient has been stabilized. The current recommendation is to excise at least 2 cm of normal viable-appearing tissue around the wound margins.

对于很多病例,就诊时导致破伤风的伤口即很明确,此时进行外科清创并无益处。如果需要进行清创,应当在患者病情稳定后进行。目前推荐切除伤口边缘至少2 cm的正常组织。

For more on the treatment of tetanus, read here.


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