Transcript Apixaban versus Warfarin in Patients with Atrial Fibrillation

<Disease review>
Tetanus
감염 내과 / R3 이민혜
1
Introduction
• First described by Hippocrates
• Etiology discovered in 1884 by Carle and Rattone
• Passive immunization used for treatment and prophylaxis during World
War I
• Tetanus toxoid first widely used during World War II
2
Clostridium tetani
• Anaerobic gram-positive rod, spore forming bacteria
• Spores found in soil, animal feces; may persist for months to years
• Multiple toxins produced with growth of bacteria
• Tetanospasmin estimated human lethal dose = 2.5ng/kg
3
Pathogenesis
• Anaerobic conditions allow germination of spores and production of
toxins
• Toxin binds in central nervous system
• Interferes with neurotransmitter release to block inhibitor impulses
• Leads to unopposed muscle contraction and spasm
4
Epidemiology
• Reservoir : soil and intestine of animals and humans
• Transmission : contaminated wounds, tissue injury
• Temporal pattern : peak in summer or wet season
• Communicability : not contagious
5
Epidemiology
6
Secular trends in the US
7
Incidence of tetanus in Korea
<파상풍 연간 발생수>
19
16
17
14
11
8
8
11
10
10
8
4
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
질병관리본부 http://www.cdc.go.kr
8
Clinical features
• Incubation period; 8days (range, 3-21days)
• Three clinical forms
 Local (not common)
 Cephalic (rare)
 Generalized (most common)
• Generalized tetanus : descending symptoms of trismus (lockjaw),
difficulty swallowing, muscle rigidity, spasms
• Spasms continue for 3-4 weeks; complete recovery may take months
9
Complications
• Laryngospasm
• Fractures
• Hypertension
• Nosocomial infections
• Pulmonary embolism
• Aspiration pneumonia
• Death
10
Diagnosis
• No laboratory findings characteristic of tetanus
• The diagnosis is entirely clinical and does not depend upon
bacteriologic confirmation
• C. tetani
 Wound in only 30% of cases
 Can be isolated from patients who do not have tetanus
11
Medical management
• Antimicrobial therapy : relatively minor role in the management of
tetanus, universally recommended
 Metronidazole(500mg IV every six to eight hours) : 7 to 10 days
 Alternative : penicillin G(2 to 4 million units IV every four to six hours)
• If tetanic spasms are occurring, supportive therapy and maintenance
of an adequate airway are critical
• Tetanus immune globulin (TIG) : recommended for persons with
tetanus




Only help remove unbound tetanus toxin
It cannot affect toxin bound to nerve endings
A single intramuscular dose of 3,000 to 5,000 units
Intravenous immune globulin (IVIG) contains tetanus antitoxin and may be used if
TIG is not available
• Active immunization with tetanus toxoid should begin or continue as
12
soon as the person’s condition has stabilized
Tetanus toxoid
• Formalin-inactivated tetanus toxin
• Schedule
 3 or 4 doses + booster
 Booster every 10 years
• Efficacy; approximately 100%
• Duration; approximately 10 years
• Should be administered with diphtheria toxoid as DTaP, DT, Td, or Tdap




DTaP = Diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed
DT = Diphtheria, Tetanus toxoids - pediatric
Td = Tetanus & diphtheria toxoids - adult
Tdap = Tetanus & diphtheria toxoids and acellular pertussis vaccine
13
Td vs. Tdap
• Td vaccine
 Used for many years
 Protects against tetanus and diphtheria
• Tdap vaccine
 Licensed in 2005
 First vaccine for adolescents and adults that protects against pertussis as well as
tetanus and diphtheria
• 11~18 year-olds and adults should receive ONE DOSE of Tdap to
replace a Td booster dose
JDT
JADTP
JDTPB
14
Td vs. Tdap
• Td vaccine
 Used for many years
 Protects against tetanus and diphtheria
• Tdap vaccine
 Licensed in 2005
 First vaccine for adolescents and adults that protects against pertussis as well as
tetanus and diphtheria
• 11~18 year-olds and adults should receive ONE DOSE of Tdap to
replace a Td booster dose
JDT
JADTP
JDTPB
15
Wound management
• All wounds should be cleaned
• Necrotic tissue and foreign material should be removed
• Proper immunization plays the more important role
16
표준 예방접종 일정표(소아용)
17
2012년 대한감염학회 권장 성인예방접종표
18
질환(상황)에 따른 성인예방접종 권장
19
의료인에게 권장하는 예방접종
20