1. Systemic Infection Dr. Weiguo Hu 胡伟国 Dr. Weihua Qiu 邱伟华 Department of Surgery Rui Jin Hospital Shanghai Jiao Tong University School of Medicine

2. Etiology ： Microorganism Following sever trauma or local infection Catheter-related Infection Gut derived infectioin DM Steroids Immunocompromised

3. Gram-negative Bacteria E.Coli, P.Aeruginosa Gram-positive Bacteria Staphylococcus Aureus Streptococci Epidermidis Anaerobic bacteria Fungi Etiology ： Microorganism

4. Clinical Manifestation: Chills, Fever 40-41. C Headache, Sweatiness Nausea, Vomiting, Flushing Tachycardia Dyspnea DIC

5. Lab Test: Leukocytosis & left shift of WBCs Acidosis Hemoglobinuria Dysfunction of Liver and Kidney MODS

6. Diagnosis: History Physical Exam Lab Test Culture and Sensitivity Test

7. Management: General Supporting Antibiotics Surgical Intervention Management of Original Lesion

8. Resulted from exotoxin produced by C.tetani a severe disease primarily of older adults who are unvaccinated or inadequately vaccinated Characterized by hypertonia, painful muscular contractions, muscle spasms Tetanus:

9. Clostridium tetani An obligate anaerobic gram-positive bacillus Formation of spores which are resistant to heat, desiccation, and disinfectants Being ubiquitous in soil, house dust, animal intestines, and human feces Etiology:

10. Animal bites Burns Chronic otitis Crush injuries Dental procedures Elective surgical abrtion Frostbite wounds Human bites Puncture wounds Surgery Common sources:

11. Median Incubation period = 7 days 73% = 4-14 days 15% = < 4 days 12% = >14days clinical manifestations occurring within 1 week of an injury have more severe clinical courses Mild penetrating wound even be healed before toxin development Incubation Period:

12. Arrhythmias Coma Difficulty breathing Difficulty swallowing High blood pressure Irritability Neck pain & stiffness Restlessness Seizures Clinical Manifestation:

13. Trismus (lockjaw)—75% Pain & Stiffness (neck, back, abdomen) Dysphagia Restlessness Reflex spasms. “Risus sardonicus” expression Clinical Manifestation:

14. Wound Management TAT Tetanus vaccine (DPT) Tetanus immune globulin (for high-risk wounds or person who has never been immunized injections) Prevention:

15. to remove necrotic tissue and foreign bodies to create an aerobic environment Surgical therapy:

16. Anticonvulsants Valium Luminal Skeletal muscle relaxants Baclofen Dantrolene Antitoxins Tetanus immune globulins Medications:

17. Antibiotics Penicillin G Tetracycline Neuromuscular blocking agents Vecuronium Medications:

18. Overall mortality is approximately 45% In the United States mortality rate is 6% (previously tetanus toxoid) mortality rate is 15% (unvaccinated individuals) Mortality:

19. Most people recover from tetanus completely Recovery from 2 to 4 months Some individuals have low muscle tone after recovery. Prognosis:

20. God Bless Yuo ！