Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1414 Tetanus Thalassemia

Treatment Options

■Human tetanus immune globulin (TIG) IM.

■Low dose as effective as higher dose. Best given before manipulating

wound. Consider infiltrating wound with TIG.

■Pooled IVIG is second line

■Equine tetanus immune toxin works, available, causes serum sick-

ness.

■If using antibiotics, metronidazole associated with better survival

rate than penicillin (a GABA antagonist).

follow-up

■Immunize since immunity not induced by disease. 2nd dT at time of

discharge, and 3rd 4 weeks later.

■During Treatment: Patients require rehabilitation and supportive

psychotherapy as they recover.

complications and prognosis

Complications

■Airway compromise – Intubation and mechanical ventilation, may

require early tracheostomy.

■Spasms (very common) – benzodiazepines

■Autonomic dysfunction from excessive catecholamine release-

labetalol or esmolol.

■Hypotension (uncommon) – may require norepinephrine

■High caloric and protein needs (common) – may require enteral and

parenteral nutrition begun early.

Prognosis

■Mortality for mild-moderate disease is 6%; 60% for severe disease

■Disease course may be 4–6 weeks

■Shorter incubation periods and more rapid progression from stiff-

ness to spasms associated with worse prognosis.

■Survivors often have post traumatic stress disorder requiring psy-

chotherapy.

THALASSEMIA

AKIKO SHIMAMURA, MD, PhD

history & physical

■Family history of thalassemia syndrome

■History of anemia. No anemia with single alpha gene deletion (alpha

thalassemia “silent carrier”)