小结
定义
病史和体格检查
关键诊断因素
- 存在破伤风易感伤口
- 破伤风免疫接种状态
- 张口困难(牙关紧闭)
- 背痛
- 肌肉强直/肌张力增加
- 吞咽困难
- 痉挛
其他诊断因素
- 注射吸毒习惯
- 呼吸窘迫
- 血压、脉搏和体温不稳
- 出汗
危险因素
- 不完整的破伤风免疫接种
- 损伤
- 无菌产科实践
- 注射吸毒习惯
- 无菌肌内注射
- 腹部手术
- 针刺疗法、穿耳洞、修脚、牙签剔牙
- 坏死肿瘤
- 中耳感染
诊断性检查
需考虑的检查
- 临床诊断
- 血清毒素
- 伤口组织或拭子中检测到破伤风梭菌
- 血清抗毒素抗体
- 药物样品或者设备上的孢子
- 腰椎穿刺:
- 脑电图 (EEG)
- 肌电图(EMG)
治疗流程
清洁的小型伤口
破伤风易感伤口
临床破伤风
撰稿人
作者
Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, FISTM, DCH, DTM&H
Honorary Consultant and Emeritus Professor of Tropical and Infectious Diseases
Liverpool University Hospitals NHS Foundation Trust and Liverpool School of Tropical Medicine
Liverpool
UK
利益声明
NJB lectures at non-commercial meetings and conferences and publishes articles in peer-reviewed publications on the topic of tetanus. He has received sponsorship from specialist societies only to attend and speak at conferences. Views expressed in this topic are those of the contributor and do not necessarily represent the official position of the National Health Service, the National Institute for Health Research, the Department of Health, or the UK Health Security Agency. NJB is an author of a number of references cited in this topic.
Christopher M. Parry, BA, MB, BCh, PhD, FRCP, FRCPath, DTMH
Consultant in Medical Microbiology
Alder Hey Children’s NHS Foundation Trust
Director of Studies for DTM&H programme & Honorary Clinical Research Fellow
Liverpool School of Tropical Medicine
Liverpool
UK
Visiting Professor
School of Tropical Medicine and Global Health
Nagasaki University
Japan
Visiting Professor
Centre for Tropical Medicine and Global Health
University of Oxford
Oxford
UK
利益声明
CMP is an author of a number of references cited in this topic.
鸣谢
Dr Nicholas J. Beeching and Dr Christopher M. Parry would like to gratefully acknowledge Dr Lucy E. Cottle and Professor Enitan D. Carrol, previous contributors to this topic.
同行评议者
Louise Thwaites, BSc, MBBS, MD
Senior Clinical Research Fellow
Oxford University Clinical Research Unit
Hospital for Tropical Diseases
Ho Chi Minh City
Vietnam
Centre for Tropical Medicine and Global Health
Oxford University
Oxford, UK
利益声明
LT is an author of a number of references cited in this topic.
Katrina Kretsinger, MD, MA
Commander
U.S. Public Health Service
Medical Epidemiologist
HIV Vaccine Team
Epidemiology Branch
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Atlanta, GA
利益声明
KK declares that she has no competing interests.
鉴别诊断
- 药物(例如吩噻嗪类)诱发性肌张力障碍
- 士的宁中毒
- 神经阻滞剂恶性综合征
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