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
Lucy E. Cottle, MA, BM BCh, MRCP, DTMH
Consultant in Infectious Diseases
Leeds Teaching Hospitals NHS Trust
Leeds
UK
利益声明
LEC declares that she has no competing interests.
Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H
Consultant and Emeritus Professor of Tropical and Infectious Diseases
Royal Liverpool University Hospital
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 Public Health England. NJB is an author of a number of references cited in this topic.
Enitan D. Carrol, MBChB, MRCP, MRCPCH, MD, DTMH, Dip Med Sci
Professor in Paediatric Infection (Honorary Consultant)
University of Liverpool and Alder Hey Children’s NHS Foundation Trust
Liverpool
UK
利益声明
EDC declares that she has no competing interests.
Christopher M. Parry, BA, MB, BCh, PhD, FRCP, FRCPath, DTMH
Consultant in Medical Microbiology
Alder Hey Children’s NHS Foundation Trust
Senior Lecturer, University of Liverpool
Honorary Clinical Research Fellow, Liverpool School of Tropical Medicine
Liverpool
UK
Professor
School of Tropical Medicine and Global Health
Nagasaki University
Japan
利益声明
CMP is an author of a number of references cited in 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
更多 鉴别诊断指南
- 19 岁及以上成人推荐免疫接种时序， 美国，2021 年
- 破伤风类毒素、减毒白喉类毒素和无细胞百日咳联合疫苗的使用：美国免疫接种实践咨询委员会最新建议 - 美国，2019 年
更多 指南
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