The potential development of tetanus in wounded patients with AIDS: tetanus toxoid and tetanus immune globulin.
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Biomedical subjects
Publications and source records attributed to W Furste.
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Traumatic, clostridial myonecrosis is a rare and serious complication of wounds. Nontraumatic, metastatic, clostridial myonecrosis may be caused by carcinoma of the large intestine. Nontraumatic myonecrosis becomes evident with localized pain, generalized toxicity, local signs of inflammation, and crepitation. Serum creatine kinase determinations may be of help in diagnosing patients suspected of having acute myonecrosis. Immediate heroic surgical intervention, usually with demonstration of Clostridium septicum, is mandatory to control the myonecrosis. Appropriate antibiotic therapy is a valuable adjunct to surgical intervention, and penicillin in massive doses appears to be the agent of choice for the clostridia. Hyperbaric oxygen therapy may help in the optimal control. General supportive measures, including frequent blood transfusions, are most important. To save the life of the patient with nontraumatic, metastatic, clostridial myonecrosis, it is necessary, as soon as the patient's general condition permits, to diagnose and eliminate the cause of the myonecrosis. In addition to the case reported, 16 cases have been reported in the literature, making a total of 17. Five patients have survived (survival rate, 29 percent).
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The two main conclusions drawn at the Dakar International Conference on Tetanus appeared to be: 1) Tetanus is a real problem in developing countries in both occurrence and mortality rates; and 2) Tetanus can be eliminated by the proper use of tetanus toxoid. Preventive medicine, more important nowadays than before, especially in light of broadened legal responsibilities of medical practitioners, must include tetanus immunology, prophylaxis, and therapy. Some currently listed standards for administration of tetanus antitoxin, immune globulin, and toxoid are perhaps in need for revision, at least in developed countries, and at the same time attention must be paid to the very high incidence of tetanus in developing nations, and to the alleviation and eventual eradication of tetanus everywhere in the world.
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