Mar 05, 2018
The tetanus is a life-threatening disease. The disease is caused by an anaerobic spore-forming rod. It is caused by a toxin produced by bacteria that usually enter the body with a deep cut or a puncture wound. Spores need to be in an environment with a low oxygen content of about 7-10 days, during which they pass into the growing form of bacteria that produce a toxin. The toxin passes through the nerves into the spinal cord, where it causes rigidity and muscle spasms. The first sign of tetanus is often difficulty in opening the mouth;Stiffness can become so strong that the jaw remains closed permanently.
Spores of Clostridium tetani bacteria are found in soils, dust, stools of animals and sometimes people around the world. Cases of the disease are more often observed in rural areas with a warm climate, and also where the population is not vaccinated or partially vaccinated. People over the age of 50 are most often exposed to the disease, usually because they have not been vaccinated properly.
The degree of manifestation of the disease varies from moderate stiffness of the muscles to convulsions, in which the patient may suffocate as a result of blockade of the airways. The disease usually lasts from four to six weeks. Infection rarely occurs when a person is properly vaccinated. Aggressive treatment reduced mortality from disease to 25 percent and now tetanus is rare.
• Tetanus causes S. tetani bacteria. Infection and disease of tetanus occurs as a result of falling into the wounds, cracks and abrasions of the skin of the tetanus rod from the soil, where it is carried along with the feces of animals and humans and where it remains for a very long time in its sporiferous form. Less often tetanus develops after a burn, surgery or injection of drugs.
The causative agent forms a strong exotoxin that, with blood flow and along the motor fibers of the peripheral nerves, enters the spinal and medulla oblongata, disrupts the physiological correlation of impulse formation in the motor cells of the anterior horns of the spinal cord. There are constant tonic muscle tension and periodically appear tetanic convulsions.
• Stiffness of muscles and muscle pain, usually in the jaw, neck, back and abdomen.
• Muscle cramps, which often begin in the jaw and neck and can go into painful spasms all over the body.
• Pain and tingling in the wound site.
• Difficulty in swallowing and breathing.
• Grimaces due to an unintentional contraction of the facial muscles.
• In severe cases: high fever, excessive sweating, fast heartbeat or heart rhythm disturbance.
Incubation period from several days to 1 month. The early sign of the disease is convulsive contraction( trismus) of the chewing muscles, involuntary jaw closure, which complicates the opening of the mouth and chewing. At the very beginning of the disease appears dull soreness in the area of the entrance gate of an infection that has already closed the wound. Approximately 50% of cases in this early period of tetanus can be caused by the following symptom: by stretching the muscles in the area of the entrance gate of infection one can note the tension, rigidity of the muscles of the patient. There is also stiff neck muscles, difficulty in swallowing( dysphagia).
At the height of the disease, the patient's face takes on a characteristic appearance: prolonged tonic convulsions of facial muscles, a wrinkled forehead, raised eyebrows, wrinkles around the eyes, clenched teeth. Seizures span different muscle groups, starting with the muscles of the head in descending order. Attacks have a tonic and clonic character;each attack is accompanied by considerable morbidity in the corresponding muscle groups, their reflex excitability sharply worsens. At the height of development of a large seizure, the head of the patient throws back, the body flexes in the form of an arc, assumes the position of the opisthotonus, resting on the back of the head and heels;possible rupture of long back muscles, fractures of the spine. When tonic muscle cramps occur, abdominal muscles become particularly strained;convulsions make swallowing difficult;urination and evacuation of the intestine are also delayed. Tonic convulsions of the intercostal muscles can cause serious disorders of external respiration, lead to asphyxia and aspiration pneumonia. Noise, light, touch can cause convulsions reflexively. The temperature rises only in the first 3-4 days of the disease.
a) fulminant tetanus, which is accompanied by severe seizures and paralysis of external respiration;
b) Local tetanus( with his convulsions limited to any area of the body, for example tetanus of the head).
During childbirth, taking place in unsanitary conditions, tetanus of newborns is possible.
• The case history should include any previous immunization against tetanus, allergic reactions to vaccines or penicillin and recent injuries.
• Diagnosis is usually based on characteristic clinical signs.
• Analysis of cultures from the wound can be done, although not all patients with tetanus give a positive result.
Differential diagnosis is carried out with strychnine poisoning, in some cases - with hysterical fits and rabies.
• Deep, often surgical, wound cleaning is performed to eliminate the ingress of bacteria.
• Antitoxin should be injected immediately to neutralize the toxin of the bacterium.
• Antibiotics( usually penicillin, doxycycline or metronidazole) are administered intravenously.
• Medications to relax muscles like diazepam can be used to reduce stiffness of the muscles.
• Neuromuscular blockers( drugs that block signals transmitted from the nerves to the muscles) can be used to monitor severe spasms, especially if they make breathing difficult.
• Patients with severe breathing difficulties can undergo tracheotomy( tube insertion through the incision in the trachea) along with mechanical ventilation.
• An antitetanus vaccine may be administered.
Patients are hospitalized, they provide complete rest, all care for the patient, therapeutic manipulations are conducted under the protection of the introduction of neuroplegic mixtures, barbiturates. Anti-tetanus serum with preliminary intradermal probe and desensitization is used. Serum is given in / m in a dose of 100,000-150,000 IU / day.30 minutes before the introduction of serum, tetanus toxoid( 0.5 ml) was administered. For the arrest of the convulsive syndrome, a neuroplegic mixture is introduced( 2 ml of a 2.5% solution of aminazine, 0.5 ml of a 0.05% solution of scopolamine, 1 ml of a 2% solution of promedol, 2 ml of a 1% solution of dimedrol) in combination with chloral hydrate( 4% solutionin enemas), barbiturates. In the absence of effect, increased seizures, fulminant tetanus, treatment with muscle relaxants is performed with the transfer of the patient to controlled breathing. It is necessary to introduce saline solutions, 5% glucose solution, 4% sodium hydrogen carbonate solution, cardiac agents, antibiotics to prevent complications.
• Vaccination must begin in infancy. The most commonly used vaccine is KDS( whooping cough, diphtheria, tetanus).
• Revaccination is done every 5-10 years or after a severe injury.
• Wash with water and soap and use an antiseptic, such as hydrogen peroxide.
Thorough surgical treatment of wounds, administration of 1 ml of adsorbed tetanus toxoid under the skin, then after 30 min 1500-3000 IU of tetanus antitetanus( after preliminary intracutaneous assay and desensitization).Prevention of injuries in the workplace. Scheduled active immunization of certain professional contingents.
• Attention! Seek immediate medical attention if you begin to feel unusual spasms or stiffness of the muscles, regardless of whether you are injured or not.