Tetanus is an acute infectious disease affecting the peripheral and central nervous systems, occurs with hypertonicity of skeletal muscles and clonic–tonic seizures.
ETIOLOGY
The causative agent of tetanus is a stick (Clostridium Tetani), has the form of drumsticks. Very stable in the external environment (up to 10 years). Tetanus bacillus is a conditionally pathogenic microorganism that constantly secretes a small amount of toxin that helps the body fight (the so-called partial immunity).
The disease develops when bacteria enter through the entrance gate: wounds, burns, splinters, cuts, bites, umbilical wound, during criminal abortions.
The production of toxin in large quantities occurs when it enters the wound from the outside under anaerobic conditions.
Clostridium secretes two potent toxins: tetanospasmin and tetanolysin. Tetanospazmin plays a major role. It is a biological poison that causes tetanic seizures. Tetanolysin has hemolytic, cardiotoxic and necrotic effects.
SYMPTOMS OF TETANUS
The incubation period is 5-14 days. Tetanus begins acutely. The patient is worried about dull pulling pains in the wound, which may occur in an already healed wound. Then there is a trism of the chewing muscles, the patient cannot open his mouth. Along with this, dysphagia appears (inability to swallow a food lump), rigidity of the occipital muscles. The patient has a sardonic smile on his face. The corners of the mouth are lowered, the forehead is tense, the lips are stretched. Hypertonicity of skeletal muscles is observed throughout the body.
Tetanus develops in a descending type. Thus, the occipital muscles are affected first, then the long muscles of the back, chest and abdomen, limbs, however, the muscles of the hands and feet are not affected.
Then clonic convulsions begin, first of the face, then of the whole body. Convulsions follow each other with stops and relaxation of muscles. As the disease develops, tetanic seizures begin, which follow each other without stopping, accompanied by pain.
This condition is called opisthotonus. At the same time , the patient has:
Head thrown back
The patient is lying on his back, the trunk is arched, the legs are stretched out
Rests on the heels and the back of the head
The stomach is tense, has the appearance of a board
A convulsive attack occurs at the slightest stimuli, visual, auditory, tactile, and enhances opisthotonus. The number of seizures can vary from 1-2 per day to dozens within 1 hour.
During convulsions and between them, the patient’s consciousness is clear, accompanied by a feeling of fear, hypersalivation, increased sweating. The patient suffers from insomnia.
COMPLICATIONS OF TETANUS
Ruptures of muscles and tendons
Bone fractures
Fractures of the spine
Fat embolism due to fractures
Asphyxia
Multiple contractures
Cranial nerve paresis
An equally formidable variant of infection is neonatal tetanus. Occurs due to violations of the rules of asepsis in the care of the umbilical wound. In most cases, the fatal outcome.
diagnostics
Tetanus is diagnosed on the basis of microscopic method, bacterial examination, serological examination of blood.
treatment
Administration of tetanus serum or immunoglobulin
For convulsive syndrome: Seduxen, Analgin, Diphenhydramine, Promedol, Diazepam, Aminazine
Antibacterial therapy
Muscle muscle relaxants
A ventilator and probe nutrition are necessarily prescribed
Surgical treatment of the wound
Individual fasting, strict bed rest
Therapeutic and protective mode: darkening of windows, soft bed with handles, complete silence, exclusion of drafts
PREVENTION
Most of the non-specific prevention consists of timely and proper treatment of wounds with antiseptic solutions, the application of an aseptic dressing.
Specific prevention consists in carrying out vaccination according to the vaccination calendar, as well as according to professional indications.
