Tetanus is an acute bacterial disease that causes severe damage nervous system with the development of tonic tension of skeletal muscles and generalized convulsions. Most people know that tetanus is extremely dangerous and very often leads to painful death. What kind of disease is this? What are the first symptoms and signs of tetanus in a person? Why is death a common outcome? How can you protect yourself? What to do if infection does occur? More details in our article.

Tetanus belongs to the group of neuroinfections. This disease can affect not only humans, but also all warm-blooded animals. Most often, signs of tetanus are found in residents of rural areas. This is due to the fact that the infectious agent can remain in the soil for a long time.

The disease is not transmitted through ordinary contact with a carrier of the bacterium. In order for a person to become infected, the pathogen must come into contact with the wound surface.

It is not the microorganism itself that is dangerous to humans, but its metabolic products, because they contain a strong biological poison that affects the nervous system: first the peripheral and then the central. The toxin is safe if swallowed, as it is not able to be absorbed through the mucous membrane. It is destroyed when:

• exposure to an alkaline environment,
• sunlight
• when heated.

Causes

Tetanus is caused by Clostridium tetani spores entering a wound. In the absence of oxygen they turn into active forms. The bacterium itself is harmless. But it produces the strongest biological poison - tetanus toxin, which is second only to botulinum toxin in its toxic effect.

Routes of infection with tetanus:

• puncture, cut or laceration wounds;
• splinters, skin abrasions;
• burns/frostbite;
• fractures and animal bites;
• umbilical wound in newborns.

People who have to get shots frequently are also at greater risk. Any wound (including bites and burns) increases the risk of contracting tetanus.

The most common causes of death from tetanus are:

• choking as a result of prolonged spasm of the vocal cords or respiratory muscles;
• heart failure;
• spine fracture;
• painful shock.

In children, tetanus is complicated, and at a later date - by indigestion.

The disease tetanus develops exclusively when the microorganism gets on the wound surface.

Incubation period

1. The incubation period of the disease can last from several days to one month, on average from 7 to 14 days.
2. The shorter incubation period, the more severe the disease and the higher the likelihood of death.
3. The farther the lesion is located from the central nervous system, the longer the IP. With a short incubation period, the disease is more severe. Short IP is observed with injuries to the neck, head and face.

Symptoms of tetanus in humans and photos

There are 4 periods during the disease:

1. Incubation.
2. Start.
3. The height of
4. Recovery.

In the photo the man has tetanus

On average, the incubation period lasts about 2 weeks. The start time for this classification is 2 days. During this period, the main symptoms of tetanus are: pain at the site of penetration of clostridia. The wound in this place, as a rule, has already healed. Then trismus appears - spasm masticatory muscles. The jaws are clenched convulsively, so that not all patients can open their mouths.

During the height of the disease, symptoms of skeletal muscle irritation appear. Muscle hypertonicity is accompanied by severe pain. Prevail extensor reflexes, which is manifested by rigidity of the neck muscles, throwing the head back, hyperextension of the spine (opisthonus), and straightening of the limbs. Hypertonicity of the muscles involved in breathing leads to hypoxia.

Symptoms of tetanus in humans:

• spasm of the masticatory muscles (difficulty opening the mouth);
• spasms of the facial muscles (a “sardonic” smile appears, the lips are stretched, their corners are lowered, the forehead is wrinkled);
• Due to spasm of the pharyngeal muscles, swallowing is impaired;
• convulsions that cover all the muscles of the body in a downward direction (a person arches, standing on his heels and the back of his head - opisthotonus). Painful cramps occur even with minor irritation;
• seizures occur in response to any irritating factor (light, sound, noise).

At an early stage, tetanus has symptoms similar to many diseases, for example, gingivitis and inflammation of the mandibular joints. Indeed, during the development of tetanus bacillus in the body, the masticatory muscles are in constant tension and sometimes twitch. Gradually the infection begins to resemble epilepsy and severe attack hysterics.

The action of the pathogen, as we have already noted, occurs extremely quickly; moreover, the first symptoms of tetanus in a person are observed within a few hours from the moment it enters the body.

The waste products of infection are not absorbed through the mucous membrane, which determines their absolute safety when swallowed; in addition, exposure to ultraviolet radiation and heating leads to a very rapid death of pathogens.

It is worth noting that The most dangerous period of tetanus is considered to be from 10 to 14 days diseases. It is at this time that the patient experiences rapid metabolism, metabolic acidosis and increased sweating. A cough begins and it is sometimes very difficult for the patient to clear his throat. In addition to all this, convulsive attacks may occur during coughing and swallowing (see photo).

The first signs of tetanus in adults

Adults have immunity against infection due to vaccination. To maintain the required concentration of protective antibodies in the blood, revaccination is required every 10 years. In the absence of natural protection, adults, like children, develop acute symptoms:

• may manifest itself most early sign- stupid nagging pain in the area where infection has penetrated through damaged skin;
• tension and convulsive contraction of the masticatory muscles, which leads to difficulty opening the mouth;
• difficult and painful swallowing caused by convulsive spasm of the pharyngeal muscles.

How does the disease progress in children?

Infection of newborns with tetanus occurs mainly during childbirth outside a medical institution, when they are delivered by people who do not have a medical education, in unsanitary conditions, and the umbilical cord is tied with unsterile objects (cut with dirty scissors, a knife, and tied with ordinary untreated threads). The incubation period is short, 3-8 days, in all cases a generalized severe or very severe form develops.

Tetanus most often occurs in children between the ages of three and seven years. Mostly this disease has a summer seasonality and affects more rural residents.

There are certain symptoms that appear when tetanus is fully developed. In a child:

• the muscles of the legs, arms and torso are under severe tension;
• they do not relax even during sleep;
• the contours of the muscles begin to emerge, especially in boys;
• after three to four days, the muscles of the abdominal wall harden, the lower limbs spend a large amount of time in an extended position, and their movement is limited;
• breathing becomes interrupted and quickens;
• swallowing becomes difficult, causing pain when breathing.

If the parents showed it on time medical workers A child who has tetanus is treated gradually and the symptoms of this disease disappear over time. The duration of this stage reaches 2 months.

Throughout this period, the child is at great risk of developing the most various complications. In this regard, it is required constant monitoring his condition.

Stages of the disease

As with any infectious process, the clinical picture of tetanus consists of several successive periods. The following stages of disease development are distinguished:

Stages of tetanus	Description and symptoms
Light	Last no more than 21 days. Characterized by moderate spasms of the facial and back muscles. Clonic-tonic convulsions may be completely absent. The temperature may remain within normal limits or be slightly elevated.
Average	The moderate degree of the disease manifests itself in the progression of muscle damage with typical signs, tachycardia and a strong increase in body temperature. The frequency of seizures is no more than one to two times per hour, and their duration is no more than half a minute.
Heavy	Symptoms: convulsions are frequent and quite intense, a characteristic facial expression appears.
Extremely heavy	A particularly severe course is encephalitic tetanus (Brunner) with damage to the medulla oblongata and upper parts of the spinal cord (cardiovascular, respiratory centers), neonatal tetanus and gynecological tetanus.

Possible complications

The prognosis of tetanus depends on the form of the course, which is more severe the shorter the incubation period and the faster the development occurs clinical symptoms. Severe and fulminant forms of tetanus are characterized by unfavorable prognosis, if timely assistance is not provided, death is possible. Mild forms of tetanus can be successfully treated with proper treatment.

Any serious illness leaves its traces and tetanus is no exception. Because of this, the following complications arise:

• Breaks muscle tissue and ligaments;
• Fractures;
• Inflammation of the lungs and bronchus.

Diagnostics

Tetanus is a serious infection that can be prevented by vaccination. If the disease does occur, early diagnosis is necessary. The sooner this disease is suspected, the greater the chance of survival the patient has.

From laboratory methods, bacteriological diagnostics is acceptable and most relevant, since it is aimed at isolating and identifying the pathogen and detecting its toxin in the material under study (microscopy of fingerprint smears, histological examination fabrics).

Treatment of tetanus in humans

Treatment of tetanus should only be carried out in a hospital setting. The main goal is to neutralize and remove the toxin from the body as quickly as possible.

The wound through which the infection occurred is injected with anti-tetanus serum, then it is opened wide and a thorough surgical treatment is carried out. The sooner treatment with anti-tetanus serum is carried out, the easier the symptoms of tetanus are tolerated and the fewer consequences the disease has for the body.

Subsequently, preparations containing proteolytic enzymes (Chymotrypsin, Trypsin, etc.) are usually used to heal the wound.

The course of treatment for tetanus includes:

1. combating tetanus pathogens in the area of ​​the primary lesion (opening the wound, removing dead skin, sanitation and aeration);
2. administration of antitetanus serum; relief of severe cramps;
3. maintaining the vital functions of all body systems;
4. prevention of complications;
5. complete nutrition, rich in vitamins and microelements to strengthen the immune system.

It is advisable that the patient be treated for tetanus in a separate room, which will eliminate the negative impact of emerging external irritants on him.

In addition, it is important to have a permanent post for systematic monitoring of the patient’s general condition. If it is not possible to eat food on your own, it is administered through the use of a probe.

If a person has had tetanus, he does not develop long-term immunity, and he can become infected with this disease again.

Prevention

Prevention of tetanus can be:

• nonspecific: prevention of injuries, contamination of wounds, sanitary education, thorough surgical treatment with timely dressings, compliance with the rules of asepsis and antisepsis in hospitals;
• specific: vaccination.

Tetanus (tetanus) is an acute infectious zooanthroponotic disease, which is characterized by primary damage to the nervous system (tonic and convulsive contractions of striated muscles) due to the effect of the tetanus bacillus exotoxin on the macroorganism.

Stobniak: causes and development factors

Pathogen of this disease is Clostridium tetani, a spore-forming bacterium. Their spores are extremely resistant to antiseptics, disinfectants and physical and chemical factors. It can survive in soil, feces and on various objects for more than 100 years. When favorable conditions occur (lack of oxygen, sufficient humidity, temperature about 37 o C), the spores transform into less stable vegetative forms, which produce one of the most dangerous poisons, second in strength only to botulinum toxin. However, the toxin is safe if swallowed, as it is not able to be absorbed through the mucous membrane. It is destroyed when exposed to an alkaline environment, sunlight and heat.

The source of infection is birds, herbivores and humans, with whose feces clostridium enters the environment. Sick epidemiological danger don't imagine. The transmission mechanism is contact (through damage and wounds on the skin and mucous membranes, burns, frostbite, during childbirth, etc.). Cases of umbilical tetanus (infection through an unsterile infected instrument during ligation of the umbilical cord) have been described. The risk group for this disease includes workers agriculture due to contact with animals, soil and sewage, as well as adolescents due to frequent trauma.

Symptoms of tetanus: how the disease manifests itself

The incubation period lasts on average 1-2 weeks. The shorter this period, the more severe the course. Symptoms of tetanus are as follows:

· Dull nagging pain, twitching and tension in the area of ​​injury;

· Headache, irritability, sweating, chills, yawning, insomnia;

· Tension and convulsive twitching of the masticatory muscles (trismus);

· Convulsive contractions of the facial muscles, which causes a person to have a sardonic smile (eyebrows are raised, lips freeze in a smile, but the corners of the mouth are lowered down);

Opisthotonus (spasm of the muscles of the back and limbs);

·Due to spasm of the pharyngeal muscles, swallowing is impaired;

Painful stiff neck;

Rigidity gradually descends down to the lower extremities, painful cramps occur even with minor irritation.

All of the above can lead to dysfunction of swallowing, breathing, urination and defecation, cardiac dysfunction, which often causes death.

Diagnosis of tetanus

For tetanus laboratory diagnostics practically does not matter, since at the beginning of the disease the toxin is not detected in the blood, antibody titers do not increase (even a lethal dose of the toxin is an insignificant antigenic irritant and does not cause an immune response). The detection of antitoxic antibodies can only indicate a history of vaccinations. Sometimes bacteriological methods are used (histological examination of tissues obtained during surgical treatment of wounds, microscopy of fingerprint smears, inoculation of wound discharge under anaerobic conditions in nutrient media).

However, early diagnosis of this disease is possible only with a careful collection of epidemiological history (injuries, burns, wound infections, surgical interventions, obtained within a time frame that corresponds to the incubation period) and with the active detection of symptoms of the prodromal period. At the height of the disease, there are no problems with diagnosis due to the presence of pathognomonic symptoms. At the same time, deviations from internal organs, meninges, cerebrospinal fluid, blood and urine are absent.

Types of disease: classification of tetanus

According to the mechanism of infection there are:

· Traumatic tetanus;

Tetanus, which developed as a result of destructive and inflammatory processes(tumors, ulcers, bedsores, etc.);

Cryptogenic tetanus (there is no history of trauma or the presence of a possible gateway of infection)

According to the prevalence, tetanus is generalized (general) and local (facial tetanus or Rose's cephalic tetanus).

According to the severity of the course, tetanus can be:

Mild course (rare, more common in previously vaccinated individuals);

·Moderate severity (tension and muscle cramps are moderate, infrequent);

· Severe severity (convulsions are frequent and quite intense, a characteristic facial expression appears);

· Particularly severe cases are encephalitic tetanus (Brunner) with damage to the medulla oblongata and upper parts of the spinal cord (cardiovascular, respiratory centers), neonatal tetanus and gynecological tetanus.

Patient actions for tetanus

Immediately contact a specialist indicating an accurate medical history.

Treatment of tetanus

To neutralize the toxin in the blood, antitetanus serum or specific immunoglobulin is injected intramuscularly. The dosage is determined by the infectious disease specialist on an individual basis. The entrance gate of the infection is injected with antitetanus serum, opened and the wound is surgically treated. Further therapy is symptomatic.

Complications of tetanus

Complications can be different: bronchitis, pneumonia, sepsis, myocardial infarction, muscle and tendon ruptures, dislocations and spontaneous fractures, thrombosis and embolism, pulmonary edema, temporary paralysis of the cranial nerves, muscle contractures, compression deformity of the spine (persists in in some cases up to 2 years), etc.

Tetanus

What is Tetanus -

Tetanus (lat. Tetanus)- a zooanthroponotic bacterial acute infectious disease with a contact mechanism of pathogen transmission, characterized by damage to the nervous system and manifested by tonic tension of the skeletal muscles and generalized convulsions.

Brief historical information

The disease has been known since ancient times; its occurrence has long been associated with injuries and wounds. The name of the disease and the first description of its clinical manifestations were given by Hippocrates. Tetanus bacillus was first discovered by N.D. Monastyrsky (1883) in the corpses of dead people and A. Nikolayer (1884) in abscesses in experimental tetanus in animals. A pure culture of the pathogen was isolated by the Japanese bacteriologist Sh. Kitazato (1887). Later, he obtained tetanus toxin (1890) and, together with E. Bering, proposed an antitoxic serum for the treatment of tetanus. The French immunologist G. Ramon developed a method for producing tetanus toxoid (1923-1926), which is still used to prevent the disease.

What provokes / Causes of Tetanus:

Pathogen- obligate anaerobic gram-positive spore-forming motile rod Clostridium tetani of the Bacillaceae family. The spores are located terminally, giving the bacteria the appearance of “drumsticks” or “tennis rackets.” C. tetani produces a potent exotoxin (tetanospasmin), a cytotoxin (tetanolysin) and a so-called low molecular weight fraction. In soil, feces and on various objects, spores can persist for years. Maintain a temperature of 90 ° C for 2 hours. Under anaerobic conditions, at a temperature of 37 ° C, sufficient humidity and in the presence of aerobic bacteria (for example, staphylococci), spores germinate into vegetative forms. Vegetative forms of tetanus bacillus die within a few minutes when boiled, after 30 minutes - at 80 ° C. Antiseptics and disinfectants kill the tetanus pathogen within 3-6 hours. In countries with warm climates, spores can grow directly in the soil. In C. tetani, two types of antigens are detected: somatic (O-antigen) and flagellar (H-antigen). Based on the structures of flagellar antigens, 10 serovars are distinguished. All serovars produce tetanospasmin and tetanolysin, which are identical in antigenic properties.

• Tetanospasmin- one of the most powerful biological poisons. It is a polypeptide with a “distanced” mechanism of action, since bacteria rarely leave the primary site of infection. The toxin is fixed on the surface of the processes of nerve cells, penetrates them (due to ligand-mediated endocytosis) and enters the central nervous system through retrograde axonal transport. The mechanism of action is associated with suppression of the release of inhibitory neurotransmitters (in particular, glycine and γ-aminobutyric acid) in synapses (the toxin binds to synaptic proteins synaptobrevin and cellubrevin). Initially, the toxin acts on peripheral nerves, causing local tetanic muscle contractions. In cultures, the toxin appears on the 2nd day, reaching its peak formation by the 5-7th day.
• Tetanolysin exhibits hemolytic, cardiotoxic and lethal effects, causes the development of local necrotic lesions. This toxin plays less of a role in the pathogenesis of the disease. important role. The maximum accumulation of the toxin in the culture is observed after 20-30 hours. The processes of its formation are not associated with the synthesis of tetanospasmin. The low molecular weight fraction enhances the secretion of mediators at neuromuscular synapses.

Epidemiology

Reservoir and source of infection- herbivores, rodents, birds and humans, in whose intestines the pathogen lives; the latter is released into the external environment with feces. Tetanus bacillus is also widespread in soil and other environmental objects, where it can multiply and persist for a long time. Thus, the pathogen has two interconnected and mutually enriching habitats, and, consequently, two sources of the pathogen - the intestines of warm-blooded animals and the soil. The significance of a particular source is apparently largely determined by the climatic and geographical conditions of the area. The most favorable for vegetation and preservation of the microorganism are chernozem and red soil, humus-rich soils, as well as soils that are well fertilized organic substances. From the soil with dust, bacteria can enter any premises (including dressing rooms and operating rooms), various items and materials used in surgical practice(various powders, gypsum, talc, medicinal clay and mud, cotton wool, etc.).

The frequency of carriage of tetanus bacillus spores by humans varies from 5-7 to 40%, and an increased degree of carriage is noted among persons who professionally or at home come into contact with soil or animals (agricultural workers, grooms, milkmaids, sewer workers, greenhouse workers, etc.). C. tetani is found in the intestinal contents of cows, pigs, sheep, camels, goats, rabbits, guinea pigs, rats, mice, ducks, chickens and other animals with a frequency of 9-64%. The contamination of sheep droppings reaches 25-40%, which is of particular epidemiological significance in connection with the use small intestine sheep for the production of surgical catgut.

Transmission mechanism- contact; The pathogen penetrates through damaged skin and mucous membranes (wounds, burns, frostbite). Infection of umbilical wounds if asepsis is not observed during childbirth can cause neonatal tetanus. The location of the pathogen's entrance gate can be different in nature and location open wounds(punctures, splinters, cuts, abrasions, crushes, open fractures, burns, frostbite, bites, necrosis, inflammatory processes); in these cases, post-traumatic tetanus develops. Surgical wounds, especially on the colon and ischemic extremities, can become an entry point for infection with the subsequent development of postoperative tetanus. Abortion interventions outside of health care facilities may cause post-abortion tetanus. Possibility of pathogen transmission from a patient healthy person absent.

Natural sensitivity of people high. Those who have recovered from tetanus do not develop immunity to the disease, since a very small dose of the toxin that can cause the disease is not sufficient to ensure an immunological response.

Basic epidemiological signs. The incidence is sporadic in the form of unrelated cases. The zonal spread of infection is determined by both climatic and geographical and socio-economic factors. The seasonality of the disease is spring and summer. Among the cases, residents of rural areas, children and the elderly predominate; It is in these groups that the majority of deaths are recorded. Due to the widespread implementation of active immunization, tetanus in newborns is not currently registered. The presence of a permanent reservoir of infection in the soil determines the possibility of infection as a result of minor household injuries. There are still cases of nosocomial infection with tetanus during operations on the extremities, gynecological operations and surgical interventions on the gastrointestinal tract.

Pathogenesis (what happens?) during Tetanus:

The pathogen in the form of spores enters the human body through damaged skin and mucous membranes. Under anaerobic conditions (deep puncture wounds, wounds with deep pockets or necrotization of crushed tissues) development and reproduction of vegetative forms occur in wounds, accompanied by the release of exotoxin. Along motor fibers peripheral nerves and with the blood flow tetanospasmin penetrates into the spinal medulla oblongata and the reticular formation of the trunk, where it is recorded mainly in polysynaptic interneurons reflex arcs. The bound toxin cannot be neutralized. Paralysis develops interneurons with suppression of all types of their synaptic inhibitory effects on motor neurons. As a result, the uncoordinated flow of motor impulses from motor neurons to muscles through neuromuscular junctions. Bandwidth the latter increases due to increased secretion of acetylcholine under the influence of the low molecular weight fraction. A continuous flow of efferent impulses maintains constant tonic tension in the skeletal muscles.

At the same time, afferent impulses increase in response to the influence of tactile, auditory, visual, olfactory, gustatory, temperature and barometric stimuli. In this case, tetanic convulsions periodically occur.

Muscle tension leads to the development of metabolic acidosis. Against this background, both tonic and tetanic convulsions intensify, cardiac activity worsens, and preconditions are created for secondary bacterial complications. Cardiovascular disorders (tachycardia, arterial hypertension, arrhythmia, ventricular fibrillation) are aggravated due to the hyperactivity of the sympathetic nervous system that develops during tetanus. The excitability of the cortex and reticular structures of the brain increases. Possible damage to the respiratory and vasomotor centers and nuclei of the vagus nerve (bulbar tetanus), which often leads to the death of patients. Other causes of death may be associated with asphyxia due to seizures and the development of complications (pneumonia, sepsis).

Post-infectious immunity does not develop in tetanus. Specific pathological changes are scanty (venous congestion, minor hemorrhages, in rare cases muscle ruptures and muscle hematomas).

Symptoms of Tetanus:

Taking into account the entrance gates of infection, they are distinguished:

• traumatic tetanus;
• tetanus, which developed as a result of inflammatory and destructive processes;
• cryptogenic tetanus (with unknown portal of entry).

According to the prevalence of the process, the disease is divided into general (generalized) and local tetanus. The latter is rarely observed.

Incubation period varies from several days to 1 month, on average not exceeding 1-2 weeks. The disease begins acutely, only sometimes prodromal phenomena are noted in the form of tension and muscle twitching at the site of injury, malaise, headache, sweating, irritability.

IN initial period of tetanus In some cases, its earliest sign may appear - dull nagging pain in the area of ​​the entry gate of infection, even in already completely healed wounds. The main specific symptoms that occur during this period are trismus, sardonic smile, dysphagia and stiff neck. These signs appear early and almost simultaneously.

• Lockjaw- tension and convulsive contraction of the masticatory muscles, which leads to difficulty opening the mouth.
• Tonic spasms of facial muscles are expressed in a “sardonic smile” (risus sardonicus), giving the patient’s face a peculiar expression: wrinkled forehead, narrowed palpebral fissures, stretched lips, drooping corners of the mouth.
• Dysphagia (difficulty and painful swallowing) caused by convulsive spasm of the pharyngeal muscles. The combination of trismus, “sardonic smile” and dysphagia is characteristic only of tetanus.
• Stiff neck, caused by tonic spasms of skeletal muscles, in tetanus is not a meningeal symptom and is not combined with other meningeal signs (Kernig's, Brudzinsky's symptoms, etc.).

IN the height of the disease painful tonic spasms spread to the muscles of the trunk and limbs (without involving the hands and feet). Tonic muscle tension is constant; muscle relaxation, as a rule, does not occur even in sleep. The contours of large skeletal muscles are clearly outlined, especially in men. From the 3-4th day of illness, the muscles of the abdominal wall become hard as a board, the legs are often extended, and movements in them are limited. At the same time, the intercostal muscles and diaphragm are involved in the process, breathing becomes shallow and rapid. Tonic tension of the perineal muscles leads to difficulty defecating and urinating. As a result of severe tension and soreness of the back muscles in severe tetanus, opisthotonus develops: when the patient is positioned on his back, his head is thrown back, the lumbar part of the body is raised above the bed in such a way that you can stick your hand between the back and the bed.

Against the background of constant tonic tension of the skeletal muscles, tetanic convulsions occur periodically with varying frequencies. Their duration initially ranges from a few seconds to a minute. Most often they are provoked by auditory, visual and tactile stimuli. In mild cases of the disease, 1-2 attacks of convulsions per day are observed; in severe cases of tetanus, they can be repeated up to tens of times within an hour, becoming longer and more widespread. Seizure attacks occur suddenly. In this case, the patient’s face takes on a pained expression and becomes cyanotic, the contours of the muscles are more clearly outlined, and opisthotonus increases. Patients moan and scream because of the pain, trying to grab the headboard of the bed with their hands to ease their breathing. Body temperature rises, the skin (especially the face) becomes covered with large drops of sweat, hypersalivation, tachycardia, shortness of breath are noted, heart sounds are loud, blood pressure tends to increase. The convulsive syndrome develops and intensifies while the patient maintains a clear consciousness; confused consciousness and delirium appear only shortly before death.

The period from the end of the first week to the 10-14th day of illness is the most dangerous for the patient’s life. Metabolic acidosis and a sharp increase in metabolism cause hyperpyrexia and increased sweating. It is difficult to produce sputum because coughing provokes tetanic convulsions. Deterioration of pulmonary ventilation often contributes to the development of secondary bacterial pneumonia. The heart is dilated due to both ventricles, the sounds are loud. The liver and spleen are not enlarged. Deep intoxication of the brain stem causes depression and arrhythmia of breathing, weakening of cardiac activity; possible cardiac paralysis. Due to frequent and prolonged tonic convulsions, painful insomnia and irritability develop, and the threat of asphyxia increases.

In cases of a favorable outcome, the period of convalescence is long; Gradually weakening clinical manifestations of the disease persist for 2-4 weeks, recovery is delayed up to 1.5-2 months.

The severity of tetanus is determined by a combination of several indicators.

• At mild current The disease incubation period often exceeds 20 days. Trismus, “sardonic smile” and opisthotonus are moderate, hypertonicity of other muscle groups is weak. Tonic convulsions are absent or insignificant, body temperature is normal or subfebrile. Symptoms of the disease develop within 5-6 days.
• In cases moderate course the incubation period is 15-20 days. The main clinical signs of the disease increase over 3-4 days. Convulsions occur several times a day, tachycardia and sweating are moderate, body temperature is low-grade or (less frequently) high.
• Severe form Tetanus is characterized by a shortened incubation period to 7-14 days, a rapid (over 1-2 days) increase in symptoms, a typical clinical picture with frequent and intense tetanic convulsions (several times within an hour), expressed by sweating and tachycardia, high fever.
• Very severe course are distinguished by a shortened (less than a week) incubation period and fulminant development of the disease. Tonic convulsions occur several times within 3-5 minutes. They are accompanied by hyperpyrexia, severe tachycardia and tachypnea, cyanosis, and threatening asphyxia.

One of the most severe forms of generalized descending tetanus is Brunner's cephalic (“bulbar”) tetanus. It occurs with primary damage to the muscles of the face, neck and pharynx, with spasms of the swallowing and intercostal muscles, muscles of the glottis and diaphragm. Usually the respiratory, vasomotor centers and vagus nerve nuclei are affected. Gynecological tetanus and neonatal tetanus, which is one of the important causes of child mortality in developing countries, are also distinguished by the severity of their course and unfavorable prognosis. It is associated with unsatisfactory conditions of provision obstetric care and the lack of immunization programs for women.

Ascending tetanus, observed in rare cases, first manifests itself as pain, tension and fibrillary twitching in one muscle group; later, as new overlying parts of the spinal cord are affected, the disease acquires the typical features of a generalized process.

Local tetanus is rare. One of his typical manifestations, developing after wounds of the face and head, there is facial paralytic tetanus Rose. Trismus, stiff neck, and “sardonic smile” occur, accompanied by paresis of the cranial nerves. The lesion is usually bilateral, more pronounced on the side of the wound.

When determining the prognosis of tetanus, much attention is paid to the period between the appearance of the first signs of the disease (trismus, etc.) and the onset of seizures. If this period is less than 48 hours, the prognosis of the disease is extremely unfavorable.

Complications

One of the dangerous complications of tetanus is asphyxia. At the same time, there is an opinion that asphyxia and cardiac arrest are not complications, but manifestations of a symptom complex of a severe course of the disease. Complications also include pneumonia, muscle ruptures, bone fractures, and compression deformities of the spine. Hypoxia that increases during convulsions can contribute to the development of spasms coronary vessels and myocardial infarction, cardiac arrest. During the recovery period, muscle contractures and paralysis of the III, VI and VII pairs of cranial nerves are possible. Neonatal tetanus can complicate sepsis.

The prognosis of the disease is always serious.

Diagnosis of Tetanus:

Tetanus should be distinguished from hysteria, epilepsy, strychnine poisoning, tetany, encephalitis and other diseases with convulsive syndrome.

The diagnosis of tetanus is made based on clinical findings. Specific symptoms of tetanus that occur already in its initial period are dull nagging pain in the area of ​​the wound (even already healed), trismus, “sardonic smile”, dysphagia and stiff neck. The combination of these symptoms is characteristic only of tetanus. During the height of the disease, painful tonic convulsions of the muscles of the trunk and limbs (not involving the hands and feet) occur, and against their background - periodic, suddenly occurring tonic convulsions, the frequency and duration of which largely determines the severity of the disease.

Laboratory diagnostics

When the blood thickens due to severe and constant excessive sweating, as well as secondary bacterial complications, neutrophilia is possible. With the development of typical clinical picture Isolation of the pathogen and its identification may not be necessary. Material from a patient or corpse, dressing and suture surgical material, as well as soil, dust and air are subject to examination. Bacteria are usually found at the point of entry into the patient's body. Therefore, it is most rational to study various material taken from the wound site. In cases where the entrance gate is unknown, the patient should be carefully examined to identify abrasions, scratches, catarrhal and inflammatory processes. Particular attention should be paid to old scars after wounds, since the pathogen can persist in them for a long time. In some cases, mucus from the nose, bronchi, pharynx, plaque from the tonsils, as well as discharge from the vagina and uterus (for postpartum or post-abortion tetanus) are examined. At bacteriological research corpses also take into account the possibility of generalization of infection. For analysis, blood (10 ml) and pieces of liver and spleen (20-30 g) are taken. To isolate the pathogen, methods common to obtaining pure cultures of anaerobic bacteria are used.

When examining material taken from a patient or a corpse, in parallel with the bacteriological analysis, tetanus exotoxin is detected in a biological sample on mice. To do this, the material is crushed, a double volume of physiological solution is added, incubated for an hour at room temperature, and filtered. Part of the filtrate is mixed with antitetanus serum at the rate of 0.5 ml (200 AE/ml) of serum per 1 ml of extract and incubated for 40 minutes. Then one group of animals is injected with the extract without prior incubation with serum, and the other group is injected with the incubated mixture. In the presence of C. tetani, animals of the first group develop symptoms of tetanus.

Treatment of Tetanus:

Treatment of tetanus carried out in the intensive care and resuscitation department with the participation of an anesthesiologist. It is necessary to provide a protective regime that excludes auditory, visual and tactile stimuli. Patients are fed through a tube or parenterally (for gastrointestinal paresis). Bedsores are prevented by frequently turning the patient in bed, smoothing out crumpled bed linen and underwear, cleaning it and periodically changing it. Infected wound, even if healed, are injected with anti-tetanus serum (at a dose of 1000-3000 IU), then a thorough inspection and surgical treatment of the wound is carried out with wide striped incisions (to create aerobic conditions), removal of foreign bodies, contaminated and necrotic tissue. To prevent seizures, all these manipulations are best performed under anesthesia. Subsequently, it is advisable to use proteolytic enzymes (trypsin, chymotrypsin, etc.) to treat wounds.

To neutralize tetanus exotoxin in the bloodstream, 50,000 IU of anti-tetanus serum or 1,500-10,000 IU ( average dose 3000 units) of specific immunoglobulin with preliminary testing of individual sensitivity to them. These drugs should be administered as soon as possible early dates, since tetanus toxin circulates freely in the blood for no more than 2-3 days, and the associated toxin is not inactivated, which reduces therapeutic effect. After administration of heterogeneous antitetanus serum, it is necessary to monitor the patient for 1 hour due to the risk of developing anaphylactic shock.

The fight against convulsive syndrome is carried out using sedatives and narcotics, neuroplegics and muscle relaxants. IN lately Diazepam 5-10 mg orally every 2-4 hours is widely used; in severe cases, it is administered intravenously at 10-20 mg every 3 hours. For children, the drug is prescribed intravenously or intramuscularly at 0.1-0.3 mg/kg every 6 hours (maximum up to 10-15 mg/kg/day). You can use injections of a mixture of 2.5% solution of aminazine, 1% solution of promedol and 1% solution of diphenhydramine (2 ml of each drug) with the addition of 0.5 ml of 0.05% solution of scopolamine hydrobromide. Also prescribed are seduxen, barbiturates, sodium hydroxybutyrate, and in severe cases, droperidol, fentanyl, curare-like muscle relaxants (pancuronium, d-tubocurarine). In case of lability of the sympathetic nervous system, a- and ß-blockers are sometimes used. In case of breathing disorders, intubation or tracheotomy is performed, muscle relaxation is combined with mechanical ventilation, cleansing respiratory tract aspirator; Patients are given humidified oxygen. There are reports of the effectiveness of hyperbaric oxygen therapy.

Laxatives are prescribed in small doses, a gas tube and catheter are placed in the bladder(if necessary). To prevent pneumonia, frequent turning of the patient, forced breathing and coughing are necessary.

To prevent and treat bacterial complications, antibiotics are used - benzylpenicillin 2 million units intravenously at intervals of 6 hours (children up to 200,000 units/kg/day), tetracycline 500 mg 4 times a day (children up to 30-40 mg/kg/day ). The use of antibiotics does not exclude the possibility of developing pneumonia and other secondary infections.

The fight against hyperthermia, acidosis and dehydration is carried out with intravenous infusions of 4% sodium bicarbonate solution, polyionic solutions, hemodez, rheopolyglucin, albumin, plasma.

Prevention of Tetanus:

Epidemiological surveillance

To identify patterns of tetanus spread, rational planning preventive measures An in-depth epidemiological analysis of the incidence and preventive measures used is necessary. To assess the quality of medical care for injuries, it is necessary to analyze its timing, volume and nature. When analyzing the effectiveness of emergency prevention, you should pay attention not only to its volume, but also to the timing of its implementation (the time elapsed after the injury and seeking medical help). Analysis is of particular relevance in connection with cases of diseases in previously vaccinated people. immune status sick. Detailed analysis the population is subject to immunization against tetanus, implementation of the vaccination plan for certain age, socio-professional groups, including rural population. Immunological control - component epidemiological surveillance of tetanus. It allows you to assess the protection of various populations, reliably judge the vaccination status and quality of immunization, as well as the duration of immunity, identify the most affected population groups and characterize areas with varying degrees risk of infection.

Preventive measures

Nonspecific prevention of tetanus is aimed at preventing injuries at home and at work, eliminating infection of operating rooms, as well as wounds (umbilical and other), early and thorough surgical treatment. Specific prevention of tetanus is carried out in a planned and urgently. In accordance with the vaccination calendar, children from 3 months of life are vaccinated 3 times with 0.5 ml of DPT vaccine with the first revaccination after 12-18 months and subsequent revaccinations every 10 years with associated drugs (ADS or ADS-M) or single drugs (AS) . After a completed course of immunization, the human body for a long period (about 10 years) retains the ability to quickly (within 2-3 days) produce antitoxins in response to reintroduction drugs containing AC toxoid.

Emergency prevention of tetanus is carried out according to the scheme for any injuries and wounds with a violation of the integrity of the skin and mucous membranes, burns and frostbite of II-IV degrees, animal bites, penetrating intestinal injuries, out-of-hospital abortions, childbirth outside of medical institutions, gangrene or tissue necrosis of any type, long-term current abscesses, carbuncles. Emergency prevention tetanus includes primary wound treatment and simultaneous specific immunoprophylaxis. Depending on previous vaccination status, patients are classified into passive immunization, active-passive prophylaxis, consisting of the simultaneous administration of tetanus serum and toxoid, and emergency revaccination with AS to stimulate immunity in previously vaccinated individuals. Emergency immunoprophylaxis of tetanus should be carried out as early as possible and up to the 20th day from the moment of injury, taking into account the length of the incubation period for tetanus.

Activities in the epidemic outbreak

The patient is hospitalized in specialized (intensive care) departments for treatment. Dispensary observation of the patient is carried out for 2 years. Disunity in relation contact persons is not carried out, since the patient is not dangerous to others. Disinfection is not carried out in the outbreak.

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Tetanus is an acute infectious disease. The causative agent of tetanus is sapronotic bacteria (live in the soil). This infection has a contact mechanism of transmission. Tetanus appears when bacteria enter and continue their vital activity in the human body through lesions on the skin, as well as from wounds of various origins.

Bacteria thrive in moist environments. That is why you can often become infected with tetanus in Asia, America and Africa, but also in Europe every year there are many people infected with tetanus. This infectious disease kills thousands of people every year. Even with adequate treatment, tetanus has a mortality rate of 80 percent. Only timely prevention of tetanus can prevent infection. To classify this disease as safe is, to say the least, short-sighted.

The first presentation of this disease appeared in the treatise of Hippocrates. His son died of tetanus. But active study of the infectious disease began only in the 19th century. Then it was noticed that many infections occur during military battles, and most of the infected military personnel die. Later, tetanus toxoid was developed, which was a vaccine against tetanus and was used as a prophylaxis.

The presentation of the vaccine made it possible to reduce the number of people sick and dying from tetanus.

Microbiology has been studying the bacterium Clostridium tetani, the name of the causative agent of tetanus, for several centuries. The bacterium is a mobile anaerobic rod. After penetration into the body, it begins to actively move, infecting more and more new areas. The causative agent of tetanus is distinguished by the fact that it has the most powerful exotoxin on the planet, which can be second only to botulinum toxin.

Minimum lethal dose This toxin is 2ng per 1 kg.

This bacterium is quite hardy and can exist in the soil for more than 10 years. Clostridium tetani also has no geographical boundaries, since it is distributed everywhere. A branch of science such as microbiology states the fact that the causative agent of tetanus can exist even at a temperature of 90 degrees Celsius, but no more than two hours.

You can get this disease anywhere. Tetanus has contact paths transfers. The pathogen is found in water and dust, in animal excrement. Children under seven years of age are most susceptible to this disease. Activation of the disease occurs in the summer, mainly in rural areas. You can become infected with tetanus even through a small scratch if the pathogen gets into it. For newborns, the route of transmission of tetanus is through an unhealed umbilical wound. The course of the disease can begin when injured skin or mucous membrane in case of burns and frostbite, during childbirth outside the walls of a medical institution.

How does the disease develop?

As soon as the tetanus bacillus is transmitted to the human body, and, accordingly, to favorable conditions, it begins its development. At the same time, the bacteria begins to produce an exotoxin, which is harmful to humans. From this moment the course of the disease begins. With blood this toxin begins to spread throughout the body. First of all, exotoxin has a detrimental effect on the medulla oblongata and its parts, the spinal cord, and the reticular formation.

The exotoxin contains tetanospasmin, which poses the greatest danger to humans, especially to their nervous system. The effect of tetanospasmin provokes muscle contraction and begins the destruction of red blood cells.

Stages of the disease, incubation period of tetanus

There are four stages in the development of tetanus.

1. The incubation period when the bacterium has just entered the human body and does not yet make itself felt with pronounced symptoms. It is not possible to recognize the disease at this stage without special tests.
2. The initial period when a person begins to constantly feel aching pain in the area of ​​a wound that is already healing. Muscle spasms begin to appear. This period of illness lasts no more than two days.
3. The peak period of the disease can last up to 12 days. During this period, all the symptoms of the disease begin to manifest themselves especially clearly. This is the most difficult moment. Convulsions appear more and more often and cause the patient more and more suffering.
4. The recovery period is indicated by a decrease in the number of seizures. This period is especially dangerous because all sorts of complications can arise.

The incubation period can last from two days to one month. Usually this period does not exceed two weeks. The acute course of the disease is indicated by prodromal phenomena, which are manifested by muscle twitching and tension at the wound site. Also arises headache, malaise, irritability and sweating.

Tetanus symptoms

• The course of the disease depends on how long the incubation period is. The shorter the incubation period, the more severe the disease will be.
• The onset of tetanus is indicated extremely acutely. First, so-called trismus occurs - convulsive clenching of the jaws. Further, as a result of spasm of the facial muscles, a “sardonic smile” appears, and then difficulties arise with swallowing, as the muscles of the pharynx contract. Together, these signs can only occur with a disease such as tetanus.

• When tetanus reaches its peak, not only the facial muscles begin to contract, but also the muscles of the limbs, except the palms and feet. Throughout the illness, the muscles are constantly tense, even during sleep. After the cramps move to the muscles of the diaphragm, difficulties begin with breathing, which becomes shallow and frequent. Muscle spasm problems cause difficulty in bowel movements as well as urination.
• As the disease progresses, severe tone of the spinal muscles develops. Opisthonus occurs when the back arches so that you can even stick your hand between the bed and the spine. When the muscles are heavily stressed, they tear away from the bones. Bone fractures are also possible. Cramps become especially painful when they cover a large part of the body.
• In a quarter of cases, death is possible. At the same time, the prognosis of the disease, even with a favorable outcome, is always serious. Recovery may occur in two to four months.

Severity of the disease

Doctors determine several degrees of severity of the disease:

• Mild course of the disease. The incubation period lasts no more than 20 days. Trismus, spasm of the facial and back muscles is moderate. At the same time, the hypertonicity of the remaining muscles is minimal. Tonic convulsions may be completely absent. Body temperature remains normal or slightly elevated. All symptoms manifest themselves within no more than six days.
• The moderate course of the disease is characterized by an incubation period of 15 or 20 days. All signs begin to increase within 3 days. Seizures may occur once every 24 hours. Sweating and tachycardia remain moderate. The temperature is subfebrile, less often - high.
• The severe course of the disease can be distinguished by a short incubation period of a week to two weeks. The main symptoms increase over two days. Convulsions are frequent and intense. tachycardia, sweating, and fever are pronounced.
• The extremely severe course of the disease has a short incubation period - up to seven days. The disease develops instantly. Cramps may occur regularly and last from 3 to 5 minutes. Spasms may be accompanied by tachypnea, tachycardia, cyanosis and asphyxia.

Possible complications of tetanus

One of the most frequent complications Tetanus are muscle ruptures, bone fractures, joint ruptures, muscle contractures. To less dangerous complications that appear in the later stages can be attributed to bacterial infections of secondary origin: sepsis, pneumonia and pulmonary atelectasis, pyelonephritis.
In case of extensive complications, phlegmon and abscesses may appear at the portal of infection. But, more often than not, it is not possible to find the gate of infection at all.

Tetanus is dangerous high probability lethal outcome.

Treatment

Treatment of tetanus should begin immediately with the detection of the first symptoms. A therapeutic and protective regimen is important to reduce the number of seizures. Patients are kept in separate rooms to keep contact with irritants to a minimum. Nutrition is predominantly parenteral (using a dropper) or tube. If convulsions are too frequent, a diagnosis of acid-base balance is needed.

Treatment should be carried out in intensive care unit. All drugs for treatment are suitable for group A. In some cases, the patient is on the device artificial ventilation lungs. Also, the patient should be catheterized, since urination is impaired due to cramps.

There are several types of therapy for treating tetanus.

• Etiotropic therapy includes a vaccine of tetanus immunoglobulin and concentrated serum. This therapy is effective when symptoms begin to clearly appear.
• Pathogenetic therapy can be combined with etiotropic therapy. This therapy uses muscle relaxants, anticonvulsants, barbiturates, antihistamines, in some cases, antibiotics can be used: penicillin, tetracycline.

If signs of tetanus are detected, the patient must be hospitalized immediately.

Prevention

The presentation of a vaccine against this disease appeared several decades ago. Timely vaccination is the best prevention of tetanus. Vaccination is carried out using diphtheria-pertussis-tetanus vaccine. It is first done at the age of 3 months. This is done three times every 45 days. Then revaccination is carried out at 18 months, at 7 years, at 14 years. Contraindications to vaccination are infectious diseases. Vaccination can be done only 30 days after recovery.

Also a preventive measure is compliance with safety precautions when working with soil. In the garden you should wear gloves and shoes with thick soles. If you are injured, you should contact medical institutions that provide emergency tetanus prophylaxis. This must be done immediately. Emergency prevention of tetanus involves removal from the wound foreign body, excision of the damaged area. If the last tetanus vaccination was given less than five years ago, then antitetanus serum is not administered. If more than five years have passed since vaccination, then administration of tetanus serum is necessary.

Tetanus is an acute life-threatening disease due to muscle spasm, paralysis respiratory center. Complex various violations the disease is quite extensive, but specific manifestations always arise that make it easy to establish a diagnosis.

It manifests itself not only as myoclonic, but also as neurovegetative syndromes. It is important to identify the first signs of infection, since acute symptoms cannot be stopped. Emergency prevention can save a person’s life.

Acute tetanus: symptoms in adults

Adults have immunity against infection due to vaccination. To maintain the required concentration of protective antibodies in the blood, revaccination is required every 10 years. With the optimal approach, European experts check the concentration of tetanus immunoglobulins in humans every 5 years. If the level drops, revaccination is carried out.

In the absence of natural protection, adults, like children, develop acute symptoms. The polyetiology of the clinic depends not only on the state of immunity, but also on the routes of penetration of the bacterium:

• For injuries;
• Necrotic tissue damage;
• Unknown entrance gate.

The severity of manifestations is determined by generalized or local form development of the disease. With the latter option, in adults, symptoms are expressed locally, and the first signs of tetanus are often hidden.

With a generalized course, an acute clinical picture occurs:

1. Slight pain in the area of ​​the entrance gate of infection at the initial stage;
2. Convulsive contraction and twitching of muscles. When symptoms are localized on the face, difficulty opening the mouth occurs;
3. Tension of the facial muscles is characterized by the symptom of a “sardonic smile,” which is characterized by wrinkling of the forehead, wide lips, narrowing of the orbital fissure, and downward displacement of the corners of the mouth;
4. Muscular trismus.

During the peak period, the main symptoms of tetanus in adults develop. In pathology, muscle soreness is observed in the area of ​​​​action of tetanus toxin. Acute clinic accompanied by trunk spasms. Limbs are less likely to experience trismus.

With active intoxication with toxins of the pathogen in the blood of an adult, a persistent spasm develops. Even at night there is no muscle relaxation. During an external examination of the patient, the outlines of the muscles are clearly visualized. When examining the skin, different muscle groups can be clearly differentiated.

On days 3-4, the muscle fibers of the abdominal wall become hard. Lower limbs stretch out. The mobility of the torso in pathology is significantly limited. Breathing movements become faster. Superficial contractions of the respiratory muscles resemble trismus of the facial muscles - prolonged twitching can be observed over a long period of time.