Tetanus bacillus is very resistant to various external influences, carries boiling resistant to phenol and other chemical agents. It can persist for decades in soils and on various subjects infected feces. It can be found in house dust, soil, salt and fresh water, faeces of many animal species.
What it is?
Tetanus - zooantroponoznoe bacterial acute infectious disease with the contact mechanism of transmission, characterized by lesions of the nervous system manifested by tonic and stress and generalized skeletal muscle convulsions.
The patient is not contagious to others. Epidemiological measures at the source of the disease is not carried out. Immunity after the disease does not develop. Recovery from clinical forms of tetanus infection does not protect against the new disease. A small amount of tetanus toxin, enough to develop the disease, does not provide the required production of antibody titers.
Therefore, all patients with clinical forms of tetanus should be required to be immunized with tetanus toxoid - immediately after diagnosis or after recovery.
exciter
The causative agent of tetanus - stick Clostridium tetani. It refers to the bacteria inhabiting in an airless environment, oxygen has a devastating effect on it. However, the microorganism is very stable due to their ability to form spores. Disputes - is resistant forms of bacteria that can exist in harsh environments. In the form of Clostridium tetani spores can easily tolerate drying, freezing and even boiling. And if it enters the favorable conditions, such as deep wound, the dispute goes to an active state.
Clostridium tetani spores are found in soil, household dust, faeces of many animals, the natural reservoirs. If this argument is so common in our environment, the question arises, why people do not become infected with tetanus? The fact that this microbe is safe if swallowed. Though he is not destroyed by hydrochloric acid and enzymes, but also can not be absorbed through the gastrointestinal tract.
As tetanus transmitted? This wound infection - pathogen can enter the body through wounds, burn surface areas frostbite. Clostridium tetani loves deep wounds, as they can create anoxic conditions.
mechanisms of disease development
Since getting tetanus bacillus in favorable conditions, it is actively begins to multiply, producing at the same time as harmful to a living organism ekzotaksin. With bloodstream ekzotaksin distributed throughout the body and affects the spinal cord, the medulla and the reticular formation.
The composition includes tetanospazmin tetanus toxin, poses a great danger to the nervous system. By acting on it, it leads to the appearance of tonic contractions of muscles, and also starts tetanogemolizina process which occurs during the process of destruction of erythrocytes.
The symptoms of tetanus in humans
In the development of tetanus in humans have identified a number of clinical periods:
- The incubation period of tetanus is usually about 8 days, but may last up to several months. When the generalization of the process, the more the site of infection is removed from the central nervous system, the longer the incubation period. The shorter the incubation period, the more severe the disease is. The incubation period neonatal tetanus an average of from 5 to 14 days, sometimes for several hours to 7 days. Disease may be preceded by headache, irritability, sweating, tension and muscle twitching in the area of the wound. Immediately before the onset of the disease observed chills, insomnia, yawning, pain in the throat when swallowing, back pain, loss of appetite. However, the incubation period may be asymptomatic.
- The initial period. Its duration is about two days. Initially, the infected person feels a nagging pain in the injured area while the wound specifically on the mend. At the same time or a little later, a man seen lockjaw, under which is commonly understood - tension and contractile motion of chewing muscles, thereby causing problems with the opening of mouth. complete inability to open the mouth as a result of a very strong clamping teeth may occur with severe disease.
- During the height of the disease lasts an average of 8-12 days, in severe cases up to 2-3 weeks. Its duration depends on the timely treatment to the doctor, the early timing of the treatment, the availability of vaccinations in the period preceding the disease. Develops tonic contraction of masticatory muscles (lockjaw), and seizures of facial muscles, so that the patient has a sardonic smile armor. risus sardonicus: eyebrows raised, mouth stretched wide, the corners are omitted, the face expresses both smile and cry. Further develop the clinical picture involving the muscles of the back and extremities ( "opisthotonos"). There is difficulty in swallowing due to spasm of the muscles of the pharynx and painful stiffness (tension) neck muscles. Rigidity is distributed in descending order, grabbing the muscles of the neck, back, abdomen and extremities. There is tension of muscles, abdomen, which becomes hard as a board. Sometimes there is complete rigidity of the trunk and limbs, except for the hands and feet. There are painful spasms, initially limited, and then spreads to the large muscle groups that last from a few seconds to a few minutes. In mild cases cramps occur several times a day, in heavy - lasted almost continuously. Seizures may occur spontaneously, but can occur as a result of the stimulus, which can be a bright light, touch or sound. In the event of seizures in humans there is sweating, his face turns blue and the whole facial expression reflects the terrible suffering. Spasms of muscles leads to disruption of swallowing function, respiration, urination. In the body occur congestion, metabolic disorders, which affects adversely on the heart. Body temperature rises above 40 degrees.
- the recovery period is characterized by slow, gradual decrease in strength and number of seizures, and muscle tension. It can last up to 2 months. This period is particularly dangerous development of various complications.
severity
Depending on the severity of tetanus can be:
- Light - has a long incubation period (20 days), expressed mild trismus, sardonic smile and dysphagia. Voltages in other muscles almost no normal body temperature or raised to 37,5 ° C. Symptoms of the disease are formed within 5-6 days. This form of the disease occurs in patients who have partial immunity.
- Moderate-severe stage lasts from 2 to 3 weeks. All the symptoms manifested and growing for three days. Characteristic convulsive syndrome that occurs while once a day. Symptoms of hyperhidrosis, tachycardia and subfebrile remain in the moderate range.
- Heavy - the incubation period of 7-14 days, the symptoms occur for 24-48 hours. Pronounced muscle tension followed by jerking a few times per hour. Indicators heartbeat, pressure, temperature increased sharply.
- Stage extremely severe disease characterized by very short incubation stage (up to seven days) and immediate development - regular, extended convulsive disorders, for five minutes, and muscle spasms accompanied tachypnea (rapid breathing surface) attributes of a tachycardia, dyspnea and cutaneous cyanosis.
What is tetanus: photo
The photo below shows how the disease manifests itself in humans.
Photos 18+
[Fold]
Diagnostics
Diagnosis of tetanus is based on clinical disease. Of great importance is history. Isolation and identification of microorganisms is rare. Determined toxin content in the muscles.
At the beginning of the disease to be distinguished from tetanus periodontitis, gingivitis, abscess retropharyngeal space inflammatory temporomandibular joints, when the patient can not open his mouth. When tetanus is present prolonged tension of the masticatory muscles and twitching. In later periods should be differentiated from epileptic seizures tetanus, strychnine poisoning, hysteria in women.
In neonatal tetanus must be distinguished from the effects of birth trauma, meningitis. In cases of doubt, resort to lumbar puncture. Older children should be differentiated from tetanus and rabies hysteria.
Effects
Complications can be different: bronchitis, pneumonia, Sepsis, myocardial infarction, ruptures of muscles and tendons, sprains and spontaneous fractures, thrombosis and embolism, pulmonary edema, temporary paralysis of the cranial nerves, muscle contractures, compression deformation of the spine (stored in some cases up to 2 years) etc.
treatment of tetanus
The man, who manifested symptoms of tetanus, is subject to immediate hospitalization. In order to produce a tetanus toxin neutralization, the patient is administered special tetanus serum, or it takes a specific immunoglobulin. As therapy seizures used a number of drugs - narcotics, sedatives, neuroplegic. Also for the treatment of tetanus using muscle relaxants.
If the patient is expressed respiratory distress, then before you begin treatment of tetanus, it is necessary to make all the necessary resuscitation. Further, for the treatment of used laxatives, the patient is placed venting tube, and if needed, the patient spends bladder catheterization. To prevent the occurrence of pneumonia in a patient, the patient's tetanus often should turn, also need constant stimulation of breathing, and coughing. To forestall further treatment of bacterial nature of complications, antibiotics are used.
tetanus treatment also involves overcoming dehydration by using intravenous infusions of sodium bicarbonate. For this purpose, a number of drugs used: polyionic solutions gemodez, albumin, reopoligljukin plasma.
Vaccination against tetanus
Children are vaccinated against tetanus fivefold. The first vaccination is done in 3 months, followed by 4.5 months., In six months, 1.5 years, and then 6-7 years.
adult revaccination is carried out at the age ranging from 18 years old. If a child was held a full course of tetanus vaccination, then, only one inoculation in 10 years. In primary adult vaccination, put 2 immunizations at monthly intervals, and a year later another. Grafting is placed intramuscularly (normally under vane shoulder or hip). After inoculation possible side effects: swelling at the site of inoculation, moderate pain, fever (it is allowed to churn antipyretics). All these symptoms should normally take place within 2-3 days.
To be vaccinated against tetanus and get detailed advice at any clinic in the community.
Prevention of tetanus
Nonspecific prevention of disease is to prevent accidents in the home and at manufacturing, compliance with the rules of asepsis and antisepsis in the operating room, delivery room, when treatment of wounds.
Specific prevention of tetanus is carried out in a planned or emergency basis. According to the national immunization schedule vaccination is carried out in children from 3 months triply vaccine DTP (or ADF), the first revaccination is carried out in 1-1.5 years followed by vaccine boosters every 10 years.
