Tetanus (Tetanus) - Causes , Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

Tetanus - particularly hard, sharp, saprozoonoznaya (inhabitant of soils) bacterial infection from contact transmission mechanism, characterized by bouts of generalized seizures on the background of muscle hypertonus.Mortality in this disease is 85% after the onset of symptoms, even though adequate treatment.

description of this disease has come more to the treatises of Hippocrates, whose son had died from tetanus.Since the beginning of the 19th century, the causative agent of tetanus have been actively studied, because it noticed that during the wars going on mass infection with lethal outcomes among soldiers.Later it was created stobnyachny toxoid used for mass prevention, which significantly reduce the risk of morbidity and mortality due to tetanus.

Pathogen Tetanus

causative agent of tetanus - the bacterium Clostridium tetani.The shape resembles a stick, which are located on the sides of flagella (they cause the active penetration and further movement through the body).The main distinguishing fe

ature of the causative agent - the presence of the most powerful in the world exotoxin, the strength is second only to botulinum toxin.Its minimal lethal dose - 2ng / kg.This exotoxin is divided into two factions - tetanospazmin and tetanolizin.

Tetanolizin - stands out from the cells of the pathogen from the first days, but his role in the pathogenesis is still not a definitive explanation.We only know that it destroys red blood cells, thus causing hemolysis and inhibit phagocytosis (devoured kltkami immune system of the pathogen) - these two areas predetermine rapid penetration of the pathogen to the target (the nervous system), which significantly reduces the incubation period and makes the development of symptoms morerapid.

tetanospazmin - the second component of the exotoxin, which is released only when the decay (ie after phagocytosis) and operates in the following way - selectively affects synaptobrevin (this is a transmembrane carrier protein, secretory vesicles, bubbles cells involved in the release of inhibitory neurotransmitters in the synapse), this leads to uncontrolled muscle contraction, because only go excitation processes without braking neurotransmitters.

With regard to sustainability, the causative agent of tetanus is one of the most enduring, because it produces spores (she rounded shape, the diameter of the larger cells, terminally situated, which gives the similarity with the pathogen "drumstick") under adverse conditions and access of oxygen.

bacterium Clostridium tetani

in faeces, soil and on various subjects infected spores persist for decades, so the soil is an inexhaustible reservoir of tetanus.Die within 14 hours from 1% mercuric chloride solution of formalin and 5% phenol solution.By UVI resistant action.

high susceptibility to tetanus.There is no seasonality, or age and gender restrictions, and with respect to the geographical boundaries - ubiquity - a problem of global importance, mortality during infection always leaves a high degree of stability.

Causes infection tetanus

source - the soil and the many species of animals, in the digestive tract which is detected tetanus pathogen, it is possible pathogen detection in the human intestine, but because of the integrity of the intestinal mucosa cover, the further introduction of the pathogen does not occur (even though the risk is alwaysthere is!).

Way - pin, infection through damaged skin or mucous membranes damaged.Basically, a gateway infection consider: gunshot, stab, cut wounds, splinters, scrapes, burns, frostbite, traumatized by the birth canal and the umbilical wound in unsanitary conditions.

But unnecessarily pathogen reproduction occurs in the input gate, it is very effective primary treatment of wound surfaces.If you are out of hospital, use the most common disinfectants - hydrogen peroxide, alcohol, furatsilin, chlorhexidine.

Symptoms of tetanus

incubation period can last from 1 day to several months, but most frequently 3-14 days.At the same time, the shorter the incubation period of the disease is more severe.This moment is the beginning of the introduction of the pathogen before the first clinical signs.As soon as there is contact with an open wound pathogen surface, is its fixation and reproduction in the place of introduction, the course of action of phagocytosis is released from the cells of the pathogen of the exotoxin - tetanospazmin.But the duration of the incubation period, due to the fact that tetanospazmin can not directly from the blood to reach the central nervous system, it has to pass a long-stage path: from vascular branches that supply blood to the muscle fibers, through the blood comes into contact with mionevralnymi synapse (connection between muscle fibers and motor neurons).Tetanospazmin first binds to the receptors, and then the membranes of nerve cells, penetrating it directly into the cell moves along the fibers of the nerve cell to the next cell, thus achieving CNS (besides the speed of advance of the toxin - 1cm / hr).After passing a number of landmark structures arises neurogenic "convulsive period" with the relevant symptoms and signs.

convulsive period starts with the tetanospazmin action.First symptoms develop locally, ie at the point of introduction, a blunt and pulling pain with muscle twitching, then the symptoms gradually become more widespread in nature, capturing more and more extensive muscle areas, in compliance with the strict phasing:

1.Trizm - tonic tensionmasticatory muscles, which makes it difficult at first closing the mouth, and after - making it impossible to breaking teeth.

Trismus of tetanus

2. sardonic smile and cry at the same time expressing and irony, but sometimes it is also called maliciously mocking;

sardonic smile

3. Dysphagia - difficulty swallowing due to spasm of the muscles of swallowing it leads in addition to the depletion of hypersalivation (excessive salivation, without the possibility of swallowing).

listed above is a triad of symptoms (trismus, sardonic smile, dysphagia) is a type specific symptom, allowing error-free, or at least put the suspect tetanus in the early stages.

4. gipertonus nape muscles, back and abdomen, with the capture of the limbs (arms and legs).Distribution of muscle hypertonus goes top-down type and, due to the fact that the tone of the back muscles developed more than the stomach, there is a opisthotonus, at least - emprosthotonos (with strongly developed abdominals, as a result of the form of the patient as in severe pain in the abdomen).

opisthotonus - kind of the most straighten the body, resulting in hyper extensor muscles, grouped mainly on the back surface of the body (muscles of neck and back extensor muscles of the limbs), the patient is bent in an arc, relying on the back of the head and heels.

opisthotonus at the time of muscle cramps that may be first clonic (ie, after the relaxation of spasms), and then passing or clonic stage, becoming titanic (ie ultimate relaxation after a seizure does not occur, and they alwaysremain in tension).They may be present simultaneously in the patient, but in different areas of the body, so when tetanus cramps often called tonic-clonic.At the time these seizures occur the full stiffness, cramps are very painful, the possibility of movement is preserved only in the hands and feet - is another important differential diagnostic sign, but in the later stages.

These cramps may result from any, even the most insignificant stimuli - tactile, auditory, visual.And the worst thing in this disease is the fact that at the time of these incredibly painful seizures a person remains fully conscious and, upon accession decompensation by the organs and systems, comes the slow and painful death, but people until the end remains in consciousness.

5. Capture tonic voltage intercostal muscles, diaphragm and glottis.Since then, the high risk of death due to respiratory failure as a result of spasm of the respiratory muscles, or as a result of direct destruction of the respiratory and vasomotor center in the medulla oblongata.

6. Formation of multiple organ failure at the height of a possible clinical manifestations, and as the investigation after suffering the disease.Changes in the acid-base balance (acid-base status of the blood), also on the part of the cardiovascular and respiratory systems:

• ↑ blood pressure, tachycardia with possible development of arrhythmias;
• due to respiratory failure develops cyanosis, and if the attacks are too frequent, then gradually formed acidosis (change KHS), which contributes to the general condition and closes formed a vicious circle, and it makes the anxiety even more easy and even more striking center of the medulla oblongata,exacerbated by respiratory and cardiovascular disorders.

neonatal tetanus - a separate form of the disease, because the disease is rapid and death occurs before the onset of typical clinical manifestations.Initially, the child is disturbed swallowing and sucking, there is rejection of the breast.Tetanic convulsions are accompanied by a cry, tremor of the lower lip / chin and tongue, joins involuntary urination and defecation.During the attack also observed cyanosis and blepharospasm (spasm of the eyelids - a strong squinting).Occurs in infants whose mothers had not been vaccinated, ie those children who did not receive passive immunity from their mothers.

Diagnostics tetanus

often enough clinical data (inspection), because complete clinic develops within 1-3 days, while maintaining a strict phasing.From laboratory methods, the most relevant and admissible bacteriological diagnosis, because it focused on the isolation and identification of the pathogen and its toxin detection in the material (microscopy smears, histological examination of tissue).In this case, no additional diagnostic methods have as other diseases which are directed to the detection antibody, because in this case it does not increase the antibody titer is due to the fact that even the minimum lethal dose of the pathogen does not cause an immune response.

Treatment of tetanus

Treatment inseparably with the regime and diet in this disease: required medical protective regime to help reduce the frequency of seizures.For this purpose, patients are placed in the insulation chamber, thus preventing contact with external stimuli.The power must go on enteral and / or parenteral nutrition (through an IV) special nutrient mixtures, mixtures of amino acids and fat emulsions.Meals prepared at the rate of 2500-3000kkal / day.With frequent convulsions diagnose acid-base balance and subsequently adjust the power, because there are large energy consumption in convulsions.

treatment is carried out only in intensive care units, because virtually all drugs are in Group A list is also necessary for the dynamic control of the laboratory changes and the patient is on the ventilator (mechanical ventilation), they necessarily cannulated (unnecessarily rude act of urinationbroken).

• Causal treatment is very limited and at the moment already present obvious symptoms of its effectiveness is reduced to a minimum, so no early or re-appointment of these drugs do not prevent the development of severe clinical forms and death.By Etiotropic drugs include tetanus immunoglobulin and tetanus purified concentrated serum.They are used only when podozerenii being infected until the symptoms have not yet seen.

• Pathogenetic therapy directed at the action of the toxin, and it is effective in combination with the causal, thereby improving survival prognosis.These medications include: muscle relaxants, the whole arsenal of anticonvulsants, narcotic analgesics, antihistamines, barbiturates, β-blockers to reduce the influence of the sympathetic nervous system.Prolonged heavy current to the desired list add antibiotics for the prevention / treatment of pneumonia and sepsis.

Complications of tetanus

• Because of complications in the first place are often broken bones, peel and tear of muscles, muscle contractures occur, breaks joints.
• Of the complications less dangerous and emerging in the later stages of the isolated secondary bacterial infections (pneumonia, pyelonephritis, sepsis, pulmonary atelectasis).
• With extensive complications arise abscesses and cellulitis infection in the gate.But in daily life relative to the gate of infection, the picture is diametrically opposite - the gates of infection is often impossible to find.

disease often ends in death.

Preventing tetanus

nonspecific - injury prevention and treatment of wound surfaces.

Specific - planned active immunization of children and adults and an extra post-traumatic prevention.Active immunization of the population, starting with 3 months of age → → 4.5 months 6 months 18 months → → first revaccination at 7 years in the second revaccination → 14 → second revaccination revaccination every 10 years from the last vaccination.You can be vaccinated following vaccines: DTP, Td, Infanrix.Vaccination is carried out in accordance with the calendar of vaccinations, taking into account all the indications and contraindications.When vaccination contraindications manipulations are delayed, and subsequently compiled the individual plan of vaccination with preservation time periods (ie the difference between the first and subsequent vaccinations / boosters Save ≈1,5 month, etc).

Emergency immunoprophylaxis made for injuries and, depending on the time of the previous vaccination toxoid, is carried out either passive immunization antitoxic serum or active-passive immunization (tetanus toxoid, or a homologous immunoglobulin) or emergency booster tetanus toxoid.It is better to select the last 2 options, because with the introduction of its antitoxic serum level remains lower than can be life of the incubation period.Therefore, passive immunization is suitable only for those who have passed a full course of immunization.

How Immunization helps alleviate disease?

Full and timely immunoprophylaxis of tetanus can completely eliminate the risk of disease.If for some reason it was held over 10 years ago, or when an emergency immunization passive immunization antitoxic serum was carried out, then the people formed the so-called "partial immunity", in which case the disease is a little easier:

• incubationformed over a period of 20 days;
• clinical triad (trismus, sardonic smile, dysphagia) is weak;
• increases muscle tone within 6 days, while keeping the possibility to eat and drink;
• convulsions or seizures may be absent or occur only a few times a day;
• temperature is normal or slightly increased;
• duration of illness to 2 weeks (while in non-vaccinated reaches an average month, even with treatment);
• deaths less frequently.

With regard to post-infectious immunity (ie, those who are ill), it is currently believed that it is not formed and the risk of re-infection in the event of survival is still as great.Sick tetanus epidemic in the sense of not dangerous to others, ie, is not contagious.

disease deystvtelno terrible, saw with my own eyes how people go through the hellish torment, being in full consciousness ... The treatment is practically meaningless, few who manage to survive, even though modern technology and preparations.

therapists Shabanova IE