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Tetanus is an acute disease with a danger to life due to muscle spasm, paralysis of the respiratory center. The complex of various disorders in the disease is quite extensive, but there are always specific manifestations that make it easy to establish a diagnosis.

It is manifested not only by myoclonic, but also by 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 desired concentration of protective antibodies in the blood, revaccination is required every 10 years. In an optimal approach, European experts check the concentration of tetanus immunoglobulins in humans every 5 years. When the level falls, revaccination is carried out.

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

• In case of injury;
• Necrotic tissue damage;
• Unknown entrance gate.

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

With a generalized course, an acute clinic occurs:

1. Minor soreness in the area of ​​​​the entrance gate of infection at the initial stage;
2. Convulsive contraction and twitching of the muscles. With the localization of symptoms on the face, there are difficulties in opening the mouth;
3. The tension of the mimic muscles is characterized by the symptom of "sardonic smile", which is characterized by wrinkling of the forehead, wide lips, narrowing orbital fissure, downward displacement of the corners of the mouth;
4. Trismus of the musculature.

During the peak period, the main symptoms of tetanus in adults develop. With pathology, muscle soreness is traced in the area of ​​\u200b\u200baction of tetanus toxin. Acute clinic is accompanied by spasms of the trunk. The limbs are less likely to experience trismus.

With active intoxication with toxins of the causative agent of the blood of an adult, a persistent spasm develops. Even at night there is no relaxation of the muscles. During an external examination of the patient, the outlines of the muscles are clearly visualized. On examination skin can be clearly distinguished different groups muscles.

On day 3-4, the muscle fibers of the abdominal wall become hard. The lower limbs are extended. The mobility of the trunk in pathology is significantly limited. Breathing movements become frequent. Superficial contractions of the respiratory muscles resemble trismus of the facial muscles - long twitches are traced over a long period of time.

Tetanus is a dangerous infectious disease that can affect the central nervous system, cause convulsions and lead to death.

Brief description of the disease

Tetanus is acute illness, appears due to infection through wounds on the skin. The causative agent is tetanus bacillus, which progresses in hot and humid weather. This disease is most common in the corresponding climate of the equatorial countries, but it also occurs in European countries, claiming thousands of human lives every year.

Varieties and forms of the disease tetanus

Tetanus is dangerous for a person at any age and can affect various bodies, causing either a sharp lethal outcome or a slow course of the disease. This category has the following features:

• tetanus in an adult;
• neonatal tetanus (infection can occur through an umbilical wound that has not yet healed);
• local form of tetanus (muscles or limbs around the wound are affected, causing convulsions);
• neurotetanus;
• head tetanus (affects the muscles of the face, neck, pharynx, leads to death).

Infection with a tetanus spore-bearing bacillus can occur through a wound on the skin when injured, through a suture in postoperative period, due to burns and after injections or abortion.

According to the form of the course of the disease, tetanus can vary in:

• mild - there is no temperature or it does not rise much, and signs of the disease appear only on the 5-6th day;
• medium - signs of tetanus have been observed for 3-4 days, the body temperature is moderate, the appearance of seizures occurs periodically during the day;
• severe - the disease progresses in 1-2 days, convulsions occur frequently, body temperature rises greatly, sweating and palpitations increase, breathing and swallowing become more difficult, muscles are toned, facial expressions change dramatically;
• extremely heavy - sharp deterioration state of health, body temperature reaches 40ºС, convulsions almost do not stop, the face takes on a cyanotic appearance, shortness of breath appears and breathing becomes difficult until it stops, death.

Based on the prevalence of tetanus in the human body, several forms are observed - the primary acute form, the ascending form of tetanus and the descending, local development illness.

Causes of tetanus

The causative agent of tetanus can easily get on the mucous membranes, in punctures and through other injuries of the human skin. Any internal deep wounds worsen the state of the course of the disease, because further infection occurs without access to oxygen. In nature, tetanus bacillus - clostridium tetani - can live in the soil and even in the intestines of animals and humans, however, in this case, it lives as a saprophyte, without causing disease to humans or representatives of the animal and plant world. But as soon as she gets into an open wound, she turns from a saprophyte into a pathogen.

Weak immunity and lack of timely hygiene procedures, ignoring the resulting lesions, minor and serious, without treatment of wounds antiseptics can lead to serious illness.

What can cause tetanus?

• penetrating wound, deep punctures with a sharp object - a nail, a splinter;
• swelling around the wound.

What injuries and injuries can lead to the disease?

• gunshot wound;
• wound from sharp piercing objects;
• injuries with damage to bones, their crushing;
• bites of various animals;
• non-healing and untreated ulcers on the soles of the feet.

Tetanus cannot be transmitted through contact with an infected person. The disease occurs only if the bacterium enters the internal environment human body.

Tetanus bacillus secretes exotoxin, which in turn consists of fractions - tetanospasmin (affects the central nervous system, causes spasm and muscle cramps) and tetanohemolysin (destroys red blood cells). Once inside the wound, bacteria begin to develop and multiply, releasing special toxins. Once the toxin has entered the body, it is no longer possible to remove it. The defeat of the central nervous system so strong that in most cases it leads to the death of a person. If the patient can be saved, then the treatment process can take a long time, on the order of several years, until the body's abilities are fully restored.

Another important feature of tetanus disease is complications after infection. Early complications can arise due to the patient's convulsions, these are dislocations and bone fractures, muscle damage with torn ligaments. Spasms of the respiratory apparatus, leading to suffocation, are also possible. The late consequences of the disease can manifest themselves within a few years, this affects the work of the heart muscle, can cause cranial nerve palsy and muscle weakness.

An adult, as a rule, can be cured of tetanus, but newborn children die from the infection received on the first day. The transferred disease in no case gives a guarantee of strengthening the body's defenses upon subsequent contact with the bacterium. Re-infection is possible more than once!

Symptoms of tetanus infection

From common symptoms, indicating infection, there is an increase in headaches, excessive sweating, weakness of the body, excessive anxiety and insomnia. At the site of damage to the skin and infection, the muscles are in good shape, involuntary twitches, stiffness occur muscle tissue.

The incubation period of the course of the disease can be about 4-14 days, but there may be exceptions here, and the disease can make itself felt in more late period. The duration of the period is affected by the type of bacillus, spores, the degree of damage and the nature of the wound, the dose of bacteria received and the ability of immunity, body forces and microflora to cause diseases. At this time, tetanus bacteria interact with the nutrient medium of the human body, multiply and release toxins that cause neuropsychiatric disorders and disorders.

The main symptom of tetanus is the onset of involuntary seizures. skeletal muscle. The masticatory muscles quickly tire, and during meals, involuntary, clonic, convulsions lead to the appearance of tonic convulsions. Trismus occurs, in which it is impossible to open the mouth due to spasm. Around the wound, such cramps can also occur. Mimic muscles are in good shape, a “sardonic smile” is formed, which is characteristic only of tetanus bacterium.

The initial period of the course of the disease is characterized by the appearance of dull pulling pains in the area of ​​damage. Chewing muscles are prone to convulsive contractions, it is difficult to open and close the mouth.

The height of the disease takes an average of 8-15 days, in rare exceptions it can be longer. It depends on how quickly the patient asked for help, what is the area of ​​tissue damage, whether tetanus toxoid was given. This period is considered active.

With timely treatment for medical help, the patient is first vaccinated against tetanus. The entire healing process can take at least two months. During this period, the likelihood of developing complications of the disease is high, so the patient's condition should be under constant enhanced control of doctors.

Signs of tetanus

Signs of tetanus that you should pay attention to and urgently go to the hospital include:

• spasms of the facial muscles;
• "sardonic smile";
• spasms of the muscles of the back and abdomen;
• labored breathing;
• temperature increase;
• increased excitability and insomnia;
• increased sweating;
• asphyxia and apnea;
• dysfunction of the kidneys and urethra;
• convulsions with pain all over the body.

Tonic and clonic convulsions replace each other and cause severe pain in the patient. The slightest creak or other loud sound, jolts and even touches cause irritation in the patient and, as a result, another attack of convulsions. Due to severe spasms and muscle contraction of the limbs, bone fractures, damage to the diaphragm and respiratory muscles can occur, which causes asphyxia and death from suffocation. Congestion due to circulatory disorders can affect the subsequent development of pneumonia.

Body temperature also directly depends on the strength of convulsive seizures; with frequent and severe convulsions, it can rise to 42ºС. There is an increase in heart rate up to 120 beats per minute. Heart sounds are clear and loud. When falling blood pressure forecasts can no longer be comforting. The withdrawal of waste products becomes more difficult against the background of spasms of the muscles of the perineum.

Despite the aggravation of tetanus symptoms, the person remains conscious and clearly understands the situation throughout the course of the disease. There are no specific changes in the internal organs.

Diagnostics

How is the disease diagnosed?

The presence of deep wounds and burns, surgical sutures and frostbite with infection in a patient can affect the early diagnosis of tetanus. Contraction of the chewing muscles and pulling pains in the affected area are harbingers of infection and are also taken into account when making a diagnosis of tetanus.

Diagnose tetanus laboratory research won't give any result. Blood testing for toxin and antibody titers cannot detect infections due to low rate antigenic stimulus. The study begins only after the symptoms of the disease, visible tissue disorders. But here, too, the diagnosis itself is rather secondary and can only confirm the diagnosis already identified by the signs inherent in tetanus.

In some cases, the wound is examined by bacteriological method:

• histological examination;
• smear microscopy;
• inoculation of samples from the wound in conditions similar to the human body.

On signs of illness during clinical course disease diagnosis is already made without difficulty and doubt. Although the symptoms may be similar to diseases such as rabies, strychnine poisoning, and hypothyroidism, trismus and a pained smile are unique to tetanus.

Meningitis and meningoencephalitis, traumatic brain injury, hysterical and epileptic seizures, exacerbations of osteochondrosis also require study in the diagnosis of tetanus.

Treatment

Treatment Methods

Treatment of tetanus is carried out in a hospital in the ward intensive care, resuscitation, for constant monitoring of the patient's condition. Any possible irritants are cut off as much as possible - bright light, loud sounds, conversations. Experienced doctors prescribe complex treatment to control and exclude the occurrence of complications of the disease.

First of all, treatment is aimed at reducing the intake and destruction of tetanus toxin. To do this, any wounds on the body are examined, they are opened and treated. The patient receives increased doses of tetanus toxoid.

The next step in the treatment of tetanus is to reduce and completely eliminate the occurrence of seizures in the patient. for this apply drugs, alcohol, magnesium sulphate, chloral hydrate, and from the novelties in the field of treatment - neuroplegic and curare-like drugs.

Further, it is necessary to achieve an improvement in the state of the body against the general background, normalize the activity of the heart muscle, and restore pulmonary ventilation. Of the important process of treatment is the prevention of the occurrence secondary complications and fight against them. These include bone fractures, sepsis, pneumonia.

The treatment plan consists of the following items:

• the introduction of serum by chipping the wound, even in cases of suspected tetanus;
• surgical treatment of the wound with the removal of dead areas, without suturing;
• cessation of seizures - anticonvulsants and sedatives are administered, muscle relaxants to relax the muscles;
• connecting the patient to a ventilator;
• regulation of kidney function and normalization of work gastrointestinal tract;
• prevention of bedsores;
• strengthening the immune system with good nutrition with the presence of vitamins and trace elements, if necessary, the introduction is carried out through a tube.

On the background general treatment a course of antibiotic therapy is added to eliminate the risk of complications. The patient should be fed predominantly in liquid form with sufficient pure water to replace the body's loss of moisture due to increased sweating.

Treatment of tetanus can take a period of 1 to 3 months.

The help of which specialists will be required for the diagnosis and treatment of the disease

First of all, with the slightest symptoms of tetanus, it is necessary to contact an infectious disease specialist for advice and study of the course of the disease. In case of injury, observation by a traumatologist will also be mandatory. Often, you may need to consult an ENT doctor and a rheumatologist.

In the course of the treatment itself, the patient is monitored by a cardiologist, a neurologist and a resuscitator.

What complications require close attention of various specialists?

• difficulty breathing due to muscle spasm and frequent convulsions;
• circulatory disorders with internal organs- bronchitis, pneumonia, thrombosis, heart attack;
• fractures of limb bones and damage to muscles and joints due to convulsive movements;
• ruptures of muscles and tendons;
• spinal injury;
• disorders due to nerve damage in certain parts of the body.

Prevention of tetanus infection

In order to prevent the occurrence of tetanus, it is first necessary to take precautions to prevent injury and damage to the skin. Children are required to carry out routine vaccination, and adults revaccination every 10 years.

Non-specific tetanus prophylaxis includes:

• injury prevention at home and at work;
• elimination of the possibility of infection of surgical and umbilical wounds;
• timely thorough treatment of wounds received.

Specific prophylaxis is provided by routine vaccination. Vaccination helps the body produce the necessary antitoxin in the event of an infection.

In case of injuries with wound contamination and damage to the skin, deep burns and frostbite, which can lead to infection with tetanus infection, emergency prophylaxis is carried out. It includes the treatment of wounds, the introduction of immunoglobulin or specific serum. The combination of drugs depends on the availability of vaccinations in the patient.

Immunoprophylaxis of tetanus in without fail carried out as soon as possible. Previously past disease tetanus virus does not give a chance not to get sick again.

In general, the prognosis of tetanus depends on the course of the disease. The more severe the infection and the faster the symptomatic picture unfolds, the shorter the incubation period, the more difficult the treatment will be. And in the event of the slightest delay, a fatal outcome is most likely.

The mild form of tetanus first of all needs to be recognized in time and proceed to complex treatment. In this case, a successful cure of the patient is noted.

Precautions never hurt, because ignoring the wounds received and their timely treatment in any case is the focus of infection. If not tetanus, then another bacterium or virus can enter the body through an open wound and do no good.

Our children often fall and at least peel off the skin on their knees and elbows. Sometimes these are simple abrasions, and more often bleeding scratches. It is to protect our children at this wonderful time and subsequently throughout their lives that it is important to teach them to treat wounds and abrasions in time. Conduct conversations and game form show how harmful bacteria enter the body through the blood.

With adults who have not been taught to take care of their health since childhood, it is also necessary to conduct informational conversations and warn about possible consequences.

Neuroinfections are pathological conditions in which the brain is affected. Their feature is that each disease from this group has specific pathogen. One of these pathologies is tetanus. This disease is extremely dangerous, as in most cases it leads to death. The signs of tetanus should be known to everyone, especially people working in agriculture. This information will help to identify the disease in time and take measures to combat the infection.

What is tetanus?

Tetanus belongs to the group of neuroinfections. This disease can affect not only humans, but all warm-blooded animals. Therefore, the infection is zooanthroponotic. Most often, signs of tetanus are found in residents countryside. This is because the infectious agent can long time be in the soil. The disease is not transmitted by ordinary contact with a carrier of the bacterium. In order for a person to become infected, it is necessary for the pathogen to enter the wound surface. The danger is not only severe injuries and animal bites, but also ordinary scratches on the skin or mucous membranes. In addition, bacteria can enter the body with penetrating wounds of the eye. Signs of tetanus in humans are described by Hippocrates. Already in antiquity, this pathology was associated with wounds and injuries. However, scientists were able to learn about the causative agent of tetanus only in the 19th century. In the same century, it was possible to obtain an "antidote" for this disease. Anti-tetanus serum is still used today. Thanks to this invention, millions of people have been saved.

Causes of the problem

The incidence of tetanus is directly related to the causative agent of infection - the bacterium Clostridius tetany. It is a gram-positive bacillus that, when ingested, releases a potent exotoxin. The bacterium is anaerobic, which explains its presence in the soil. She prefers cold temperature air, therefore, when heated, it forms spores that are very stable in the external environment. Signs of tetanus in humans can most often be seen in the autumn-summer period. At this time, people are most in contact with the soil. Spores remain in the ground for many years, regardless of temperature. environment. Despite its danger, the causative agent of tetanus belongs to the conditionally pathogenic microflora. Normally, this bacterium is present in the intestines of healthy people.

Development mechanism

The pathogenesis of tetanus infection begins from the moment the pathogen enters the human body. Spores that have been dormant for a long time are activated in an environment suitable for life. The disease develops especially rapidly when the infection penetrates through deep punctured or cut wounds. This is due to the fact that the microbe immediately finds itself in anaerobic conditions. Once in a favorable environment, the bacterium begins to multiply rapidly. This is followed by the production of tetanus toxin. This substance penetrates into the motor fibers of small nerves, which are located on the entire surface of the human body. Further, the toxin enters the bloodstream, reaches the spinal cord and brain. There, it wedged into the intercalary neurons, thereby disrupting the motor function of muscle tissue. This is due to tetanospasmin, a substance that is part of the toxin. Under its influence, characteristic signs of tetanus are observed - tonic convulsions. Another toxic substance released by the bacterium is tetanohemolysin. Because of it, the destruction of red blood cells occurs. In addition, he provides toxic effect on the heart muscle, causing tissue necrosis.

Tetanus: signs of the disease in adults

Symptoms of infection do not appear immediately. The patient can observe the first sign of tetanus in 7-8 days from the moment of infection. In some cases, the incubation period is delayed up to one month or even more. The first signs of tetanus in adults occur gradually. At first, it may not be very pronounced muscle pain. Then a symptom characteristic of the disease appears - lockjaw of the masticatory muscles. It is manifested by a strong tension of the muscles of the mouth, due to which the teeth and lips become tightly closed. We can assume that this is the first sign of tetanus. since the symptoms that appear earlier are not observed in all patients and are not characteristic of this pathology. Another hallmark of the disease is the sardonic smile. It means that the lips of the patient are widely stretched, but the corners of the mouth are directed downwards. As a result, the patient's face depicts laughter and sadness at the same time. final stage in the clinical picture, the development of opisthotonus is considered.

Signs of tetanus in young children

In young children, the incidence of tetanus infection is less common than in adulthood. The reason is that babies spend more time at home and do not have contact with the soil. However, infection in children early age may develop. Sometimes this happens right after the baby is born. Entrance gates for bacteria can be mucous membranes, scratches on the skin, as well as an umbilical wound. The symptoms of tetanus in children are the same as in adults. The exception is the incubation period, which may take less time (up to 1 week), as well as a more pronounced intoxication syndrome.

Stages of development of tetanus

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

1. Incubation. The length of this period may vary. On average, it is 8 days. With a good immune response, the incubation stage is lengthened. At this point, the characteristic signs of tetanus are not expressed. Perhaps the complete absence of a clinical picture. In some cases, harbingers of the disease are observed: headache, fever, discomfort throat and muscle aches.
2. Initial stage. Lasts about 2 days. It is characterized by the appearance of soreness at the site of the entrance gate of infection. Later, difficulty in eating due to lockjaw of the masticatory muscles joins.
3. The peak period of the disease. Lasts approximately 1-2 weeks. At this point, you can observe all the symptoms characteristic of tetanus. The patient is disturbed by a convulsive syndrome, which is initially localized, and then spreads to the whole body (opisthotonus). Trismus and a sardonic smile are pronounced. Body temperature reaches 40-41 degrees. In severe cases, a spasm of the respiratory muscles occurs.
4. Recovery stage. Lasts several months. During this period, there is a gradual relaxation of muscle tissue, the patient begins to move normally again.

Complications

Tetanus is a disease that develops severe complications. They are responsible for the high mortality rate. The most dangerous period is considered to be the height of tetanus infection, when paralysis of all muscle groups occurs. At this point, the patient may die from cardiac arrest or asphyxia. In addition, the strongest contractions of skeletal muscles during opisthotonus can lead to bone fractures and rupture of muscle tissue. This threatens with fatal bleeding, since it is almost impossible to help a patient in this condition. one more dangerous period is the recovery stage. At this time, the patient may develop congestive pneumonia, septic damage to the body, as well as myocardial infarction or thromboembolism.

Therapy

Specific treatment of the infection consists in the introduction of tetanus toxoid, which can help only at the initial stage of the disease. With the development of this pathology, immediate hospitalization is required. In addition to serum prescribed symptomatic therapy: anticonvulsant and analgesic drugs, sanitize the entrance gate of the infection.

Preventive measures

Signs of tetanus with cuts and other types of injuries do not appear immediately. Nevertheless, already in the first hours it is necessary to carry out specific prevention of infection. To avoid infection, you need to carefully monitor the condition of the skin and mucous membranes when working in agriculture and in contact with animals. People in areas of infection should be vaccinated against tetanus annually and also be screened.

Tetanus - acute bacterial disease, in which there is a severe lesion of the nervous system with the development of tonic tension of the skeletal muscles and generalized convulsions. The causative agent of the disease is tetanus bacillus, which can exist in the external environment in the form of spores for years. These spores are very resistant to antiseptics and disinfectants in addition, they are able to survive at a temperature of 90 C for 2 hours. When favorable conditions occur (anaerobic environment, humidity, temperature 37 C), spores germinate into vegetative forms, which produce the strongest tetanus toxins. Only botulinum toxin is recognized as more poisonous.

The source of infection are herbivores, birds and the person himself, with the feces of which the tetanus bacillus enters external environment. The pathogen transmission mechanism is contact, tetanus bacillus enters the human body through damaged skin or mucous membranes (burns, frostbite, wounds, bites, etc.). There are cases of infection of newborns, when, if the rules of asepsis are not followed, the tetanus bacillus enters umbilical wound. Cases of transmission of infection from a sick person to a healthy person have not been recorded.

A person has an extremely high susceptibility to the causative agent of tetanus. In those who have been ill, immunity is not formed. dose of toxin developmental diseases, insufficient for the formation of immunity. The high-risk group includes adolescents, especially boys, due to high injury rates, workers Agriculture and other industries where work is associated with contact with animals, land and sewage.

Tetanus symptoms

The causative agent of tetanus is the bacterium Clostridium tetani, and in the people - tetanus bacillus.

The incubation period of the disease can last from several days to one month, with an average of 7 to 14 days. The shorter the incubation period, the more severe the disease and the higher the likelihood of death.

The onset of the disease is always acute, only in rare cases a small prodromal period is recorded, which is expressed by malaise, headache, tension and muscle twitching at the site of injury. One of the first signs of tetanus can be a dull pulling pain at the site of injury, even in an already healed wound. First specific symptoms diseases that allow suspecting tetanus are:

• trismus (convulsive compression) of the masticatory muscles, leading to difficulty opening the mouth;
• the so-called sardonic smile, giving the face a maliciously mocking expression (wrinkled forehead, narrowed eyes, lips stretched into a smile);
• dysphagia (impaired swallowing), which develops due to convulsive spasm of the pharyngeal muscles, manifests itself in the form of painful swallowing difficulty;
• neck stiffness.

The combination of the first three symptoms is characteristic only of tetanus. In this case, stiff neck resulting from tonic spasms of skeletal muscles is not a meningeal sign, other meningeal symptoms no. This also distinguishes tetanus from other diseases accompanied by a convulsive syndrome.

At the height of the disease, tonic convulsions seize the muscles of the trunk and limbs, with the exception of the hands and feet. Tonic tension in the muscles remains almost constant, relaxation does not occur even in sleep. From 3-4 days of the disease, the intercostal muscles are involved in the pathological process, as a result of which breathing becomes rapid and superficial. The pathological process also captures the muscles of the perineum, which leads to impaired urination and defecation. In a severe course of the disease, as a result of strong tension in the muscles of the back, opisthotonus develops - a convulsive posture in which the patient's head is thrown back, and the lumbar part of the back is raised above the bed so much that you can stick your hand under it (support on the back of the head and heels).

As a result of constant tension of the skeletal muscles, patients periodically experience tetanic convulsions, most often provoked by visual, auditory or tactile stimuli. With a mild course of the disease, 1-2 seizures per day are observed, lasting from several seconds to several minutes. In severe cases, attacks can be repeated many times within an hour, becoming longer.

The period from 7 to 10-14 days of the disease is considered the most dangerous for the life of the patient. At this time, due to severe intoxication of the body, respiratory and cardiac activity may be disturbed, which can lead to death.

The recovery period is long, the symptoms of tetanus subside very slowly and may persist for 4 weeks. Full recovery of the body occurs 1.5–2 months after the onset of the disease.

Tetanus treatment

Tetanus can only be treated in the intensive care unit of a hospital. The patient is provided with a protective regime, it is necessary to exclude the impact of auditory, visual and tactile stimuli. Patients are fed through a probe, with paresis of the gastrointestinal tract - parenterally. Required.

In order to neutralize tetanus toxin in the blood, a large dose of tetanus toxoid or specific immunoglobulin is injected intramuscularly once (the dosage is determined by the doctor individually in each case). The earlier these drugs are administered, the better the therapeutic effect will be.

The wound through which the infection occurred is cut off with tetanus toxoid, then it is widely opened and a thorough surgical treatment is carried out. Subsequently, preparations containing proteolytic enzymes (Chymotrypsin, Trypsin, etc.) are usually used to heal the wound.

To combat the convulsive syndrome, sedatives and narcotic drugs and muscle relaxants are used. For respiratory disorders artificial ventilation lungs. If necessary, a catheter is inserted into bladder and vent tube into the rectum.

Prevention bacterial complications and are treated with antibiotics. To combat dehydration and intoxication, detoxification therapy is carried out.

Prevention of tetanus

Vaccination can help protect against tetanus.

Non-specific prevention of the disease consists in the prevention of injuries in everyday life and at work, compliance with the rules of asepsis and antisepsis in operating rooms, delivery rooms, in the treatment of wounds.

Specific tetanus prophylaxis is carried out in a planned or urgent order. According to national calendar vaccinations from 3 months three times with the DPT (or DTP) vaccine, the first revaccination is carried out after 1–1.5 years, followed by revaccinations every 10 years.

Emergency prophylaxis is carried out for any injuries in which there is a violation of the integrity of the skin and mucous membranes, frostbite and burns of the II-IV degree, animal bites, penetrating intestinal wounds, community-acquired abortions and childbirth, gangrene, etc. In addition to the introduction of drugs for vaccination the wound is carefully treated. Emergency prophylaxis is carried out up to the 20th day from the moment of the alleged infection, but the sooner the victim seeks medical help, the higher its effectiveness.

All patients with tetanus are under dispensary observation for 2 years.

Which doctor to contact

If you suspect tetanus or if you are injured, especially if earth has got into the wound, you should contact the emergency room. Treatment of the disease is carried out in an infectious diseases hospital with the participation of an anesthesiologist-resuscitator and a surgeon.

Dr. Komarovsky talks about the DTP vaccination.

Tetanus is now enough rare disease, but its pathogen can be found everywhere in the external environment, which means that there is a high risk of infection.

Tetanus is a severe infectious disease that affects the nervous system, can lead to irreversible complications in the body, up to death.

How to avoid danger and not get infected with tetanus, what are the symptoms of the disease and what to do if infection does occur?

What is tetanus

Tetanus refers to the most severe infectious diseases, in which the nervous system is damaged, leading to tonic tension of the skeletal muscles and convulsions. As a result, irreversible complications develop in the body, up to death.

The causative agent of the disease is Clostridium tetani, a bacterium that thrives in an airless environment. That is, the tetanus bacillus is destroyed under the influence of oxygen, but the microorganism forms spores that are very stable and can exist under almost any adverse conditions.

Spores tolerate freezing, drying, boiling, and begin to actively multiply when they enter favorable conditions(for example, an open wound). For humans, the danger is not the causative agent of tetanus itself, but the products of its vital activity, which release a powerful biological poison that destroys the peripheral and central nervous systems.

Tetanus bacillus spores can be found in soil, animal feces, house dust, natural reservoirs. This spread of tetanus bacillus provides a high risk of infection, but the microbe can only be transmitted through open wounds, especially deep lesions, in which oxygen-free existence is possible.

Note! Tetanus bacillus is safe when swallowed, because it is not able to be absorbed through the mucosa of the gastrointestinal tract.

Tetanus bacillus spores can persist in natural conditions decades, but highest concentration microorganisms seen in areas with warm and humid climates.

In terms of mortality, tetanus is in second place, after, among all infectious diseases. Therefore, all over the world introduced compulsory vaccination against tetanus, allowing you to control the situation with infection.

Where does tetanus appear and how does it develop

Tetanus is a zoonotic disease, that is, characteristic of both humans and animals. But a person cannot infect another if there are no open wounds on the skin surface.

Tetanus enters the body through open wounds, the peak of the disease occurs from April to October, if there is an injury to the feet when walking barefoot

Birds are the source of infection infected person, whose feces enter the external environment, herbivores. In this case, the risk zone for infection includes:

• Children under 7-8 years old (especially boys) due to frequent injuries and cuts of the skin;
• Newborn children in case of violations of the rules of antisepsis during the separation of the umbilical cord;
• Adults who have received severe skin damage (fractures, cuts, lacerations and stab wounds, frostbite, burns, skin abrasions).

People who have been bitten by insects and people who have to frequently inject or take injections are also at greater risk.

Important! Tetanus is not transmitted by normal contact. For infection, the pathogen must enter the open wound surface.

The peak of the disease occurs from April to October, when tetanus infection passes when walking barefoot through a wound in the foot. Therefore, tetanus is often referred to as "bare foot disease".

When a spore enters the wound, they begin vigorous activity, resulting in the production of tetanus toxin, which is second only to toxins in the strength of poisoning. Toxins through the blood and nerve fibers penetrate into the spinal cord and brain and block the nerve cells that are responsible for the inhibition of muscle contractions.

As a result, convulsions occur that affect all the muscles of the body (larynx, face, heart, spine, limbs). Biologically disturbed circulation active substances in the brain, damaged respiratory center, the work of the heart worsens, suffocation may develop.

One of the difficulties in diagnosing the disease is a long incubation period. Its duration can be either a few days or a month, but the average duration is usually 7-14 days. Over such a long period, people usually forget where they could get hurt and get an infection.

But doctors, in order to choose the right treatment and make any prognosis, need to clearly know the time frame in which the infection occurred, because. there is a direct dependence of the severity of the course of the disease on the duration of the incubation period.

The shorter the incubation period, the greater the likelihood of death and the more severe the degree of the disease. short period incubation is usually observed with injuries to the face, neck and head, tk. these lesions are closer to the central nervous system.

First signs and symptoms

Usually the disease always occurs acutely, but there are cases when the first symptoms of tetanus are absent altogether. In general, the course of the disease can be divided into four periods:

1. Incubation;
2. Elementary;
3. The height of the disease;
4. Recovery stage.

Incubation period

The average incubation period is 8 days, but can last several weeks. In newborns, the incubation period can be from several hours to seven days.

During this period there may be general deterioration well-being, headaches, sweating, irritability, loss of appetite, back and throat pain. But sometimes the clinical picture of the disease does not appear at all.

Note! One of the first and obvious signs tetanus can become dull It's a dull pain and muscle twitching at the site of injury, even in an already healed wound.

Due to the non-specificity of symptoms, they are usually rarely noticed, although it is better to respond to the disease already at this stage.

Initial period

Duration initial stage usually is 1-2 days. At this time, the first signs of tetanus appear:

1. Convulsive contraction (trismus) of the masticatory muscles, in which the mouth is difficult to open. In severe cases of the disease, there may be a complete inability to open the mouth due to the strong closing of the teeth.
2. "Sardonic smile" - the face takes on a mockingly malicious expression: the eyes are narrowed, the forehead is wrinkled, the lips are stretched into an unnatural smile.
3. Swallowing disorders (dysphagia) - due to spasms of the pharyngeal muscles, it becomes difficult and painful to swallow.

It is the combination of these three symptoms that is characteristic of the clinical picture of tetanus.

With tonic convulsions, stiff neck muscles are also observed - but this symptom also manifests itself with, therefore, its independent manifestation is not a sign indicating specifically tetanus.

The height of the disease

The peak period of tetanus can last from 8 to 12 days (in severe cases - 2-3 weeks). The duration of this period depends on the timely application for medical assistance, the presence of vaccinations, the nature of the disease.

Tetanus symptoms:

• Rigidity (tension) spreads in descending order: the muscles of the neck, back, abdomen, limbs. The abdomen becomes very hard, complete stiffness of the body may occur.
• On the 3rd-4th day of the development of the disease, the intercostal muscles are covered by the pathological process - this is manifested by difficulty and increased breathing, as well as the muscles of the perineum, which leads to impaired defecation and urination.
• The severe course of tetanus is characterized by the development of opistonus - as a result of overstrain of the back muscles, a convulsive posture occurs, in which the patient's head is thrown back, and the lumbar part is raised above the surface so much that you can stick your hand under it.
• Tonic convulsions completely cover the entire muscles of the limbs and body, excluding the hands and feet. At the same time, tension is stored in the muscles constantly, even in sleep.
• Convulsions are observed constantly, while their occurrence may be associated with external tactile, sound or visual stimuli. With a mild course of the disease, 2-3 attacks of convulsions per day are observed, which last a few seconds or minutes. In severe forms, the attacks are repeated and their duration increases.
• During seizures, a person's face expresses terrible suffering, the face turns blue, there is severe sweating, and the temperature may rise. The person feels fear severe pain all over the body, he can scream and grind his teeth.

The most dangerous for life is the peak of the disease - 7-14 days of the peak of the disease. During this period, irreversible disturbances in respiratory and cardiac activity are possible, which can lead to death.

convalescence period

Recovery is characterized by a long period, because. tetanus symptoms improve very slowly and may last up to two months. There is a gradual decrease in the number of seizures, a decrease in the duration of seizures.

But the period is very dangerous for the development of complications, because. if a person has not been vaccinated against tetanus, he can die from heart failure or from spasms of the airways. Against the background of the disease, myocardial, embolism, may develop.

With high-quality, fast and adequate therapy, the symptoms completely disappear within a few weeks, and full recovery a person comes after 1.5-2 months.

Tetanus in children

The most dangerous and severe in nature is tetanus in newborns. The tetanus bacillus enters the baby's body through the umbilical wound. This is typical when antiseptic rules are violated in hospitals, as well as when children live in conditions of poor hygiene.

The first signs may appear already several hours after infection, but symptoms may also appear at 2-3 weeks of a child's life.

The onset of the disease may indicate constant anxiety child, frequent and causeless crying. Later, lockjaw occurs, due to which the child cannot open his mouth normally, there are problems with sucking. Then other signs of tetanus are added - muscle spasm, "sardonic smile", fever, arching of the back, convulsions.

The disease proceeds faster and more actively than in adults, is characterized by severe course and in most cases ends in death.

Important! Mortality from tetanus in newborns is 45%.

In older children, cases of tetanus occur mainly at 3-8 years of age, when there is a high risk of injury. Mostly the disease is observed at the peak of the summer season and is typical for residents of rural areas.

The child has the following symptoms:

• The muscles of the limbs and trunk are in constant strong tension;
• Relaxation is not observed even during sleep;
• The contours of the muscles are clearly outlined;
• After 3-4 days from the onset of the disease, the abdominal muscles harden, the movement of the lower extremities is limited - the legs are almost always in an extended position;
• Breathing quickens, becomes intermittent;
• Pain occurs when breathing and swallowing.

If you seek medical help in time, then a complete cure of the child is possible within 1.5-2 months. But during this period, the risk of developing complications remains, so the child needs constant monitoring by doctors and parents.

Forms and stages of tetanus

As with any infectious disease tetanus develops sequentially and has several stages, which are characterized by their own symptoms.

Stages of tetanus:

• Light . Typical for patients with partial. It has a long incubation period - over 20 days. Symptoms (“sardonic smile”, trismus, dysphagia) are not pronounced. In other muscles, tension is not noted, the temperature does not rise above 37.5 degrees. The disease develops within 5-6 days.
• Medium-heavy. Symptoms of the disease increase within 2-3 days, while the peak of the disease lasts 2-3 weeks. Seizures may occur, but not more than 1-2 times a day. Signs of hyperhidrosis, subfebrile condition are absent or remain moderate.
• heavy . It is characterized by a rapid increase in symptoms (within 24-48 hours), the incubation period is from 7 to 14 days. Muscle tension is pronounced in all muscle groups, convulsions can be observed with a frequency of once per hour. Indicators, heartbeat, temperature are greatly increased.
• Extremely heavy . A short incubation period with the immediate development of all symptoms of the disease: prolonged and frequent seizures, muscle spasms, rapid breathing, signs of suffocation, severe.

The described stages and symptoms are characteristic of the so-called generalized tetanus, which is most common.

Rarer forms of the disease include local tetanus, in which the pathological process covers only the area adjacent to the wound. The course of the disease is mild form and is accompanied by slight local muscle tension. Facial tetanus belongs to this form.

The ascending form of tetanus is characterized by the gradual development of the disease - at first there are spasms and twitching at the site of the wound, but gradually the toxins affect the departments spinal cord and the disease acquires the symptoms of generalized tetanus.

How is tetanus treated

Treatment of tetanus is carried out only in a hospital, in the intensive care unit.

To begin with, the diagnosis is confirmed: tetanus should be distinguished from periostitis, inflammation of the mandibular joints and other conditions in which it is difficult for the patient to open his mouth. Late stages tetanus should be distinguished from seizures, hysteria,.

Therapeutic measures are reduced to the following measures:

• Destruction of tetanus bacillus in the wound;
• Neutralization of toxins that poison the body;
• Relief of severe convulsions;
• Decrease in temperature indicators, normalization;
• Fight against dehydration;
• Prevention of complications;
• Maintenance of organ functions (lungs, heart, brain, kidneys);
• Compliance with the special regime.

The patient is placed in a separate room, all external irritants are eliminated. He is provided good nutrition(if necessary - through a probe), enriched with microelements and vitamins that strengthen.

The wound through which the infection has drooped is treated: the site of injury is chipped with antitetanus serum, then the wound is opened wide and undergoes a thorough surgical treatment. For wound healing, drugs containing proteolytic enzymes are used.

To neutralize toxins, tetanus toxoid horse serum is used, which is administered as a single dose:

• Adult patients - from 10,000 to 150,000 IU;
• Babies to newborns - from 20,000 to 40,000 IU;
• Older children - from 80,000 to 100,000 IU.

At the same time, human tetanus immunoglobulin (6 ml) is injected intramuscularly.

To stop the convulsive syndrome, muscle relaxants are used, anticonvulsants, neuroleptics, sedatives and narcotic substances.

Anticonvulsants administered intramuscularly to relieve seizures

In case of respiratory failure, resuscitation and artificial lung ventilation. In case of violations of defecation and urination, a gas outlet tube is placed in the rectum and a catheter in the bladder.

To prevent complications of a bacterial nature, the patient is prescribed a course of antibiotics and vitamin therapy.

Complications and prognosis

The clinical picture of tetanus persists for 2-4 weeks, while full recovery comes in 1.5-2 months. However, the person is still long time is not able to work due to compression of the vertebrae and stiffness of movement.

In half of the cases, the prognosis is poor. It is diagnosed if convulsions occur frequently and for a long time, the temperature rises to 40 degrees and above, there is an increase in heart rate, convulsions in the larynx that interfere with breathing.

The outcome of the disease depends on the form of tetanus - the shorter the incubation period, the more severe the course of the disease, the faster the disease progresses. Lightning and severe forms tetanus mostly ends in severe complications and death, mild forms are safely cured with proper and timely treatment.

In adults and children, the following complications can develop against the background of tetanus:

• detachment of ligaments;
• Sepsis;
• Muscle tear;
• bone fractures;
• Bronchitis.

Causes of death from tetanus include spinal fracture, cardiac paralysis, suffocation with prolonged spasm of the respiratory muscles, or vocal cords, pain shock.

All persons who have had tetanus are on dispensary records for two years.

Prevention of tetanus

Distinguish preventive measures from tetanus of two varieties:

• Non-specific: observance of hygiene rules, injury prevention, timely and correct handling wounds, etc.;
• Specific character - vaccination.

Vaccination is carried out in an emergency or planned manner.

Routine vaccination is mandatory from 3 months to 18 years of age. A tetanus injection can be given as a separate tetanus toxoid or as part of combined vaccines (ADS-M, DTP).

As part of the DTP (vaccination against and tetanus), a tetanus vaccine is given to children:

• 3 months;
• 4.5 months;
• 6 months;
• 18 months;
• 6-7 years;
• 14 years old;
• 18 years.

After the age of 18, a tetanus shot for adults is optional every 5-10 years.

Important! With tetanus, long-term immunity is not formed. Even if a person has been ill with tetanus, he can become infected again.

You can get vaccinated against tetanus DTP vaccines, ADS-M, DTP-M, Tetrakok, Pentaxim, Infanrix.

Emergency vaccination is performed in the following cases:

• With injuries and wounds, accompanied by contamination of wounds;
• During operations and wounds in the gastrointestinal tract;
• With severe burns and frostbite;
• With abortions, childbirth, accompanied by trauma;
• With necrosis, gangrene, ulcers.

Tetanus is dangerous for its complications, with a disease, even with a favorable outcome, a person experiences terrible torment. Even despite modern medical measures, allowing to alleviate the course of the disease, mortality from tetanus still remains very high. Therefore, the emphasis should be on preventive measures against tetanus, the main among which is vaccination. After vaccination against tetanus, if the vaccination was carried out fully and in a timely manner, the possibility of the disease is completely excluded.