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Tetanus is an acute infectious disease characterized by tonic skeletal muscle tension and periodic generalized seizures, which is associated with damage to the motor structures of the central nervous system by the toxin of the pathogen.

The causative agent of tetanus has the ability to produce the strongest exotoxin, with which the clinical manifestations of the disease are associated. Spores of tetanus bacillus are resistant to external influences, they are able to persist in nature for years and even decades even under adverse conditions. Thus, spores of tetanus bacillus can withstand heating up to + 90 ° C for 2 hours; when boiled, they die only after 30-50 minutes.

The source of infection is animals and humans. The transmission method is contact-household. The causative agent of tetanus is widespread in nature. It can be found in house dust, earth, salt and fresh water, animal feces. The disease is widespread among the rural population and has summer seasonality. After the infection, a short immunity is formed. Mortality is 40% or more.

Clinical manifestations. The incubation period lasts about 5-14 days. The shorter the incubation period, the worse the disease.

Common tetanus is the most common. The disease has an acute onset. Sometimes there are prodromal phenomena in the form of general malaise, decreased appetite, anxiety, as well as burning, tingling, pulling pains in the wound. One of the first and characteristic symptoms of the disease is cramps in the masticatory muscles, which makes opening the mouth difficult at first and then becomes impossible. In severe cases, the teeth are strongly clenched. Then there is difficulty swallowing, which is associated with spasm of the swallowing muscles. There are convulsions of facial muscles of the face. The face at the same time takes a peculiar expression of a smile and crying at the same time, the skin of the forehead folds, the mouth is stretched. Then the tension of the long muscles of the back increases. Tetanus convulsions are characterized by the sudden appearance of tonic contractions of different groups, causing flexion and adduction of arms, clenching of the hands, extension of the legs.

At first, cramping is mild, lasts seconds and is replaced by periods of relaxation. Subsequently, convulsions become stronger, longer and exhaust the patient. Attacks of seizures can provoke any visual, auditory or tactile stimulus, and seizures can occur spontaneously. Throughout the entire period of the disease, consciousness remains, the patient experiences pain. Cramps in the muscles of the pharynx and respiratory tract can lead to closure of the respiratory tract, causing difficulty in breathing. Urinary retention develops due to spasm of the sphincter of the bladder. In addition, involuntary urination and defecation may occur. Excessively severe cramps often lead to fractures of the vertebral bodies and muscle hemorrhages. During the first 3–7 days, the symptoms of the disease increase, over the next two weeks the patient’s condition stabilizes, and only after that, his gradual improvement is observed. Full or partial restoration of violations occurs in a few weeks and even months.

Local tetanus is rare. It is manifested by pain and muscle spasm above the site of damage. These phenomena can persist for several weeks and then disappear. But it is possible to spread the process with the transition of local tetanus to generalized. Local and easily occurring common tetanus is sometimes observed in children with chronic otitis media. Lethal outcomes with a localized form of the disease occur in 1% of cases. Relapses are very rare. They can occur a few weeks or months after a full recovery. In such cases, re-infection, as well as the possibility of maintaining the pathogen in the wound, cannot be ruled out. Tetanus bacillus, under the influence of various factors that weaken the body, can activate and again begin to secrete a toxin.

Features of tetanus in young children. Tetanus of newborns usually begins at the age of 3-10 days. Infection of the newborn often occurs with infection of the umbilical cord. The first signs of the disease appear during feeding. At first, the sucking act is violated in the child, anxiety and severe crying appear. Soon, swallowing disorders begin, convulsions begin. During the attack, the child is excited, screaming. The muscles of the trunk and limbs become tense, while the arms are bent at the elbows and pressed to the trunk, the hands are clenched into fists, the legs are bent and crossed. Breathing during the attack is superficial, asphyxia may occur. Seizures may be accompanied by involuntary discharge of urine and feces.

Diagnostics. Diagnosis of tetanus is based on clinical manifestations. As a rule, unvaccinated individuals and children born to unvaccinated women fall ill.
Most patients have indications of an injury suffered during the previous two weeks.

Complications Adequate treatment and careful care reduce the frequency and severity of complications that develop with tetanus. Biting of the tongue and mucous membrane of the cheek, vertebral fractures result from severe seizures. Pneumonia, emphysema are caused by impaired pulmonary ventilation due to spasm of the respiratory muscles, spasm of the larynx and accumulation of discharge in the bronchi.

Prevention Nonspecific tetanus prophylaxis includes primary treatment of wounds, prevention of injuries. Specific tetanus prophylaxis includes routine and emergency immunization. Routine active immunization is carried out for children from the age of three months. For this purpose, the following drugs are used - DTP, ADS, ADS-M.

Active immunization is the best method of tetanus prophylaxis. It is preferable to immunize women before pregnancy, and unvaccinated to vaccinate immediately after childbirth. Children under six years of age and older should be immunized according to the recommended method for adults. Tetanus and diphtheria toxoids are administered intramuscularly in three doses. The second dose is prescribed 4-6 weeks after the first, the third - another 6-12 months after the second. In subsequent years, immunity is maintained every 10 years. The main immunization should be with a tetanus toxoid.

Preventive measures after an injury depend on the patient’s immune status and the nature of the lesion itself. Surgical treatment of the wound should be carried out immediately and thoroughly. The wound is cleaned, foreign bodies and dead tissue are removed.

Patients for whom active immunization was not carried out or it was incomplete, intramuscularly administered human tetanus toxoid immunoglobulin. The introduction of maintenance doses of toxoid is indicated when a child is injured five years or more after a full course of active immunization.

Treatment and patient care. A patient with suspected tetanus should be hospitalized as soon as possible. Treatment of severe infections is carried out in the intensive care unit. The main goal of tetanus treatment is to eliminate the source of exotoxin formation and supportive therapy until exotoxin fixed by nerve tissue is destroyed. Maintenance therapy should be carried out quite intensively and thoroughly. The human tetanus immunoglobulin is administered as early as possible, it neutralizes the toxin circulating in the blood. Surgical measures for the treatment of wounds are performed after the introduction of antitoxin and sedatives. Necrotic tissue and foreign bodies are removed from the wound. Wound surfaces are left open. Antibiotic treatment is being carried out.

Careful patient care is very important. The patient should be in a quiet and calm environment, exposure to any auditory and visual stimulus should be excluded. Muscle relaxants are administered to all patients with tetanus, which reduces the increased muscle tone and prevents the occurrence of seizures. In severe cases, the patient is transferred to mechanical ventilation (mechanical ventilation).

It is necessary to weigh patients daily, carefully monitor the amount of fluid taken and released, maintaining electrolyte and caloric balance. Enteral nutrition is not possible in all patients, in most cases it is necessary to use intravenous infusion and the introduction of food through a gastric tube.

Particular attention should be paid to skin care, oral cavity and monitor the functions of the bladder and intestines. They carry out activities aimed at preventing complications, normalizing homeostasis and maintaining cardiovascular activity, and preventing the attachment of secondary bacterial flora.

Forecast. The outcome depends on many factors. In infants and the elderly, the disease often ends fatally, in adolescence and youth, recovery most often occurs.

Adverse signs include widespread damage to muscle tissue, high body temperature, a short interval between the time of injury and the development of clinical manifestations of the infection. On the contrary, a long incubation period, limited manifestations of infection, and the absence of high body temperature allow us to hope for a successful outcome. Intensive and supportive care to a large extent determines the outcome of tetanus.

Surviving children after tetanus may have paresis, mental disorders. Persons who have been ill with tetanus do not have stable immunity, therefore, even those who have suffered it must subsequently be actively immunized.

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  1. Tetanus
    Tetanus is an acute infectious disease caused by the action of the toxin secreted by the bacillus of Nicolaera (Clostridium tetani), a microorganism that can remain viable for many years while in the ground. This bacillus easily penetrates the human body through a wound, especially if dirt enters the wound. See the article SHOOTS, taking into account that the metaphysical meaning of tetanus
  2. Tetanus
    Tetanus is an acute toxemia caused by the action of exotoxin (tetanospasmin) produced by the bacteria Clostridium tetani. The toxin is produced by the vegetative forms of the microorganism at the place of its penetration into the tissues of the body, and then enters the central nervous system and is fixed there. Etiology. The causative agent of tetanus is an obligate anaerobic, thin gram-positive motile
    Tetanus [Greek - Tetanus (curing); English - Lockjaw] - an acute, non-contagious wound toxico-infectious disease of mammals of animals, birds and humans, characterized by increased reflex excitability, convulsive tonic convulsions of the muscles of the body under the influence of the toxin of the pathogen (see color insert). Historical background, distribution, hazard and damage.
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  5. Tetanus
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  6. Tetanus
    Scope of examination 1. Tetanus is an acute infectious disease characterized by toxic damage to the nervous system, manifested by tonic convulsions. The causative agent of the disease is the anaerobic spore-forming bacillus of Clostridium tetani. 2. Entrance gates are wounds or other injuries to the skin and mucous membranes, including burns, frostbite, abrasions, criminal abortions,
  7. Tetanus
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  8. Tetanus
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