How does tetanus occur? How the disease develops

Tetanus is infectious pathology, caused by the bacterium Clostridium tetani. The disease is characterized by severe damage to the central nervous system (CNS), characterized by multiple spasms of skeletal muscles, asphyxia (suffocation), opisthotonus (characteristic arching of the back). The disease is often severe and threatens many complications; the mortality rate is 25%.

How can you get tetanus?

Pathology is a zooanthroponotic disease, i.e. poses a danger not only to humans, but also to animals. Infection occurs when there is an open wound on the body through the entry of pathogenic bacteria into the affected area. Clostridium tetani belongs to the biological series of spore-forming rod-shaped bacteria. The bacillus itself does not pose a danger; the threat is posed by the tetanus toxins it secretes, to which the human body is highly susceptible.

Infection is possible if antiseptic measures are not observed during the treatment of wounds, burns, and frostbite. Children are susceptible to the disease due to high level injuries, newborn babies if the rules of asepsis are not observed during cutting of the umbilical cord, adults after serious injuries to the face, limbs, etc. A direct method of transmission of infection from a sick person to a healthy person is impossible.

Routes of transmission

Bacteria, causing pathology, live in the intestines of humans, herbivores, rodents, birds, and are released into the environment with feces in the form of spores. The method of infection with the disease is contact. Spores of pathogenic bacteria can long time be in the soil, water bodies, cover any surfaces, penetrate with dust into the premises. Then, when favorable conditions occur, the spore becomes active; in this state, it releases toxic substances that, even in very small doses, are dangerous to the body.

The causative agent of tetanus

Tetanus bacillus has several dozen flagella and is shaped like a tennis racket. It is gram positive anaerobic bacterium, the spores of which are highly resistant to heat, freezing, and boiling (they die after two hours). Clostridia transform into a vegetative form upon the onset of favorable anaerobic conditions in the presence of staphylococcal flora. Clostridium tetani “loves” to reproduce in deep wounds due to the ability to create oxygen-free conditions there. Specific tetanus toxin has two components:

Exotoxin (tetanospasmin) is a strong poison that causes disturbances in the functioning of nerve cells, leading to inhibition of the inhibitory mechanism motor activity muscles. Tetanospasmin, thanks to the blood circulation and nerve processes, penetrates into the central nervous system, causing reflex uncontrolled contractions of the muscles of the face, limbs, heart and other organs. In the initial stage of exposure to tetanus toxin, predominantly peripheral synapses are affected, which leads to the appearance of tetanic convulsions. In addition, blockade of neurons in the reticular formations of the brain stem leads to increased temperature and dehydration.

A cytotoxin (tetanolysin or tetanohemolysin) plays a minor role in the development of tetanus. The substance promotes the destruction of red blood cells and damages heart muscle tissue, which can lead to local necrosis.

Classification of forms of the disease

There are several types of classifications of pathology depending on the location and circumstances of infection, manifested during the development of the disease, clinical picture and associated causes. A significant factor is the prevalence of infection throughout the body, the involvement of one or more body systems in the pathological process.

Depending on the route of infection

Clostridia cannot penetrate intact skin, so the main factor of infection is injury of various nature. Experts distinguish several types of tetanus according to the method of infection:

Post-traumatic (wound, postoperative, burn, postpartum, post-abortion, neonatal tetanus).
Tetanus developed due to inflammatory processes in the body (tumors, ulcers, etc.).
Cryptogenic in nature, in which the patient’s medical history contains no information about any damage. This often means that the infection occurred as a result of a microtrauma (for example, domestic or industrial).

By localization

Often the disease begins with muscle twitching at the site of injury, then generalization of seizures occurs. Based on the prevalence of infection throughout the body, there are:

local tetanus, in which convulsions and nagging pain at the site of infection (Rose paralytic tetanus).

a generalized form in which the central nervous system is affected (Brunner's encephalitic bulbar tetanus).

According to severity

There are four forms of progression depending on the severity of the disease. Their characteristics:

Severity	Incubation period, day	Increase in symptoms, days	Body temperature, ºС	Characteristic signs
			Low-grade or absent	Moderate hypertonicity, rare or absent seizures
Moderate				Typical symptoms, tachycardia, short-term convulsions are observed 1-2 times per hour, no complications develop
				Typical symptom complex, frequency and duration of seizures increases, muscle tension abdominal wall and limbs, severe sweating
Very heavy				Except severe symptoms, pneumonia and pressure surges occur. Serious condition lasts several weeks. Possible complications: cardiac paralysis, asphyxia, cyanosis

How it manifests itself

Depending on the number of microorganisms and toxin in the body, the infection can occur either latently or lightning fast. The development of pathology includes several characteristic stages:

The incubation period for tetanus lasts 1-20 days (can last several months). In some cases, this stage is asymptomatic, in others the patient feels slight muscle tension and tremor in the wound area.
The initial period lasts up to 2 days, characterized by the occurrence of nagging pain at the site of infection (by this time the wound may have completely healed). Then trismus appears (convulsive contraction masticatory muscles), as a result of which the patient is practically unable to open his mouth.
The peak period lasts about 8-12 days, sometimes lasting up to 2-3 weeks. The duration of the stage depends on the history of vaccinations and the timing of the start of treatment. The height of the development of pathology is characterized standard features tetanus: trismus, “sardonic smile”, opisthotonus. Tetanic convulsions occur and spread throughout the body with varying frequency and duration, body temperature rises to 40-42 ºС. Due to constant muscle tension, even between attacks, the patient has problems with independent urination, defecation, breathing, and swallowing. Because of this, it is possible to develop diseases such as bronchitis, pneumonia, pulmonary edema, myocardial infarction, and sepsis.
The recovery stage can last up to 2 months. At this time, the number and strength of seizures gradually decreases. The period is dangerous due to the occurrence and development of complications.

The first signs of tetanus

The incubation period of the disease depends on the prevalence of infection in the body, the location of the injury, the degree of activity of spores of pathogenic bacteria, local immunity and the resistance of the body as a whole. The stage may be asymptomatic or with the presence of prodromal signs. The severity of the disease, associated complications and prognosis depend on the incubation period - it is believed that the faster tetanus develops, the more difficult it is for the patient to endure the pathology.

Prodromal signs of infection

TO primary symptoms tetanus infection includes general malaise, headache, increased irritability, chills, sweating, sore throat and lower back. The patient may experience low-grade fever, sleep disturbances, yawning, and loss of appetite. In addition, dull, nagging pain and muscle tension may occur at the site of suspected infection.

Specific symptoms

There is a triad of tetanus symptoms, the combination of which is characteristic exclusively of this pathology. Typical signs:

Trismus is a convulsive contraction of the masticatory muscles, in which the patient cannot unclench his jaw; the symptom occurs due to irritation facial nerve.
Dysphagia - difficulty swallowing reflex, painful sensations due to weak tone of the pharyngeal muscles.
“Sardonic smile” is a specific spasm of the facial muscles, in which the patient’s facial expression looks like a combination of laughter and horror (lips are stretched in a smile, the corners of the mouth are lowered, the forehead is tense, the eyes are narrowed).

The listed signs are accompanied by rigidity (tension) of the neck muscles (without other meningeal symptoms), opisthotonus. Between attacks, muscle relaxation does not occur, which makes the course of the disease exhausting for the patient. Convulsions occur with of different durations and frequency in response to any external stimulus (light, sound), so patients are placed in a sound-proof sterile box for the duration of treatment. As the pathology progresses, the strength of the spasms increases, they cover the diaphragm and intercostal muscles, which provokes difficulty breathing.

Opisthotonus of muscles

In severe cases of pathology, convulsions spread throughout the body in a descending direction, opisthotonus develops - a specific strong tension back muscles and limbs, in which the patient bends into an arched position, resting on the back of the head and heels. The convulsions intensify over time, but the patient does not lose consciousness, experiences severe pain and fear, and is observed excessive sweating and drooling, as a result of which the patient suffers from dehydration.

Complications of tetanus and prognosis

The course of the disease is usually very severe and is accompanied by the development of complications. During the illness and after recovery, the patient may develop the following pathologies:

fractures of the spine and bones;
ligament and tendon ruptures, dislocations;
muscle separation from bones;
compression deformities of the spine;
bronchitis, pneumonia, pulmonary edema, pulmonary embolism;
myocardial infarction, coronary spasm;
paralytic lesions of the cranial nerves;
circulatory disorders;
sepsis.

Patient survival

The prognosis for patients with tetanus is disappointing - according to various sources, the mortality rate ranges from 25 to 70% (a significant part of this figure is made up of representatives of the unvaccinated population of the planet). The mortality rate among children is especially high infancy due to their weak resistance to the disease. This indicator depends on timely diagnosis and proper treatment, the presence of concomitant diseases and vaccination history.

Diagnostics

A physical examination allows you to quickly diagnose the disease. If necessary, the doctor directs the patient to make a scraping from the wound site, a smear from the mucous membrane of the vagina, pharynx or nose to isolate tetanus toxin and perform a biological test on mice. In the early stages of the disease, tetanus should be distinguished from gingivitis, retropharyngeal abscesses, and inflammation of the joints lower jaw, periostitis. In case of tetanus infection in children, the possibility of birth injuries, meningitis, epilepsy and rabies should be excluded.

Treatment of tetanus

A patient diagnosed with tetanus should be immediately admitted to the intensive care unit. This pathology is treated by an anesthesiologist-resuscitator. Feeding is often done using a gastric tube (for paresis of the gastrointestinal tract - parenterally). To avoid the development of pneumonia and bedsores, the patient is often turned over. Treatment of tetanus infection includes the following steps:

neutralization of the toxin (using a special serum);
cleansing the wound from infectious agents (opening and disinfection);
eliminating cramps, lowering temperature, maintaining the functioning of organs and systems, combating dehydration.

Neutralization of toxin

Used to neutralize the toxin intramuscular injection antitetanus serum (often together with an injection of tetanus immunoglobulin) in the following doses:

newborn child – 20,000–40,000 IU;

older children – 80,000–100,000 IU;

adults – 100,000–150,000 IU.

Opening and treating the wound

To eliminate the tetanus bacillus, large incisions are made in the affected area under anesthesia to clear the source of infection from dead tissue. The wound is not sutured to ensure a constant supply of oxygen (aeration); a special dressing is applied, which is changed every few hours. For further wound healing, proteolytic enzymes (trypsin, chymotrypsin) are used.

Symptomatic treatment

To eliminate tetanic tension, anticonvulsants, muscle relaxants, neuroplegics, narcotics, sedatives and antipsychotics (eg, diazepam). An effective remedy is considered a mixture of chlorpromazine, diphenhydramine, trimeperidine and scopolamine hydrobromide. Also wide application For the treatment of severe tetanus, fentanyl, droperidol, sodium hydroxybutyrate, barbiturates, and peripheral muscle relaxants with curare-like action have been found. For a labile nervous system, α- and ß-blockers are used.

If the patient has difficulty breathing, he is intubated and then connected to the device. artificial ventilation lungs. If necessary, the patient is given a gas tube and catheterization is performed. Bladder. For severe acidosis and dehydration, use infusion administration solutions of sodium bicarbonate, plasma, albumin, sodium bicarbonate, rheopolyglucin. To avoid secondary infections, antibiotic therapy is carried out. There is an opinion about the effectiveness of use hyperbaric oxygen therapy.

Preventive actions

Tetanus infection poses a serious threat to different segments of the population, so prevention is of great importance to prevent an increase in the incidence. There are several types of measures to prevent tetanus infection in children and adults. Emergency prevention tetanus includes the administration of AS toxoid (to form the body’s own immunity) and anti-tetanus serum or immunoglobulin (passive immunization) into following cases:

wounds, injuries to the limbs, gastrointestinal tract, and other organs;
burns, frostbite;
ulcers, gangrene, etc.

Routine vaccination

The most effective method prevention are tetanus vaccinations, which are given according to the plan: 7 times for children (from 3 months to 18 years), adults - every 5-10 years. Routine immunization is carried out tetanus toxoid, which is part of the DPT vaccine (against whooping cough, diphtheria and tetanus), ADS-M (tetanus + diphtheria), AS toxoid.

Nonspecific prevention

This includes proper hygiene for skin lesions, timely and competent treatment of wounds. Disinfection when treating wounds includes the following rules:

Cleaning the affected area from contamination, washing the wound with furacillin solution, hydrogen peroxide or other means.
Removing moisture with a swab.
Treating the skin around the wound alcohol solution iodine or brilliant green.
Applying a sterile dressing.

Video

The causative agent of tetanus - WITH.tetani. Causes an acute, non-contagious wound infection in which the nervous system is affected by the microbial exotoxin.

The disease occurs as a result of various injuries and wounds, provided that pathogen spores are introduced into them, which is possible when soil gets in, and is accompanied by tonic and clonic muscle spasms.

The causative agent of tetanus was discovered by N. D. Monastyrsky (1883) and A. Nikolayer (1884), pure culture isolated in 1889 by Kitazato.

Morphology.WITH.tetani – a large thin rod with rounded ends, 3-12 microns long and 0.3-0.8 microns wide. In preparations from affected tissues, bacteria are located separately and in groups of 2-3 cells; from cultures, especially young ones, in liquid media - in the form of long curved threads. Tetanus bacillus is mobile (peritrichous), has up to 20 or more flagella; in old cultures, cells without flagella predominate. Does not form a capsule. The round spores, located terminally, are 2-3 times wider than the cell, as a result of which the bacterium takes on the appearance of a drumstick. Spores usually form in cultures after 2-3 days; they also form in the body. The spore sticks are immobile. On days 4-6, cultures in liquid media consist exclusively of spores and contain almost no vegetative cells, which are lysed.

Vegetative cells are well stained with alcohol-water solutions of aniline dyes. Gram-positive, but in old cultures some bacteria are gram-negative.

Cultivation. The causative agent of tetanus - strict anaerobe. It grows on the surface of solid nutrient media under conditions of anaerobiosis with a residual pressure of no higher than 0.7 kPa. Optimal conditions: pH 7.4-7.6 and temperature 36-38 0 C; WITH.tetani. The growth limit of spores lies within the range of 14-43 0 C.

In Kitta-Tarozzi medium the pathogen grows slowly; usually after 24-36 hours an intense uniform turbidity appears with slight gas formation in the form of single bubbles; by 5-7 days a loose precipitate forms, and the medium becomes transparent. The crops, especially on the 3-5th day of growth, emit a peculiar smell of female horn.

On glucose-blood agar under anaerobic conditions it forms delicate whitish-gray colonies with shoots and a raised center, sometimes in the form of small round ones resembling dew drops. Colonies are surrounded by a weak zone of hemolysis (2-4 mm). If the dishes are additionally kept at room temperature, the hemolysis zone will increase; with abundant inoculation, hemolysis can occur over the entire surface of the medium. In a high column of agar, after 1-2 days, dense colonies grow, resembling lentil grains, sometimes a disk (R-shape). After 5-12 days, a herringbone-shaped growth appears in the gelatin column and the substrate slowly liquefies. The milk coagulates slowly with the formation of small casein clots on days 5-7; the brain medium turns black during prolonged cultivation.

Biochemical properties. Unlike other pathogenic clostridia, the causative agent of tetanus is characterized by weak biochemical activity: it does not ferment monosaccharides and polyhydric alcohols. However, some strains can ferment glucose depending on the concentration of iron ions in the medium.

WITH.tetani has weak proteolytic properties, causing the slow fermentation of proteins and peptones to amino acids, which then decompose to form carbonic acid, hydrogen, ammonia, volatile acids and indole.

Toxin formation. The causative agent of tetanus is devoid of invasive factors, but has the ability to synthesize exotoxin high activity. Tetanus toxin was obtained and described by Bering and Kitazato (1890). The toxin determines all the specifics of the pathogenesis and clinical picture of tetanus.

Tetanus exotoxin contains two components: tetanospasmin and tetanolysin (tetanohemolysin). Tetanospasmin selectively acts on the nervous system and causes tonic contractions of striated muscles, tetanolysin - nonspecific hemolysis of red blood cells. Tetanospasmin is the main toxic factor that has the properties of a neurotoxin that affects motor neurons of the central nervous system; It does not exhibit a cytopathic effect on cells of other tissues. It is produced in the body and cultures on the second day of incubation and reaches a maximum on days 5-7. Purified crystallized tetanospasmin is a thermolabile protease consisting of 13 amino acids with a predominance of asparagine. The toxicity of crystalline tetanospasmin is 66x10 6 LD 50 for white mice per 1 mg of toxin nitrogen. Tetanolysin is a hemolysin that is destroyed in the presence of oxygen and has common properties with betoxin. WITH.perfringens, pneumolysin of pneumococci and O-streptolysin of hemolytic streptococci. It accumulates in the culture fluid in significant quantities after 20-30 hours; in old cultures it is destroyed. It has hemolytic, cardiotoxic and lethal effects.

The processes of formation of tetanospasmin and tetanolysin are not mutually determined: some strains can produce large amounts of tetanolysin and small amounts of tetanospasmin.

The exotoxin of the tetanus causative agent is unstable and is easily destroyed at high temperatures (at 60 0 C - after 30 minutes, at 65 0 C - after 5 minutes), as well as under the influence of direct sun rays, ionizing radiation and chemicals: potassium permanganate, silver nitrate, iodine, acids, alkalis. Antibiotics and sulfonamides do not destroy this toxin. It does not penetrate the intestinal wall and is not inactivated by gastrointestinal enzymes. Under the influence of formalin at 35-38 0 C it turns into anatoxin - a non-toxic immunogenic drug.

The pathogenicity enzymes of clostridia tetanus include RNase and fibrinolysin. RNase is toxic to leukocytes and inhibits phagocytosis; fibrinolysin promotes the absorption of tetanospasmin.

Antigenic structure. Mobile strains of clostridia tetanus contain somatic O- and flagellar H-antigens. The heat-labile H-antigen determines the type specificity of the microbe. 10 serovars of the causative agent of tetanus have been described, differing in the structure of the H-antigen, designated by the numbers I, II, III , IV, etc. In nature, serovars I and II are most often found. All of them produce an immunologically homogeneous exotoxin, neutralized by antitetanus serum. The thermostable O-antigen belongs to the group.

The antigenic structure of tetanus toxin has not been sufficiently studied.

Sustainability. Vegetative cells WITH.tetani low resistance to influence various factors external environment. A temperature of 60-70 0 C kills tetanus bacilli within 30 minutes, solutions of conventional disinfectants - after 15-20 minutes.

Spores, on the contrary, are very resistant. In soil, dried feces, on various objects (nails, wood chips, agricultural tools, plant thorns, etc.), protected from light, they are preserved for many years (for example, on a piece of dry wood - up to 11 years). Direct sunlight inactivates spores after 3-5 days. In a humid environment, when heated to 80 0 C, they remain viable for 6 hours, and when heated to 90 0 C - 2 hours. They are also relatively resistant to various disinfectants: 1% solution of sublimate 5% solution of phenol kills them in 8-10 hours, 5 % creolin solution - for 5, 1% formalin solution - for 6 hours, 0.5% solution of hydrochloric acid - for 30 minutes, 10% tincture of iodine - for 10, 1% solution of silver nitrate - for 1 minute.

Pathogenicity. All types of farm animals are susceptible to tetanus, but horses are the most susceptible. Dogs, cats and wild mammals are also affected. Cases of tetanus have been described in chickens, geese and turkeys. Humans are extremely susceptible to tetanus toxin. Cold-blooded animals - frogs, snakes, turtles, crocodiles - are immune to tetanus at temperatures below 20 0 C, but the injected toxin circulates in their body for a long time.

Among laboratory animals, the most susceptible are white mice, guinea pigs and rabbits. The incubation period in white mice lasts up to 36 hours, in guinea pigs - up to 48 hours, in rabbits - up to 3-4 days. Their disease develops according to the general or ascending type ( tetanus ascendes) tetanus. The clinical picture is especially characteristic in white mice: rigidity of the tail and inoculated paw. The limb is elongated, limited in mobility, the body is curved towards the inoculated paw, and the process gradually affects the second half of the body. A mouse placed on its back cannot roll over on its own. Dying animals take a characteristic pose with a curvature of the body and outstretched legs. Their death occurs within 12 hours to 5 days.

Pathogenesis. The main pathogenetic factor in tetanus is exotoxin, and primarily tetanospasmin, which is a neurotoxin. It does not affect the skin and does not have a cytotoxic effect. Protease enzymes and fibrinolysin, melting blood clots and blood clots, contribute to the spread of the toxin beyond the source of microbial reproduction. With a deep wound, spores quickly vegetate under conditions of anaerobiosis, intensive bacterial reproduction and toxin synthesis occur.

The exotoxin affects the motor nerve centers, spinal cord and brain, which ultimately causes the main symptom complex of tetanus. Under the influence of the toxin, the activity of cholinesterase decreases and, accordingly, the hydrolysis of acetyl chloride, inevitably leading to its excessive formation, as a result of which the end plate of the neuromuscular synapse comes into a state of increased automatic excitation. Convulsions lead to respiratory distress, laryngotracheospasm develops, hypoxia, respiratory and metabolic acidosis occurs. Under the influence of excess lactic acid, cerebral edema can develop. Animals die as a result of asphyxia or cardiac paralysis.

Epizootological data. All types of domestic animals, especially young animals, are susceptible to tetanus. Birds are relatively resilient. People are susceptible to tetanus. The disease is not contagious.

The source of the pathogen is clostridium-carrying animals that excrete the pathogen in their feces. The main route of infection is when spores of the tetanus pathogen get into wounds, especially deep ones With muscle rupture.

Pre-mortem diagnostics. Sick animals experience tension, numbness, and muscle cramps. The first signs of the disease: difficulty in taking food and chewing, cramps of the masticatory muscles, tense gait, immobility of the ears, prolapse of the third eyelid, cyanosis of the mucous membranes, sometimes acute pulmonary edema, slow peristalsis; in cattle, chewing the cud stops, the rumen expands, feces and urine are difficult to excrete. Animals stand with their limbs spread wide apart. In sheep and goats, there is a convulsive contraction of the neck muscles, the head is thrown back (opisthotonus).

Post-mortem diagnostics. No pathological changes characteristic of tetanus are found. The muscles may have the color of boiled meat, fiber breaks, and small nested hemorrhages. Degenerative changes are sometimes noted in the kidneys and liver, and hemorrhages are observed in the pleura and epicardium. The diagnosis of the disease is usually made based on pre-mortem examination data, and, if necessary, laboratory tests and bioassays are performed on mice.

Laboratory diagnostics. Pieces of tissue from the deep layers of wound lesions, pus, and discharge from wounds are sent to the laboratory for examination. When the process is generalized, the pathogen can be found in the internal organs, so pieces of the liver and spleen weighing 20-30 g and 10 ml of blood are taken from the corpse. If tetanus occurs due to childbirth or abortion, discharge from the vagina and uterus is sent, and if suspected, the corpse of a newborn animal is sent.

During the study, the causative agent of tetanus and its toxin are isolated. Smears are Gram stained. The presence of gram-positive rods with round terminal spores in the preparations gives reason to suspect tetanus. However, saprophytic bacteria are often found (WITH.tetanomorphum And WITH.putrificum), very similar to Clostridia tetanus. Therefore, microscopy is only of indicative value.

The material is inoculated into Kitta-Tarozzi medium. The culture is microscopically examined and, if it is contaminated, heated for 20 minutes at 80 0 C or 2-3 minutes at 100 0 C. Then, subculture is carried out using the fractionation method on Petri dishes with glucose-blood agar and grown under anaerobic conditions. After growth appears, characteristic colonies are selected and screened to isolate a pure culture.

A bioassay is carried out to detect the toxin in pathological material and culture. The test material is ground in a sterile mortar with quartz sand, and a double volume of physiological solution is added. The mixture is kept for 60 minutes at room temperature, after which it is filtered through a cotton-gauze or paper filter. The filtrate is injected intramuscularly into the thigh of the hind paw of two mice at a dose of 0.5-1 ml. To achieve faster results, it is recommended to inject the filtrate into the tail root area in a mixture with calcium chloride.

If a pathogen culture is examined, then to accumulate the toxin, it is first kept at 37-38 0 C in a thermostat for 6-10 days, filtered (or centrifuged) and administered in a dose of 0.3-0.5 ml to two white mice.

The bioassay can also be carried out on guinea pigs. Animals usually die within 12 hours to 5 days. The experimental animals are observed for at least 10 days.

Tetanus toxin in cultures can also be detected using neutralization reactions (RN) and indirect hemagglutination (IDHA) with tanned erythrocytes.

Specific prevention. Some animal species are naturally resistant to tetanus. It is known that cattle and pigs get sick less often than other animal species. It is believed that they receive spores of the tetanus causative agent with food, which vegetate in the digestive tract to form a toxin, which, when absorbed in very small quantities, causes immunity. Tetanus antitoxin is found in the native sera of cows, zebu, buffalo, and sheep; in smaller quantities it is found in the sera of horses and camels.

It is generally accepted that immunity in tetanus is mainly antitoxic. Vaccination of animals with tetanus toxoid gives them a stable and intense immunity that lasts several years. In 1924, French researchers Ramon and Descombes obtained an toxoid, which was later actively used to prevent tetanus.

In our country, we use a highly effective concentrated tetanus toxoid, which is a precipitate of 1% alum toxoid, made from native tetanus toxin by treating it with formaldehyde, heat, potassium alum and phenol. It is used for prophylactic purposes in areas that are enzootically unfavorable for tetanus, especially where frequent cases of the disease in adult animals and young animals are registered. Immunity occurs 30 days after vaccination and persists in horses for 3-5 years, in other species of animals - for at least a year.

For passive immunization and treatment of sick animals, an antitoxic antitetanus serum horses hyperimmunized with tetanus toxoid.

Veterinary and sanitary assessment and measures. Sick animals are not allowed to be slaughtered. If the disease is detected after slaughter, the carcass with all organs and skin is destroyed. Residues of feed, manure, and bedding are burned. All impersonal products (legs, udders, ears, blood, etc.) obtained from the slaughter of other animals, mixed with slaughter products from sick animals, are destroyed.

Sanitation is carried out: mechanical cleaning of the room, washing off contaminants from surfaces with a 1% solution of caustic soda (70-80 0 C), disinfection with a 5% solution of caustic soda (70-80 0 C) and thoroughly wiping the surfaces at the time of applying the solution with mops, etc. P.; after 3, 6, 24 hours - disinfection is repeated with a 3% formaldehyde solution and a 3% caustic soda solution or bleach with 5% active chlorine (1 l/m3). The overalls are boiled.

It does not develop after the disease. Recovery from clinical tetanus infection does not provide protection against new disease. A small amount of tetanus toxin, sufficient for the development of the disease, does not ensure the production of the necessary antibody titers. Therefore, all patients with clinical forms of tetanus must be immunized with tetanus toxoid - immediately after diagnosis or after recovery.

Encyclopedic YouTube

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✪ TETANUS OR WHAT IS THE DANGER OF WOUNDS?

✪ Clinical case tetanus

Subtitles

Unfortunately, we live in a world where even a small cut in the skin can pose a serious threat to human life. Today we will get acquainted with such a dangerous disease as tetanus. Hello my dears! The disease that we will talk about today has claimed and continues to claim thousands of human lives since time immemorial. For the first time, a complete description of tetanus was given by the great scientific mind of the past, Hippocrates, whose family, because of this illness, she lost her son. Until the end of the 19th century, medicine was unable to establish the true cause of tetanus, however, doctors and healers rightly associated its development with injuries. The causative agent of the disease, the tetanus bacillus, was isolated by the outstanding Russian surgeon Nestor Dmitrievich Monastyrsky in 1883. But only almost half a century later, in the mid-twenties of the twentieth century, through the efforts of the French immunologist G. Ramon, medicine made a breakthrough in the treatment of tetanus. It was G. Ramon who developed the method for producing tetanus toxoid, which is still used in vaccination today, protecting humanity from this serious illness. It would not be wrong to say that in almost all third world countries where vaccination is not carried out, the number of people infected with tetanus annually exceeds 1 million. And from its consequences, according to the World Health Organization, about 400 thousand people die. What is tetanus and why is it so dangerous? Tetanus or Tetanus is an acute infectious disease transmitted by contact. You can get tetanus in any part of the world, but a high probability of infection, in case of injury, is observed in hot, humid climates, where the presence of the pathogen in the soil is extremely high, and wound healing takes a long time. The causative agent of the disease is the spore-forming motile anaerobic bacterium Clostridium tetani, which produces one of the most powerful toxins found on the planet - tetanospasmin. The presence of tetanospasmin in the body in an amount of only 2 ng per 1 kg of weight can lead to death. The bacterium lives in the intestines of herbivores, birds and humans, where it enters with contaminated food. With feces, the tetanus bacillus ends up in the external environment, where it exists in the form of spores that are very resistant to aggressive influences. For example, spores can withstand temperatures of 90 °C for two hours. While in the host's intestines, the bacterium does not cause any problems. But when the pathogen enters a wound deprived of oxygen, the spores develop and further multiply bacteria, accompanied by the release of toxins that affect the nervous system. In the vast majority of cases, tetanus infection occurs as a result of injury to the legs. For this reason, tetanus is also popularly called a “disease bare feet" Injuries can be of various types: cuts, punctures, abrasions, burns, frostbite. Even a banal splinter can cause the development of tetanus. The most dangerous are punctured and deep wounds , in which there is no access to oxygen. Tetanospasmin, formed as a result of the vital activity of bacteria, penetrates through the processes of nerve cells into the central nervous system, disrupting the activity of the spinal cord and brain. From the moment of infection to the first symptoms of tetanus, on average, about two weeks pass, but sometimes this period of time can decrease to 1-4 days or increase to a month, depending on the severity of the disease. As a rule, the disease begins acutely. The first sign of tetanus is the appearance of nagging pain and muscle twitching at the site of infection, where by this time, the wound has often already completely healed. The next, most characteristic symptom of tetanus is severe tension and cramps of the masticatory muscles, causing difficulty opening the mouth. Following this, spasms of the facial muscles develop, giving the face the expression of a so-called “sardonic smile.” A person seems to smile and cry at the same time: wrinkles appear on the forehead, the eye slits narrow, the lips stretch wider, and the corners of the mouth droop. As a result of spasm of the pharyngeal muscles, it becomes difficult and painful for the patient to swallow. Due to increasing tension in one or another muscle group, the patient can take a wide variety of, sometimes bizarre, poses. In severe cases of tetanus, due to a sharp spasm of the back muscles, the head is thrown back, the body is arched in such a way that you can stick your hand between the back and the bed. Excruciating, sharply painful spasms spread throughout the entire body causing suffocation, cardiac paralysis or respiratory arrest. The most dangerous complications of tetanus include bone fractures, dislocations, ruptures of muscles and tendons caused by severe muscle cramps and blood poisoning caused by the layering of a secondary bacterial infection. In the case of a positive outcome of the disease, recovery occurs no earlier than after 1.5-2 months, and the rehabilitation period extends for many years. Treatment of tetanus is carried out only in a medical clinic in the intensive care unit. Without qualified assistance, the patient most often dies. How to protect yourself and protect yourself from tetanus infection? First of all, any wounds and scratches should be washed, treated with an antiseptic (hydrogen peroxide, brilliant green solution, etc.) and a clean, dry bandage applied. However, no matter how carefully the wound is treated, in the case of tetanus this may not be enough. Currently, the basis for both emergency and planned prevention of tetanus is vaccination, the need for which we discussed in sufficient detail in previous issues. If the injured person has not been vaccinated against tetanus in the last 10 years, then in order to prevent possible infection, he should immediately contact the nearest medical facility to receive anti-tetanus serum. Remember, tetanus is a very insidious and serious disease, often leading to death. If you are not vaccinated against it, do not ignore visiting your doctor. It’s easier to protect yourself by vaccination than to treat both the disease itself and its consequences for a long time and persistently! Do not be ill! Give it a like! Subscribe to the channel! Health to you!

Etiology

The causative agent of tetanus is a gram-positive bacillus, which is a spore-forming obligate anaerobe, that is, living in an oxygen-free environment. This is a mobile, large, thin rod with rounded ends, 4-8 µm long and 0.3-0.8 µm wide, with up to 20 long flagella.

The causative agent of tetanus belongs to the category of ubiquitous (ubiquitous), but at the same time opportunistic microorganisms. It is a common inhabitant of the intestines of humans and animals, where it lives and reproduces without causing harm to the host.

Therefore, the greatest contamination with tetanus bacillus is observed in agricultural areas with sufficient humidity, where the bacillus is found in the soils of gardens, vegetable gardens, pastures and other places where there is contamination with human and animal feces.

In the presence of oxygen and a temperature of at least 4 ° C, it forms spores. The spores are resistant to external influences: they can withstand heating up to 90 °C for 2 hours, when boiled they die only after 1-3 hours, in a dry state they can withstand heating up to 150 °C, in salty sea water live up to 6 months. They remain in feces, soil, and on various objects for more than 100 years [ ] .

In the absence of oxygen, a temperature of 37 °C and sufficient humidity, the spores germinate into a low-resistant vegetative form.

The pathogen forms tetanus exotoxin- one of the strongest bacterial poisons, second in strength only to botulinum toxin. The toxin is destroyed when heated, exposed to sunlight, or an alkaline environment. It is not absorbed through the intestinal mucosa and is therefore safe if swallowed.

Story

Mechanism of action

The pathogen, finding itself in favorable conditions, begins to actively multiply, producing tetanus toxin, which penetrates through motor fibers peripheral nerves and with blood flow in the spinal cord, medulla and into the reticular formation of the brainstem.

Tetanus toxin consists of tetanospasmin, which acts on the nervous system, causing tonic contractions of striated muscles, and tetanohemolysin, which causes hemolysis of red blood cells.

Paralysis occurs interneurons polysynaptic reflex arcs. As a result, impulses arrive to the muscles uncoordinated, causing constant tonic tension in the skeletal muscles, resulting in cramps. The excitability of the cerebral cortex and reticular structures increases, damage respiratory center vagus nerve.

Rigidity (tension) of the muscles spreads from the affected limb to the opposite one, then to the torso, neck, head, and then cramps occur. Paralysis of the respiratory organs and heart muscle may occur.

Classification of forms of tetanus

Depending on the route of infection:

Traumatic tetanus (wound, postoperative, postpartum, newborns, post-injection, after burns, frostbite, electrical injuries, etc.).

By location in the body:

General, or generalized tetanus (a variety - Brunner's tetanus cephalus, or bulbar tetanus).
Local tetanus (a variety - Rose's cephalic tetanus or facial tetanus).

According to the severity of the disease:

Mild - rarely observed (mainly in previously vaccinated people). Symptoms are mild, the temperature is normal or slightly elevated.
Moderate - cramps and muscle tension are infrequent and moderate. The temperature is elevated.
Severe - relatively frequent and intense convulsions. Characteristic facial expression, elevated temperature.
Particularly severe - encephalitic tetanus (Brunner's tetanus) with damage to the upper parts of the spinal and medulla oblongata (respiratory center, vagus nerve nuclei, cardiovascular center), gynecological tetanus and neonatal tetanus.

Clinical picture

Generalized tetanus

There are 4 periods of the disease: incubation, initial, peak and recovery.

Incubation period for tetanus it usually lasts about 8 days, but can last up to several months. When the process is generalized, the more distant the source of infection is from the central nervous system, the longer the incubation period. The shorter the incubation period, the more severe the disease.

Incubation period neonatal tetanus on average from 5 to 14 days, sometimes from several hours to 7 days.

The disease may be preceded by headache, irritability, sweating, tension and twitching of muscles in the wound area. Immediately before the onset of the disease, chills, insomnia, yawning, sore throat when swallowing, back pain, and loss of appetite are noted. However, the incubation period may be asymptomatic.

Initial period lasts up to 2 days. The earliest symptom is the appearance of dull nagging pain in the area of the entrance gate of the infection, where by this time complete healing of the wound can be observed. Almost simultaneously or after 1-2 days, trismus appears - tension and convulsive contraction of the masticatory muscles, which makes it difficult to open the mouth. In severe cases, the teeth are clenched tightly and it is impossible to open the mouth.

High period The illness lasts on average 8-12 days, in severe cases up to 2-3 weeks. Its duration depends on the timeliness of seeing a doctor, the early start of treatment, and the availability of vaccinations in the period preceding the disease.

Tonic contraction of the masticatory muscles develops ( lockjaw) and spasms of facial muscles, as a result of which the patient develops a sardonic smile. risus sardonicus: eyebrows are raised, the mouth is stretched wide, its corners are lowered, the face expresses both a smile and crying. Further develops clinical picture involving the muscles of the back and limbs (“opisthotonus”).

There is difficulty swallowing due to spasm of the pharyngeal muscles and painful rigidity (tension) of the muscles of the back of the head. Rigidity spreads in a descending order, affecting the muscles of the neck, back, abdomen and limbs. Tension appears in the muscles of the limbs and abdomen, which becomes hard as a board. Sometimes there is complete stiffness of the torso and limbs, with the exception of the hands and feet.

Painful cramps occur, initially limited, and then spreading to large muscle groups, which last from a few seconds to several minutes. In mild cases, convulsions occur several times a day, in severe cases they last almost continuously.

Convulsions appear spontaneously or with minor irritations (touch, light, voice). During convulsions, the patient's face becomes covered with large drops of sweat, becomes puffy, turns blue, and expresses suffering and pain. Depending on the tension of a particular muscle group, the patient’s body can take the most bizarre poses. The patient bends on the bed into an arched position, resting only on the heels and the back of the head (opisthotonus). All muscles are so tense that you can see their outlines. The legs are stretched out, the arms are bent at the elbows, the fists are clenched.

Some patients prefer to lie on their stomach without their legs, arms and head touching the bed. Patients experience fear, grind their teeth, scream and moan in pain. During the period between spasms, muscle relaxation does not occur. Consciousness is usually preserved. Patients sweat profusely. Persistent insomnia occurs. Apnea, cyanosis, and asphyxia are observed.

Muscle spasms lead to difficulty or complete cessation of the functions of breathing, swallowing, defecation and urination, circulatory disorders and the development of congestion in the internal organs, a sharp increase in metabolism, and impaired cardiac activity. The temperature rises to 41-42 °C.

Recovery period characterized by slow gradual decline strength and number of cramps and muscle tension. May last up to 2 months. This period is especially dangerous for the development of various complications.

Cause of death

The most common cause of death is asphyxia due to spasm respiratory muscles, glottis and diaphragm, in second place is paralysis of the heart muscle. In some cases, the cause of death may be myocardial infarction, pneumonia, sepsis, embolism pulmonary arteries and other diseases associated with complications after tetanus.

Brunner's tetanus, or bulbar tetanus - the most severe form of the disease, a type of general tetanus, which affects the upper parts of the spinal cord and medulla oblongata. The disease resolves with the most severe clinical picture of general tetanus. Typically develops with head or neck injuries.

Local tetanus It is rare, mainly in previously vaccinated individuals. It is characterized by local paralysis that does not affect the entire body. The disease is characterized by spasms and muscle twitching at the site of injury, slight increase temperature, absence of general convulsions. Often develops into generalized tetanus.

Tetanus Rose. A type of local tetanus, which occurs with wounds to the head and neck, is manifested mainly by paralysis of the facial nerve on the affected side. May develop into general tetanus or Brunner's cephalic tetanus.

Newborns They suffer only from general tetanus.

Treatment

The patient is subject to immediate hospitalization in a specialized hospital.

Treatment includes:

Fighting the pathogen at the primary site of infection (opening, sanitation and aeration of the wound).
Neutralization of tetanus toxin by administration of antitetanus serum.
Anticonvulsant treatment (total muscle relaxation).
Soundproof aseptic box
Maintaining vital functions of the body (artificial ventilation, control of cardiac activity).
Prevention and treatment of complications (fighting concomitant infections, thrombosis), prevention mechanical damage with convulsions.
Good nutrition and care.

The patient is placed in a separate darkened room, where the possibility of exposure to external stimuli(noise, light, etc.). 24-hour medical supervision (post) is established. The patient should not leave the bed.

Nutrition of patients during the height of the disease is very difficult, since strong muscle tension prevents the administration of food through a tube and intravenously. It is recommended to eat liquid foods (milk, broth, etc.). Patients drink water willingly and with pleasure.

The period of treatment in a hospital ranges from 1 to 3 months.

Complications

During the height of the disease, against the background of muscle spasm and congestion, bronchitis, pneumonia, myocardial infarction, sepsis, auto-fractures of bones and spine, dislocations, ruptures of muscles and tendons, separation of muscles from bones, venous thrombosis, pulmonary embolism, pulmonary edema may occur.

Later complications include weakness, tachycardia, spinal deformity, contractures of muscles and joints, temporary paralysis of the cranial nerves.

Compression deformity of the spine can persist for up to 2 years.

Upon recovery, a person can start working only after 2 months. He should be observed by a neurologist for at least 2 years.

Extremely rarely, for unclear reasons, a relapse (repeated manifestation) of the disease occurs.

Prevention

Prevention of the disease is carried out in three directions:

Prevention of injuries and health education among the population.
Specific prevention as planned by administering antitetanus

Tetanus is an acute infectious disease caused by the spore-forming anaerobe Clostridium tetani (C.tetani), which produces one of the most powerful toxins - tetanospasmin, and when it enters the human body through a wound or cut, it affects the central nervous system, causing convulsions. For humans, the lethal dose of the toxin is only 2.5 nanograms per kilogram of weight.

Tetanus bacillus is very resistant to various external influences, tolerates boiling, and is resistant to phenol and other chemical agents. It can persist for decades in the soil and on various objects contaminated with feces. It can be found in house dust, earth, salty and fresh water, feces of many animal species.

What it is?

Tetanus - zooanthroponotic bacterial acute infection 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.

The patient is not contagious to others. Epidemiological measures are not carried out in the outbreak of the disease. Immunity does not develop after illness. Recovery from clinical tetanus infection does not provide protection against new disease. A small amount of tetanus toxin, sufficient for the development of the disease, does not ensure the production of the necessary antibody titers.

Therefore, all patients with clinical forms of tetanus must be immunized with tetanus toxoid - immediately after diagnosis or after recovery.

Pathogen

The causative agent of tetanus is Clostridium tetani. It belongs to bacteria that live in an airless environment; oxygen has a detrimental effect on it. However, this microorganism is very stable due to its ability to form spores. Spores are resistant forms of bacteria that can exist in favorable conditions environment. In the form of spores, Clostridium tetani easily tolerates drying, freezing and even boiling. And when exposed to favorable conditions, for example, a deep wound, the spore becomes active.

Clostridium tetani spores are found in soil, house dust, feces of many animals, and natural bodies of water. If this spore is so common in our environment, then the question arises, why do not all people become infected with tetanus? The fact is that this microbe is safe if swallowed. Although it is not destroyed by hydrochloric acid and enzymes, it cannot be absorbed through the gastrointestinal tract.

How is tetanus transmitted? This is a wound infection - the pathogen can enter the body through wounds, burn surfaces, areas of frostbite. Clostridium tetani loves deep wounds, as they can create oxygen-free conditions.

Mechanism of disease development

From the moment the tetanus bacillus enters favorable conditions, it actively begins to multiply, producing exotaxin, which is so harmful to a living organism. With the bloodstream, exotaxin spreads throughout the body and affects the spinal cord, parts of the medulla oblongata and the reticular formation.

The composition of tetanus toxin includes tetanospasmin, which poses a great danger to the nervous system. By acting on it, it leads to the appearance of tonic muscle contractions, and also triggers the process of tetanohemolysin, during which the process of destruction of red blood cells occurs.

Symptoms of tetanus in humans

There are several clinical periods in the development of tetanus in humans:

The incubation period for tetanus is usually about 8 days, but can last up to several months. When the process is generalized, the more distant the source of infection is from the central nervous system, the longer the incubation period. The shorter the incubation period, the more severe the disease. The incubation period of neonatal tetanus averages from 5 to 14 days, sometimes from several hours to 7 days. The 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, chills, insomnia, yawning, sore throat when swallowing, back pain, and loss of appetite are noted. However, the incubation period may be asymptomatic.
Initial period. Its duration is about two days. At the beginning infected person feels a nagging pain in the area of the wound, while the wound is purposefully getting better. At the same time or a little later, a person experiences trismus, which is usually understood as tension and contractile movements of the masticatory muscles, resulting in problems with opening the mouth. In severe cases of the disease, there may be a complete inability to open the mouth as a result of very strong closure of the teeth.
The peak period of the disease lasts on average 8-12 days, in severe cases up to 2-3 weeks. Its duration depends on the timeliness of seeing a doctor, the early start of treatment, and the availability of vaccinations in the period preceding the disease. A tonic contraction of the masticatory muscles (trismus) and convulsions of the facial muscles develop, as a result of which the patient develops a sardonic smile. risus sardonicus: the eyebrows are raised, the mouth is stretched wide, its corners are lowered, the face expresses both a smile and a cry. Next, the clinical picture develops with the involvement of the muscles of the back and limbs (“opisthotonus”). There is difficulty swallowing due to spasm of the pharyngeal muscles and painful rigidity (tension) of the muscles of the back of the head. Rigidity spreads in a descending order, affecting the muscles of the neck, back, abdomen and limbs. Tension appears in the muscles of the limbs and abdomen, which becomes hard as a board. Sometimes there is complete stiffness of the torso and limbs, with the exception of the hands and feet. Painful cramps occur, initially limited, and then spreading to large muscle groups, which last from a few seconds to several minutes. In mild cases, convulsions occur several times a day, in severe cases they last almost continuously. Seizures can occur spontaneously, or they can appear as a result of a stimulus, which can be a bright light, touch or sound. When convulsions occur, a person experiences increased sweating, the face turns blue and all facial expressions reflect terrible suffering. Muscle spasms lead to dysfunction of swallowing, breathing, and urination. Congestion and metabolic disorders occur in the body, which adversely affects cardiac activity. Body temperature rises above 40 degrees.
The recovery period is characterized by a slow, gradual decrease in the strength and number of cramps and muscle tension. May last up to 2 months. This period is especially dangerous for the development of various complications.

Severity

Depending on the severity of the course, tetanus can be:

Mild – has a long incubation period (more than 20 days), mild trismus, sardonic smile and dysphagia. There is practically no tension in other muscles, body temperature is normal or increased to 37.5°C. Symptoms of the disease develop within 5-6 days. This form of the disease develops in patients who have partial immunity.
The moderate-severe stage lasts from 2 to 3 weeks. All symptoms appear and increase within three days. A convulsive syndrome is typical, occurring once a day. Signs of hyperhidrosis, tachycardia and low-grade fever remain within moderate limits.
Severe - the incubation period is 7-14 days, symptoms appear within 24-48 hours. Severe muscle tension is accompanied by convulsive twitching several times an hour. Heart rate, blood pressure, and temperature are sharply increased.
Extreme stage severe course The disease is characterized by a very short incubation stage (up to seven days) and immediate development - regular, prolonged convulsive syndromes, up to five minutes, and muscle spasms accompanied by tachypnea (shallow rapid breathing), signs of tachycardia, suffocation and skin cyanosis.

What does tetanus look like: photo

The photo below shows how the disease manifests itself in humans.

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Diagnostics

Diagnosis of tetanus is based on the clinical presentation of the disease. Great importance has an anamnesis. Isolation and identification of the microorganism is rarely carried out. The toxin content in the muscles is determined.

At the onset of the disease, tetanus should be distinguished from periostitis, gingivitis, abscesses of the retropharyngeal space, inflammation of the mandibular joints, when the patient cannot open his mouth. When tetanus is present long-term stress chewing muscles and their twitching. In more late dates Tetanus should be differentiated from epileptic seizures, strychnine poisoning, hysteria in women.

In newborns, tetanus must be distinguished from the consequences birth trauma, meningitis. In doubtful cases, resort to spinal tap. In older children, tetanus should be differentiated from hysteria and rabies.

Consequences

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

Treatment of tetanus

A person who exhibits symptoms of tetanus should be immediately admitted to a hospital. In order to neutralize the tetanus toxin, the patient is given a special anti-tetanus serum or takes specific immunoglobulin. A number of drugs are used as therapy for seizure syndrome medicines- narcotic, sedative, neuroplegic. Muscle relaxants are also used to treat tetanus.

If the patient has severe respiratory distress, then before starting treatment for tetanus, it is necessary to carry out all the necessary resuscitation measures. Next, laxatives are used for treatment, a gas outlet tube is placed in the patient, and if there is such a need, the patient undergoes catheterization of the bladder. To prevent the patient from developing pneumonia, the patient with tetanus should be turned over very often, and constant stimulation of breathing and coughing is also necessary. To prevent in further treatment complications of a bacterial nature, antibiotics are used.

Treatment of tetanus also involves managing dehydration by using intravenous infusions of sodium bicarbonate solution. A number of other drugs are used for this purpose: polyionic solutions, hemodez, albumin, rheopolyglucin, plasma.

Tetanus shot

Children are vaccinated against tetanus five times. The first vaccination is given at 3 months, then at 4.5 months, at six months, at 1.5 years, then at 6-7 years.

Revaccination of adults is carried out at the age of 18 years. If in childhood was carried out full course Tetanus vaccination, then one vaccination every 10 years is sufficient. During the primary vaccination of an adult, 2 vaccinations are given at a monthly interval, and a year later another one. The vaccine is given intramuscularly (usually under the shoulder blade, shoulder or thigh). After vaccination, side effects are possible: swelling at the vaccination site, moderate pain, fever (it can be brought down with antipyretic drugs). All such symptoms should normally subside within 2-3 days.

You can get a tetanus vaccination and get detailed advice at any clinic near your place of residence.

Prevention of tetanus

Nonspecific prevention disease is to prevent injuries in everyday life and at work, compliance with the rules of asepsis and antiseptics in operating rooms, maternity rooms, and when treating wounds.

Specific prevention of tetanus is carried out routinely or urgently. According to national calendar Vaccinations: Vaccination is carried out in children from 3 months three times with the DTP vaccine (or DPT), the first revaccination is carried out after 1–1.5 years, followed by revaccinations every 10 years.

Tetanus (tetanus) is an acute infectious bacterial disease humans and warm-blooded animals, occurring with symptoms of damage to the nervous system in the form of generalized convulsions and tonic tension of skeletal muscles. Trismus, “sardonic smile” and dysphagia are strictly specific symptoms of tetanus. The disease is often fatal.

A person with tetanus is not dangerous to others

The causative agent of tetanus

The causative agent of tetanus (Clostridium tetani) is a ubiquitous bacterium. She happens to be opportunistic microorganism, lives in the intestines of animals and humans, where it lives and reproduces. Bacteria enter the soil with feces, contaminating the soil of vegetable gardens, orchards and pastures.

The presence of oxygen and low ambient temperature are factors in the formation of spores, which exhibit tremendous stability in the external environment. They do not collapse when heated for 2 hours at a temperature of 90 °C, in dry form they remain viable when heated to 150 °C, and live in sea water for up to six months.

Rice. 1. The photo shows the causative agents of tetanus.

The causative agent of tetanus is a spore-forming bacterium. Under unfavorable environmental conditions, bacteria form spores that are extremely resistant to a number of chemical factors, disinfectants and antiseptics. Clostridium tetani persists as spores for many years.

Under favorable conditions (in the absence of free oxygen and sufficient humidity), the spores germinate. The resulting vegetative forms produce the exotoxin tetanospasmin and the exotoxin hemolysin. Tetanus exotoxin is a powerful bacterial poison, second in strength only to the toxin secreted by the spore-forming bacillus Clostiridium botulinum (botulinum toxin). Heat, exposure to sunlight and an alkaline environment have a detrimental effect on the exotoxin.

Rice. 2. The photo shows spore-bearing tetanus bacteria. They look like sticks with rounded ends (photo on the left). In unfavorable environmental conditions, bacteria form spores that resemble rackets in appearance (photo on the right).

Rice. 3. The photo shows a tetanus bacterium. The bacterium has up to 20 long flagella, as a result of which it has good mobility.

Prevalence and incidence rate

Up to 400 thousand people die from tetanus every year. The prevalence of the disease on planet Earth is uneven. Hot and humid climate, lack of preventive work and medical care are the main reasons for the spread of the disease. In such regions, the mortality rate from tetanus reaches 80%, and in newborns - 95%. In countries where they apply modern methods treatment and prevention of tetanus, about ¼ of those affected die annually. This is due to severe complications of the disease caused by tetanus toxin that are incompatible with life.

Rice. 4. Dark red and red colors indicate incidence rates (very high and high, respectively) for the period from 1990 to 2004.

Epidemiology of tetanus

Tetanus bacteria are permanent inhabitants of the intestines of herbivores (herbivores, horses, sheep). Standing out in external environment Together with feces, microbes contaminate the soil. Tetanus most often affects older people. In regions where children are actively immunized, the disease develops extremely rarely.

The gates of infection are:

injuries, abrasions and splinters of the skin,
deep pyoderma in the form of boils and carbuncles,
skin damage due to bedsores, trophic ulcers and gangrene,
extensive wounds in wartime,
burns and frostbite,
postpartum and postoperative wounds, skin damage due to injections,
umbilical wound of newborns,
bites of poisonous animals and spiders.

Sometimes it is not possible to identify the entrance gates of infection.

The condition for the development of tetanus bacteria is an oxygen-free environment. These are puncture wounds and wounds that have deep pockets.

Rice. 5. Injuries, abrasions and splinters of the skin are the main entrance gate for bacteria.

A sick person is not a spreader of infection.

Pathogenesis of tetanus

When spores of tetanus bacteria enter through damaged skin, they germinate. The resulting vegetative forms produce exotoxin. The exotoxin tetanospasmin is a high molecular weight protein consisting of 3 fractions - tetanospasmin, tetanohemolysin and protein.

Neurotoxin tetanospasmin- the most powerful of all exotoxins. The toxin passes through the blood vessels and lymphatic vessels, along the perineural tract and is firmly anchored in the cells of the nervous system. Tetanospasmin blocks the inhibitory effect of interneurons on motor neurons and impulses that spontaneously arise in motor neurons begin to be freely transmitted to the striated muscles in which the tonic tension. Initially, muscle tension is recorded on the side of the affected limb. Next, muscle tension affects the opposite side. Next - the torso, neck and head. Tonic tension of the intercostal muscles and muscles of the diaphragm leads to impaired ventilation of the lungs, which leads to the development of metabolic acidosis.

When touched, loud sounds and the appearance of various odors, the patient develops tetanic convulsions. Prolonged convulsions are accompanied by large expenditures of energy, which aggravates the development of metabolic acidosis. A block of neurons in the brain stem region leads to inhibition of the parasympathetic nervous system. The respiratory and vasomotor centers are affected. Spasm of the respiratory muscles and paralysis of the heart muscle are the main causes of death in tetanus.

Rice. 6. In the photo, signs of tetanus in a child are convulsions (left) and opisthonus (right).

Signs and symptoms of tetanus

Signs and symptoms of tetanus during the incubation period

The incubation period for the disease lasts from 5 to 14 days. Fluctuations range from 1 day to 1 month. Tetanus almost always begins acutely. The prodrome period is rare. Its main manifestations are restlessness and irritability, insomnia, yawning and headache. In the area of damage to the skin, nagging pain occurs. Body temperature rises. Appetite decreases.

The further the lesion is located from the central nervous system, the longer the incubation period. With a short incubation period, the disease is more severe. A short incubation period is observed for injuries to the neck, head and face.

Rice. 7. In the photo there is a “sardonic smile” with tetanus. With tonic tension of the facial muscles, the mouth stretches, its corners drop, the wings of the nose rise, the forehead wrinkles, and the palpebral fissures narrow.

Signs and symptoms of tetanus in the initial period

Tetanus almost always begins acutely. Its first symptom is a tonic contraction of the masticatory muscles, characterized by the inability to open the mouth. Trismus is often preceded by “fatigue of the masticatory muscles.” With tonic tension of the facial muscles, the mouth stretches, its corners drop, the wings of the nose rise, the forehead wrinkles, and the palpebral fissures narrow ). As a result of contraction of the pharyngeal muscles, dysphagia. Duration initial period is 1 - 2 days.

Rice. 8. The first symptom of tetanus is a tonic contraction of the masticatory muscles (trismus) and facial muscles (“sardonic smile”).

Trismus, "sardonic smile" and dysphagia are strictly specific symptoms of tetanus

Signs and symptoms of tetanus during the height of the disease

The duration of the peak period of the disease is from 8 to 12 days. In severe cases - from 2 to 3 weeks.

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

When touched, loud sounds and the appearance of various odors, the patient develops tetanic convulsions. Prolonged convulsions are accompanied by large expenditures of energy, which contributes to the development of metabolic acidosis. During convulsions, body temperature rises, it is noted increased secretion saliva and tachycardia. Spasm of the perineal muscles is manifested by difficulties in urination and defecation. Convulsions last from a few seconds to one minute. Spasm of the respiratory muscles and paralysis of the heart muscle are the main causes of death in tetanus. In the absence of qualified medical care and preventive vaccinations, the mortality rate from tetanus reaches 80%. When vaccination is used and timely qualified medical care is provided, the mortality rate is 17 - 25%.

Rice. 9. The photo shows opisthonus (hyperextension of the spine) in a patient with tetanus.

Rice. 10. In the photo there is opisthonus in a child.

A patient with tetanus meningeal symptoms are absent, and consciousness remains clear throughout the entire period of the disease.

Signs and symptoms of tetanus during recovery

The recovery period for tetanus lasts 3 to 4 weeks. In some cases - 8 weeks. Already on the 10th day of the disease, an improvement in the patient’s well-being is noted. Signs of infectious-toxic myocarditis and asthenovegetative syndrome appear.

Severity and prevalence of tetanus

Mild form of the disease lasts about 2 weeks. Patients with this form of the disease have partial immunity from tetanus. Muscle hypertonicity, tetanic convulsions and dysphagia are mild. Convulsions are rare or absent.
Moderate form of tetanus proceeds with the phenomena typical symptoms diseases. The patient experiences convulsions every 1 to 2 hours. Their duration is short - 15 - 30 seconds.
At severe tetanus noted heat body, seizures are frequent - every 5 - 30 minutes, their duration is 1 - 3 minutes. Hypoxia and cardiac weakness develop. Pneumonia occurs.
It is especially difficult encephalic form of the disease(Brunner's cephalic bulbar tetanus), which affects the medulla oblongata and the upper spinal cord. The disease develops with injuries and injuries to the neck and head. The swallowing, respiratory and facial muscles are involved in the spasms. The incubation period for bulbar tetanus is short. Mortality is extremely high.
Very rarely observed local tetanus. Its variety is facial paralytic tetanus (Rose's cephalic tetanus), which develops with injuries and wounds of the neck and head, sometimes with otitis media. Characterized by trismus (contraction of the masticatory muscles), paralysis of the muscles that are innervated cranial nerves(either one or several). Most often, the disease affects the nervus facialis (facial nerve).

Rice. 11. The photo shows facial paralytic tetanus.

Complications of tetanus

Hypertonicity of the muscles involved in breathing leads to hypoxia. Mucus production increases. Violated drainage function bronchi. Against the background of congestion, bronchitis and pneumonia occur, complicated by pulmonary edema. Thrombosis of the pulmonary arteries develops.
The great strength of the muscles during the contraction period leads to the fact that they can be torn away from the place of attachment, fractures of the vertebral bodies, joint dislocations, ruptures of the muscles and tendons of the limbs and the anterior abdominal wall occur, compression deformation of the spine and muscle contractures develop.
Extensive wounds are often complicated by abscesses and phlegmon.
Later complications include spinal deformities, muscle contractures, and temporary cranial nerve palsies.

After recovery, the patient has been worried about general weakness, weakening of cardiovascular activity and stiffness of skeletal muscles for a long time.

In regions where there is no preventative work and proper medical care Mortality from tetanus reaches 80%, and in newborns - 95%. In countries where modern methods of treatment and prevention of the disease are used, up to 25% of patients die annually. This is associated with severe complications of tetanus that are incompatible with life.

Rice. 12. In the photo, a child has tetanus. Above - opisthonus, below - tetanic convulsions.

Relapses of the disease are extremely rare. The reasons for their occurrence are unknown.

Diagnosis of tetanus

Epidemiological history

Epidemiological history when diagnosing tetanus is of paramount importance. Domestic injuries, burns, frostbite, criminal abortions and surgical interventions are most often the cause of the disease.

Clinical symptoms of tetanus during the height of the disease make it easy to make a diagnosis. Trismus, dysphagia and “sardonic smile” at the beginning of the disease, hypertonicity of skeletal muscles, periodic tetanic convulsions and opisthonus are the supporting diagnostic signs diseases.

Rice. 13. The photo shows tetanus in adults.

Laboratory diagnostics

Laboratory diagnosis is of secondary importance. Tetanus toxin cannot be detected even when symptoms appear. Detection of antitoxic antibodies indicates previous vaccinations. The exotoxin does not cause an immune response, so there is no increase in antibody titer.

Smear microscopy is used to diagnose the disease. histological examination material and inoculation of wound discharge on nutrient media.