Tetanus is expressed. Tetanus: symptoms, incubation period, complications

Tetanus has been known since the time of Hippocrates, who was the first to make a detailed description of this disease. In ancient times, tetanus was common in men during wars. And for women - after childbirth or abortion. At that time, the nature of tetanus was not yet known. The fact that this disease is caused by a bacterium was discovered only at the end of the 19th century.

Tetanus still scares people today. After all, most people know that it is extremely dangerous and very often leads to painful death. What kind of disease is this? What symptoms does it manifest? Why is death a common outcome? How can you protect yourself? What to do if infection does occur?

The causative agent of tetanus

What is tetanus? is a severe infectious disease in which the nervous system is affected and multiple severe convulsions occur, often leading to death.

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 survive in unfavorable environmental conditions. 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, and frostbite areas. Clostridium tetani loves deep wounds, as they can create oxygen-free conditions.

Where is the disease common?

Tetanus is distributed throughout the globe. Large concentrations of the pathogen in the soil have been observed in areas with a humid and warm climate. The incidence worldwide is about 1 million people per year.

Do people die from tetanus? In terms of mortality, the disease is in second place after rabies among all infectious diseases. Its mortality rate, depending on the area, ranges from 40 to 70%. More than 60,000 people die from this disease every year. These statistics do not include unexpressed forms of the disease and unreported cases. In developed countries where tetanus vaccination is mandatory, the mortality rate is 0.1–0.6 per 100,000 population, and in developing countries the mortality rate is up to 60 per 100,000.

Among children, 80% of cases of the disease occur in newborns, mainly in poor countries (Africa, Latin America, Asia). Among the adult population, 60% are elderly. In rural areas, mortality is higher than in urban areas due to high injury rates.

Routes of infection

How can you get tetanus? This is a zooanthroponotic disease, that is, characteristic of both animals and humans. But one person cannot infect another. You can get tetanus if you have a deep wound. The following are susceptible to this disease:

• children under the age of 8–9 years due to the high level of traumatization (especially boys);
• newborns as a result of violation of the rules of asepsis and antisepsis when cutting the umbilical cord;
• adults with deep wounds (especially feet, palms, face).

The source of infection is humans and animals. The Clostridium tetani bacillus is a normal inhabitant of the intestine, does not cause harm to the host, lives, reproduces and is released as spores into the environment with feces.

You can notice the seasonality of the disease. Outbreaks are observed from April to October, during the period of active agricultural work. In 60% of cases, tetanus infection occurs when the feet are wounded. Walking barefoot, puncture wounds from nails, plant thorns, and splinters often lead to the development of tetanus. No wonder it is called “bare foot disease.”

The mechanism of origin and development of tetanus

Tetanus is caused by Clostridium tetani spores entering a wound. In the absence of oxygen, they transform into active forms. The bacterium itself is harmless. But it produces the strongest biological poison - tetanus toxin, which is second only to botulinum toxin in its toxic effect.

Tetanus toxin consists of tetanospasmin, which affects the nervous system, causing seizures, and tetanohemolysin, which causes hemolysis of red blood cells. The toxin penetrates the nerve fibers and blood into the structures of the brain and spinal cord. There it blocks the nerve cells responsible for inhibiting muscle contractions. Motor impulses from the brain continuously flow to the muscles, and they contract sharply and uncoordinated.

Muscle cramps last a long time, all muscles of the body are involved:

• limbs;
• spine;
• faces;
• larynx;
• hearts.

Tetanus toxin disrupts the circulation of biologically active substances in the brain, damages the respiratory center and other vital structures. Hemolytic ones fade into the background compared to neurological ones.

The first signs and symptoms of tetanus

The incubation period for tetanus from the moment the bacteria enters the wound until the first symptoms appear is 1–14 days. Its duration depends on the location of the wound, the depth of the wound, and the amount of microbe that has entered. Depending on the proximity of the wound to the face, palms or feet, the depth of penetration of the infection and its quantity depends on the speed of development of the disease.

The first signs of tetanus:

• pain in the wound area;
• headache;

Symptoms of tetanus in humans:

• spasm of the masticatory muscles (difficulty opening the mouth);
• spasms of the facial muscles (a “sardonic” smile appears, the lips are stretched, their corners are lowered, the forehead is wrinkled);
• convulsions that cover all the muscles of the body in a downward direction (a person arches, standing on his heels and the back of his head - opisthotonus);
• seizures occur in response to any irritating factor (light, sound, noise).

Convulsive attacks last only a few seconds or minutes, but during this time the person spends a huge amount of energy, becomes very exhausted and exhausted. As the disease progresses, the frequency of attacks increases. The condition is considered severe when they visit the patient almost continuously one after another.

During convulsions, a person does not lose consciousness, he feels severe pain throughout the body, fear, screams, and grinds his teeth. Outside of attacks, he suffers from insomnia.

How else does tetanus manifest in humans?

Difficulty opening the mouth and spasms of the throat lead to dehydration and starvation. At the same time as all the muscles, the muscles of the anus and the sphincter of the bladder also contract, so emptying is difficult. Body temperature rises to 40 °C.

a sign of illness - difficulty opening your mouth

There are milder local forms of tetanus, for example, facial, when only contraction of the facial muscles is observed. But they are rare.

The tetanus clinic lasts 2–4 weeks. Recovery occurs in 1–2 months. But a person cannot start work for a long time due to stiffness of movements, compression of the vertebrae, and contractures. The prognosis in half of the cases is unfavorable. The possibility of a bad outcome may be indicated by cramps in the larynx, respiratory muscles, temperature above 41.0 °C, decreased breathing, and increased pulse.

In newborn children, tetanus is manifested by impaired sucking and swallowing, contraction of facial muscles, and a “sardonic” smile. In premature and low birth weight babies, tetanus (an attack of seizures) may manifest itself as arching to one side. The course of the disease in newborns is particularly severe; they suffer only from general forms of tetanus. Over the course of a day, more than 30 attacks of varying duration may occur.

Complications

In adults, the disease can be complicated by:

• muscle rupture;
• tearing of ligaments;
• bone fractures as a result of strong muscle contraction;
• bronchitis;
• pneumonia;
• sepsis.

The most common causes of death from tetanus are:

• choking as a result of prolonged spasm of the vocal cords or respiratory muscles;
• heart failure;
• spine fracture;
• pain shock.

In children, tetanus is complicated by pneumonia, and at a later date by indigestion and anemia.

Diagnosis of the disease

Diagnosis of tetanus is based on the clinical picture of the disease. Anamnesis is of great importance. 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. With tetanus, there is prolonged tension in the masticatory muscles and their twitching.

At a later date, tetanus should be differentiated from epileptic seizures, strychnine poisoning, and hysteria in women.

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

Treatment

Treatment of tetanus should only be carried out in a hospital setting. The main goal is to neutralize and remove the toxin from the body as quickly as possible.

The complex of treatment measures includes:

The patient is placed in a separate darkened room, all possible irritants are minimized. The pathogen is eliminated by surgical treatment of the wound. Neutralization of the toxin is carried out using equine tetanus serum. It is done once intramuscularly in a dose:

• - 100,000–150,000 IU;
• newborns -20,000–40,000 IU;
• for older children - 80,000–100,000 IU.

In addition to serum, anti-tetanus human immunoglobulin is administered intramuscularly in a dose of 6 ml.

Anticonvulsants, muscle relaxants, and antipsychotics will help relieve seizures. In very severe forms, only muscle relaxants can cope with muscle contractions.

Disease prevention

The main measures to prevent tetanus are:

• vaccination;
• injury prevention.

Active and passive prevention of tetanus is carried out routinely or urgently.

All children aged 3 months to 17 years are routinely vaccinated according to the national vaccination calendar. Vaccination, depending on the circumstances, can be done with an isolated tetanus toxoid or a combined vaccine (,). For children, tetanus toxoid as part of the DTP vaccine is given:

When do adults get tetanus shots? Vaccinations are given to adults every 5–10 years if desired, or to persons at risk of disease: diggers, railway workers, construction workers and others.

Vaccination of adults against tetanus, if they have not previously been vaccinated, is carried out twice, and then revaccination is done every 10 years.

If a person has had tetanus, he does not develop long-term immunity, and he can become infected with this disease again.

What vaccines are available for routine immunization? Both children and adults can be vaccinated with DPT, DPT-M, ADS-M, Pentaxim, Tetrakok, Bubo-Kok, Infanrix vaccines.

Emergency prophylaxis against tetanus is carried out in the following cases:

Emergency prevention of the disease is carried out with tetanus toxoid in a dose of 0.5 ml. If the child or adult has not been vaccinated previously, then an additional anti-tetanus serum is administered at a dose of 3 thousand IU. You can inject 3 ml of human immunoglobulin.

Tetanus vaccination during pregnancy is done only in case of strict indications. It is better to do it in advance when planning a pregnancy.

Low incidence in cities can create the impression of low prevalence and irrelevance of the disease. But that's not true. Although now is peacetime, tetanus is still a big problem. The disease is terrible because, while conscious, a person experiences enormous agony. Even with modern drugs, techniques and treatment methods, the mortality rate from tetanus remains very high. Therefore, the main emphasis should be on its prevention. If vaccination against tetanus is carried out in a timely and complete manner, this can almost completely eliminate the occurrence of this dangerous disease.

Tetanus is one of the most dangerous infectious diseases with a rapid progression and frequent deaths. Symptoms of the disease are caused by a toxin released by bacteria that enter the body through breaks in the skin. This poison leads to the death of 17-25% of patients, even in countries where vaccination is mandatory and the level of medicine is quite high. In regions where there are no mandatory vaccinations and the quality of medical care is low, about 90% of those infected die. Only rabies and pneumonic plague have higher mortality rates.

Reasons for the development of the disease

The entry point for infection is any damage to the skin. These can be either extensive burns and wounds, or minor abrasions and punctures, which are found on the body of most people. Very often, newborns become infected through the umbilical cord if the hospital does not maintain the required cleanliness.

Through defects in the skin, tetanus bacillus spores find themselves in optimal conditions for their life – a warm place without access to air. Here they germinate into vegetative forms and begin to secrete exotoxin. It consists of three fractions - tetanospasmin, tetanohemolysin and protein that enhances the synthesis of acetylcholine.

Sometimes children become infected due to improper treatment of the umbilical cord

The most dangerous is tetanospasmin, a neurotoxin that spreads throughout the body through the blood, lymph, or perineural route. It is firmly fixed in nerve tissues and changes their normal functioning. This leads to the fact that spontaneously occurring impulses can be unhindered to the striated muscles and cause their tonic tension.

The ancient doctors of India, China, Greece and Egypt also have descriptions of tetanus. They noticed that there was a connection between this disease and previous injuries. And the first description of the clinical course of the disease was made by Hippocrates, whose son died from it.

Any impulses from auditory, tactile, olfactory or other receptors provoke convulsive muscle contractions, which, in turn, lead to the development of hyperemia and increased energy expenditure. Large energy losses provoke acidosis, which is aggravated by respiratory failure caused by a decrease in lung volume due to tonic tension of the intercostal and diaphragmatic muscles.

Any scratch can cause tetanus

In addition, neurons in the brain stem are blocked, which causes inhibition of the parasympathetic nervous system and can cause damage to the vasomotor and respiratory centers, which can lead to cardiac arrest and respiratory failure. The severity of the disease and prognosis depend on the depth and extent of damage to the nervous system.

Symptoms of tetanus (Video)

Modern doctors distinguish four periods of this disease. The incubation period can last from several hours to several months. At this time, bacteria begin to multiply and release toxins, which leads to headaches, sweating, muscle tension, insomnia, chills, and increased irritability. There is also a sore throat when swallowing and loss of appetite. But sometimes no symptoms are observed.

In the initial stage of tetanus, dull and/or nagging pain appears in the area where it enters the body, even if the damage has already healed. Around this period or after 2-3 days, trismus or characteristic convulsive contractions of the masticatory muscles appear. Often a person simply cannot open his mouth.

The height of the disease can last 8-12 days, but sometimes lasts up to 3 weeks. The course of this stage depends on how soon the patient was admitted to the hospital, whether he was vaccinated and how severe the skin damage was during infection. Characteristic symptoms at this stage:

• “sardonic smile” caused by spasm of facial muscles and difficulty swallowing;
• muscle tension in the limbs and abdomen;
• painful cramps;
• insomnia;
• profuse sweating;
• cyanosis, apnea or even asphyxia;
• circulatory and urinary disorders;
• high body temperature.

Unvaccinated patients without timely treatment, as a rule, die quickly from spasm of the respiratory muscles or paralysis of the heart muscle. Embolism, sepsis, pneumonia and myocardial infarction also often lead to the death of victims.

Tetanus is found in all climatic zones and on all continents, but it is most common in southern latitudes. This is due both to its pleasant climate and to the low level of medical care in many countries in Africa, Asia and Latin America.

If treatment is started in a timely manner and carried out correctly, then over time the last stage begins - recovery. It can last up to 2 months, and all this time the patient must be under the supervision of doctors, as complications may develop.

Treatment of the disease

Treatment of tetanus is carried out exclusively in intensive care or intensive care settings. The patient is provided with a protective regime, which is necessary to exclude any stimuli - visual, auditory, etc. Patients are usually fed through a tube, and in case of paresis - intravenously. Prevention of bedsores is mandatory - this means turning the person over, carefully smoothing the linen and periodically replacing it.

Treatment of tetanus is complex and not always successful.

The wound through which the infection has entered must be injected with anti-tetanus serum, even if it has already healed. After this, surgical treatment of the wound is carried out with striped incisions to create aerobic conditions, foreign bodies, contaminated or necrotic tissue are removed. To avoid seizures, all these manipulations are performed under anesthesia.

To neutralize tetanus exotoxin, the patient is given a single dose of antitetanus serum or specific immunoglobulin. Before this, individual sensitivity to drugs is checked. They must be introduced as early as possible. After using heterogeneous antitetanus serum, the patient must be observed for one hour due to the possibility of developing anaphylactic shock.

In areas where the change of seasons is not very pronounced, tetanus occurs all year round. In countries with temperate climates, the peak incidence occurs in early spring and late autumn.

To treat convulsive syndrome, neuroplegics are used: both sedatives and narcotics, as well as muscle relaxants. In case of serious breathing disorders, intubation or tracheotomy may be required; muscle relaxation is often combined with mechanical ventilation. To prevent pneumonia, forced breathing and coughing may be necessary. If necessary, laxatives, gas tubes and catheters into the bladder are also used.

The mortality rate among newborns infected with tetanus is very high

Antibiotics are required to help prevent the development of bacterial complications or treat them. Dehydration, acidosis and hyperemia are treated with intravenous administration of sodium bicarbonate solution, rheopolyglucin, polyionic solutions, albumin, hemodez, plasma.

Consequences of tetanus

The most serious consequence of tetanus is the death of the patient. But there are other complications - for example, pneumonia, which develops due to a violation of the drainage function of the lungs against the background of decreased ventilation and increased mucus production. Patients often suffer from sepsis, when other pathogenic microflora penetrate through the wound.

According to statistics, boys get tetanus more often than girls. This is associated with their more active lifestyle and frequent injuries.

Often during severe seizures, bones are broken and deformed, as well as muscles being torn from their normal attachment site. Also, after a prolonged tonic contraction, tower contractures may occur.

Prevention of tetanus

Today, two directions can be distinguished in the prevention of this disease: the first is vaccination, the second is the prevention of infection. Vaccination is the simplest and most convenient means of combating any disease, including tetanus.. In our country, all people starting from the age of three months are given vaccines against it. In addition, there is emergency immunoprophylaxis after significant damage to the skin and with the likelihood of infection.

Vaccination is the best way to prevent tetanus

When it comes to preventing infection, things are more complicated. Tetanus is caused by a special bacterium, Clostridium tetani, which can be found almost everywhere. The risk of infection is highest if the wound was caused by a dirty object containing soil, feces or saliva. Sometimes infection can occur even through very minor damage to the top layer of skin. Therefore, it is always necessary to treat all wounds, even the smallest ones.
There are frequent cases of infection during medical procedures.. Sometimes people become infected through tattoos and piercings. Therefore, you should always ensure the sterility of surgical instruments and, if possible, use disposable ones.

Tetanus is an acute disease in which the exotoxin secreted by bacteria causes damage to the nervous system, leading to tonic spasms of skeletal muscles.

After an illness, immunity does not develop, so infection can occur many times. However, it should be remembered that 30-50% of people die from tetanus, even after toxoid is administered. The sick person himself is not contagious, since the clostridial bacterium requires special conditions for habitation, reproduction and acquisition of pathogenic properties.

Routes of transmission of tetanus:

Clostridium tetani- a bacterium that requires anaerobic conditions. It is activated and acquires pathogenic properties in the presence of deep damage in the tissues and the absence of oxygen in them.

The main route of transmission is contact. Infection can occur when:

• injuries - puncture, incised wounds;
• burns and frostbite;
• during childbirth, through the umbilical cord;
• microtraumas;
• bites from animals or poisonous insects.

Mechanism of action of the toxin:

The tetanus bacterium, when exposed to favorable conditions, begins to actively multiply and secrete exotoxin. He consists of two factions:

• tetanospasmin - acts directly on the motor fibers of the nervous system, causing constant tonic contraction of the striated muscles. This tension spreads throughout the body and paralysis of the respiratory and cardiac muscles can occur. As the vocal cords contract, asphyxia occurs.
• tetanolysin - acts on red blood cells, causing their hemolysis.

During tetanus there are 4 stages:

• incubation period- the duration can range from several days to a month, it all depends on the distance of the lesion from the central nervous system. The further you go, the longer the period and the easier the disease progresses. During this period, the patient may be bothered by intermittent headaches, slight twitching in the wound area, and irritability. Before the onset of the disease, the patient may notice a sore throat, chills, loss of appetite, and insomnia. However, it should be remembered that there may be an asymptomatic course.
• initial period - duration about two days. The patient notices nagging pain in the wound area, even if it has already completely healed. During this period, standard symptoms of tetanus (triad) may appear: trismus (tonic contraction of the masticatory muscles without the ability to open the mouth), sardonic smile (tonic convulsions of the facial muscles make a facial expression, either smiling or suffering - the forehead is furrowed, the eyebrows are raised, the mouth slightly open, and the corners of the mouth are lowered), opisthotonus (tension of the muscles of the back and limbs, leading to a posture of a person lying on the back of the head and heels in the form of an arc).
• peak period - duration on average 8-12 days. There is a clearly visible triad of symptoms - trismus, sardonic smile and opisthotonus. Muscle tension can reach such a degree that complete stiffness of the torso occurs, with the exception of the hands and feet. The abdomen feels board-shaped. This period is accompanied by painful cramps that can last up to several minutes. During an attack, sweating increases, temperature rises, tachycardia and hypoxia appear. The person’s face takes on a puffy shape, turns blue, and the facial expression conveys suffering and pain. During periods between convulsive contractions, muscle relaxation does not occur. The patient also notes difficulty swallowing, defecating and urinating. From the respiratory side, apnea may be observed, from the larynx - asphyxia, and due to insufficient cardiac activity, cyanosis is visible on the skin.
• convalescence period- lasting up to two months. During this period, muscle strength and the number of cramps slowly decrease. By 4 weeks they stop altogether. Restoration of normal heart activity occurs by the end of the third month. At this time, complications may arise, and if this does not happen, then complete recovery occurs.

The degree of severity is assessed according to several indicators:

• mild degree- the triad of symptoms is moderate, convulsions are usually absent or insignificant. Body temperature does not exceed subfebrile levels. Tachycardia is rarely present. Duration up to two weeks.
• average degree- occurs with a typical clinical picture, there is tachycardia with an increase in body temperature. Convulsive attacks are recorded 1-2 times within one hour with a duration of up to 30 seconds. Complications, as a rule, do not arise. Duration up to three weeks.
• severe- the symptoms are pronounced, the high temperature is constant, seizures are recorded every 15-30 minutes, lasting up to three minutes. Severe tachycardia and hypoxia are noted. Often accompanied by complications. Duration more than three weeks.

Typical signs of tetanus include:

• lockjaw;
• sardonic smile;
• opisthotonus;
• difficulty swallowing, as well as its pain;
• tachycardia;
• temperature increase;
• tonic convulsions;
• apnea;
• cyanosis;
• increased sweating;
• hypersalivation.

The diagnosis is made on the basis of the patient’s complaints, which are already clearly expressed in the initial period, the history of the disease (tissue damage is present) and a reliable clinical picture (the presence of signs that appear only with tetanus). Laboratory diagnostics, as a rule, do not give results. To determine the presence of exotoxin, material is taken from the wound and cultured on a nutrient medium, and a biological test is performed on mice.

Treatment is carried out in a hospital in the intensive care unit for constant monitoring of the functions of vital organs. The patient is placed in a separate room to avoid external irritants (light, noise, etc.).

Treatment is carried out according to the following plan:

• Administration of antitetanus serum - even if there is just suspicion, this point must be followed.
• Wound sanitation - primary surgical treatment, wide opening of tissue flaps to improve aeration, sutures are not applied in any case.
• Relief of convulsive attacks - muscle relaxants are administered.
• Transferring the patient to artificial ventilation (correction of hypoxia), monitoring the functioning of the cardiovascular system.
• Combating complications.
• High-calorie nutrition, tube or parenteral.

The most serious consequence is death. It can occur from asphyxia (spasm of the vocal cords), hypoxia (tension of the intercostal and diaphragmatic muscles - decreased pulmonary ventilation), damage to the brain stem - respiratory and cardiac arrest.

Tetanus– an acute anaerobic infection that develops during wound trauma. This disease can affect the nervous system, in some cases causing and experiencing suffocation.

Classification and symptoms of tetanus in adults

There are different developments of the disease, as it depends on the form of infection and on the method of entry of the tetanus bacillus into an open wound:

A subtype of generalized tetanus is maternal tetanus, which affects pregnant women or women during childbirth. This is very often associated with childbirth or even abortion, which took place under very poor hygienic conditions. Another subtype is neonatal tetanus, where the neonatal umbilical cord is the most common source of infection.

The second main type is local tetanus. Not as widespread, cramps affect the adjacent area of ​​the injury site. They can last for several weeks. The third type is tetanus, it is very rare and very often affects the nerves and muscles only in the head area.

• traumatic tetanus;
• infection based on inflammation and necrosis;
• an infection that entered the body through an unknown route.

Considering the first symptoms of tetanus and the form of its damage, they distinguish:

• general or generalized tetanus;
• local form of the disease, which in practice is quite rare.

Signs of tetanus in people

The incubation period is about two weeks, but in certain cases it can last up to a month. Everything depends on human nature. As a rule, the disease begins abruptly and proceeds in an acute form. Depending on the severity of the disease, different symptoms may appear. These are twitching and tense muscle joints precisely at the site of infection. Severe headaches, profuse sweating, and nervousness are common.

Tetanus cannot be clearly detected by routine blood collection. When the disease is diagnosed, the patient is usually admitted to the intensive care unit, where the main goal is to prevent damage to the respiratory system. The patient should also receive tetanus immunoglobulin as soon as possible to prevent further spread of the infection.

Antibiotics are then administered to the inflammation itself and the spasms are relieved by squeezing. Common complications of the disease include lung, heart, or kidney disease. The most effective disease prevention is vaccination. In our country it is necessary to vaccinate from one year onwards.

Here are the symptoms of tetanus that appear at the initial stage of the disease:

• dull pain at the site of infection;
• tonic tension of the masticatory muscles - it is difficult for the patient to open his mouth;
• facial convulsions - the forehead becomes covered with wrinkles, the lips are stretched as if smiling;
• the patient has difficulty swallowing due to spasms in the throat;
• the muscles in the back of the head are tense.

To accurately determine the disease, it is necessary to diagnose all the symptoms, since some of them are quite similar to other diseases. Only a doctor can cope with this after passing the appropriate tests. The main symptoms of tetanus disease are painful cramps in the torso, as well as the hands and feet. If such complaints are present, the disease can be confidently considered identified. It is worth noting that the most dangerous period of tetanus is considered to be from the tenth to the fourteenth day of the disease. It is at this time that the patient experiences rapid metabolism, metabolic acidosis and increased sweating. A cough begins and it is sometimes very difficult for the patient to clear his throat. In addition to all this, convulsive attacks may occur during coughing and swallowing. A person in such a situation may simply suffocate. In some cases it is of a secondary nature. At night, it is difficult for the patient to sleep, normal mental balance is disrupted, and disturbances in the functioning of the nervous system occur.

Another important point of prevention is thorough cleaning of all injuries. Tetanus is not spread from person to person, and permanent immunity does not occur through disease. Tetanus is a serious disease caused by the tetanus bacillus. It is virtually ubiquitous in soil, especially in damp and fertilized soil, and in the feces of healthy herbivores, cattle and horses. If tetanus bacilli enter a wound without air access, the toxin that generates the typical symptoms of tetanus begins to multiply and be produced: muscle spasms and a stiff neck.

Treatment of tetanus

If you seek help from a doctor in time, the outcome will be quite positive. As a rule, treatment does not last more than two months, and clinical relapses gradually subside on the 20th day. In severe forms of tetanus, no one can guarantee complete recovery. In such cases, serious treatment is carried out, aimed directly at diagnosing the central nervous system and eliminating problems in its functioning. The occurrence of severe tetanus does not guarantee complete recovery and death is more than likely. If you detect the slightest signs of tetanus, you should immediately contact an infectious disease doctor for diagnosis and treatment. Timely help is a good chance for a complete recovery, without relapses and other complications. Already on the first day of possible infection, seek specialized help, do not stop at self-medication and your own suspicions about the course of the disease.

The disease is especially sensitive to horses and other animals, sheep and goats, rodents and rabbits. The dog is much more resilient and even better able to resist the cat's illness. In birds, the infection has been virtually eliminated. It is rod-shaped and produces highly resistant spores. It is grown only under anaerobic conditions, in the absence of air. Plant stages can be killed by conventional disinfectants or physical agents. The spores, however, are very resilient and, if not exposed to sunlight, will survive for several years.

Tetanus is a serious infectious disease that affects the nervous system. The disease is transmitted by the bacterium Clostridium tetani. Tetanus occurs when bacteria enter a wound and the bacteria produce specific toxins. The name of the bacterium comes from the Greek words tetanos and teinein, and means “tight”, “stretching”. The bacterium Clostridium tetani is quite hardy and can live for many years in the soil as spores. The tetanus bacterium was first discovered in 1889 by Dr. K. Shibasaburo during his work with R. Koch in Germany. Shibasaburo also discovered a toxin produced by tetanus bacteria and developed the first protective vaccine against this disease.

They do not harm the effects of phenol, cresol and mercury. Thus, disputes are almost universal. They can also be found in house dust, but they are most often found in soil, especially moist, tilled and fertilized soil. It does not cause any clinical symptoms, tetanospasmin does not pass through the intestinal wall, and also destroys digestive enzymes. Tetanus is caused when clostridial spores are found in a deep wound where they can multiply without oxygen. The wound produced by tetanospassin penetrates the proximal terminal nerve endings and spreads them to the central nervous system.

With tetanus, a person experiences painful contraction of muscles, especially the jaw and neck. As a result, the ability to breathe is impaired and life is threatened. Thanks to the invention of the tetanus vaccine, the disease is much less common in the United States and Europe than in developing countries such as Africa or the Middle East. About a million cases of tetanus occur worldwide each year. There is no treatment for tetanus in developing countries. Basic treatment is complicated by the fact that the tetanus bacterium Clostridium tetani produces a powerful toxin. Mortality from tetanus is high among social groups such as older people without vaccinations and people with weakened immune systems. As a rule, symptoms of the disease appear at different periods after infection: from several days to several weeks after entering the human body. The average incubation period for tetanus is seven to eight days.

Tetanus is relatively rare in cats. Carnivores are resistant to tetanus. In a dog, clinical symptoms appear only when exposed to 600 times the dose of tetanus toxin that is sufficient to produce tetanus in a horse or human.

In dogs, dental beds are the most common site of infection when teeth change. Puppies at this age are exposed to a variety of objects, and oral contamination with Clostridia spores from soil or feces is relatively easy. 76% of dogs with tetanus become ill during rewinding. Mostly sick dogs from poor hygienic conditions from July to November. There are areas in the Czech Republic where canine tetanus is somewhat more common, for example in Karlovy Vary and South Moravia.

Are common tetanus symptoms appear in this order:

• jaw muscle spasms, muscle hardening;
• stiffening of the neck muscles;
• difficulty swallowing;
• hardening of the abdominal muscles.

Painful body spasms lasting several minutes are usually a reaction to loud noise, touch or light.

In addition to oral infection, tetanus is a common morning infection caused by trauma caused by spore contamination. There may also be infections through the vagina, uterus or digestive tract. The incubation period for tetanus in dogs is usually 5 to 10 days, but can last up to three weeks. If the site of infection is on the head, the incubation time is shorter. As the disease progresses, the initial injury may not be noticeable. There are two forms of tetanus: local and generalized.

Local tetanus is more common and manifests itself in the strengthening of the muscles located between the site of infection and the spinal core, thereby affecting, for example, only the injured limb. Localized tetanus may spread to the opposite side of the body or develop into generalized tetanus.

In addition to the main ones, there are also additional symptoms of tetanus:

• fever;
• sweating;
• high blood pressure;
• acceleration of heart rate.

When to see a doctor if you suspect tetanus?

It is necessary to consult a doctor for revaccination (if you have previously been vaccinated against tetanus) in the case when a person has a deep wound with contamination or has not been re-vaccinated in the last five years. If animal feces or saliva gets into a wound or deep scratch, you should also consult a doctor.

Generalized tetanus begins with walking, the limbs are stiff, and the dog has difficulty standing up and lying down. It will not take more than 48 hours from the first symptoms to general affection. Increased tension also affects the skin and subcutaneous tissue, which is especially noticeable on the head: wrinkles form between the ears, the ears tighten, and the corners of the muzzle recede. The eyes are sunken and the third lid is visible. Because the autonomic nerves are affected, salivation, laryngeal spasms, and abnormally slow breathing and heart rate may occur.

Fully developed tetanus is typical of the shyness of the animal, which, with any increased stimulus, progresses to full painful convulsions when the head is turned away. Tetanus is a rare disease in cats. Twenty dogs with tetanus - one sick cat. Due to the high natural resistance, it is usually necessary to have a flat wound and massive spore contamination. Incubation time is similar to that for dogs of 5-10 days, with a possible extension of up to three weeks. In cats, there is a more common localized form, generalized tetanus occurs when the site of infection is on the head.

The bacteria Clostridium tetani, which causes tetanus, is found in soil, dust and animal feces. When bacterial spores enter the wound tissue, they begin to produce powerful toxins. Tetanospasmin actively worsens the quality of work of motor neurons that control muscle function. The effect of the toxin on motor neurons leads to muscle stiffness and cramps, the main symptoms of tetanus.

In sheep and goats, tetanus is unfortunately quite common, although cases of the disease are sporadic in the herd. Rise after injuries, contamination of wounds, but also in relation to treatment and veterinary care: After birth, after surgery, after haircuts, after ear tags, castration and tail docking. The disease first manifests itself with pompous movement or lameness, stiffness has spread to the muscles of the trunk and neck, the animals stand in the position of a horse with the tail, which is removed from the body. The head has stubborn ears, elongated corners of the mouth, and dark eyes with a visible third lid.

The main factors contributing to the proliferation of tetanus bacteria in the body are:

• presence of a penetrating wound;
• the presence of other pathogens in the body;
• foreign body (nail, splinter, splinter);
• swelling around the injured area of ​​the body;
• lack of immunization or failure to receive a dose of tetanus vaccine in a timely manner.

Tetanus occurs due to one of the following types of injuries:

Disability of the autonomic nerves reduces the ability to swallow saliva and animal rumen rotation of the heart leads to bloating. As with dogs and cats, any agitation of the animal can cause generalized tetanus spasms. Death usually occurs from suffocation, and the risk of inhalation of the tripe is also a major risk.

Generalized tetanus is not easy. It takes a long time, costs money and care for the animals, and sick animals can die even though they are healed. Dogs and cats usually involve hospitalization, which can take up to three weeks. This will eliminate the production of another toxin. If the animal has a visible wound, it is treated. Unfortunately, the binding of tetanospasmin to nerve endings is irreversible. Therefore, another solution is tetanus maintenance treatment: The animal must survive until new, undamaged nerve fibers grow, which lasts for several weeks.

• puncture wounds. These include a fresh piercing or tattoo, puncture of the skin with a syringe needle while using drugs;
• gunshot wounds, fractures, injuries with bone fragmentation;
• animal bites, ear infections, surgical incisions, foot ulcers;
• infection of the umbilical stump in newborns born to mothers unvaccinated against tetanus.

Once Clostridium tetani has released toxins inside the wound, removal of the toxins is impossible. Full recovery from tetanus requires the growth of new nerve endings, which takes at least several months.

The basis is maximum peace, silence and darkness and complete isolation of the animal. Any excitement can lead to seizures. Affected animals are often unable to eat, due to spasms of the masticatory muscles and the inability to swallow. Some of them can eat liquid or suspension. Therefore, nutrition is supplemented intravenously.

A complication of tetanus is spasm of the sphincter of the rectum and bladder and the associated difficulty with impossible excretion, swallowing, which lead to aspiration pneumonia in sheep and goats, bloating, rumen acidosis, its contents are caused by the lack of saliva. Cats have a good prognosis, have only a localized form of the disease and can be cured without treatment. Muscle stiffness will go away in one to two weeks. In dogs, the prognosis is unclear. The younger the dog is affected, the worse the prognosis, and the prognosis worsens when the focus of the infection is in the head, and the onset of the disease is rapid and treatment was started late.

Complications of tetanus. Treatment and prevention of tetanus

Tetanus can lead to broken bones. Severe cramps and spasms sometimes lead to vertebral fractures. In some cases, the disease becomes a cause of disability. Treatment for tetanus usually involves the use of powerful sedatives to control muscle spasms. Prolonged immobility due to the use of these drugs can lead to permanent disability. In newborns, the infection can cause long-term brain damage, ranging from minor mental limitations to cerebral palsy.

In sheep and goats, tetanus is always generalized and the animals often die during treatment. Chances include animals that begin treatment as soon as symptoms are detected. Tetanus is one of the few diseases that can be reliably identified based on clinical symptoms alone.

It is important to carefully treat all deep wounds, especially those that may have become infected with soil or manure. Chew toys should be washable. For small ruminants, hygiene during surgery or delivery assistance is important. Along with treatment of wounds or after bloody interventions, a tetanus antitoxin can be given, which protects the animal for two to three weeks. Antitoxin is not used preventively in dogs or cats due to the risk of anaphylactic reaction.

Tetanic convulsions during tetanus provoke periods when a person cannot breathe at all. Respiratory failure is the most common cause of death in tetanus. Lack of oxygen can cause cardiac arrest and death. Another complication is pneumonia.

If the wound is small and clean, but there are concerns about infection, you should consult a doctor. If the wound is serious and symptoms of tetanus have already appeared, seek emergency medical attention.

These vaccines are combined with other serious diseases of small ruminants caused by various Clostridium species. Lambs and kids are vaccinated against tetanus at 2-3 months of age, with a booster dose for three weeks, and then every year or every two years, depending on the type of vaccine.

Vaccinating pregnant sheep and goats helps protect newborn babies. Only small dogs can be vaccinated. Because the dog is resistant to the disease, this vaccination is not part of the regular vaccine doses. However, it is useful for dogs in hazardous environments accompanying horse owners, farm dogs and sheepdogs. Dogs are vaccinated at the age of three months, twice within three weeks, the created immunity lasts two years.

For a more accurate diagnosis, it is necessary to tell the doctor when and where, under what circumstances the injury occurred, as well as immunization status, including the date of the last tetanus shot. In addition, the doctor must know how the wound was cared for, and whether the patient has chronic diseases or pregnancy.

Tetanovka is now included in the Czech Republic in the list of mandatory vaccinations carried out by the state. Now we can try to figure out how we want this assessment, because none of us can reasonably defend a reasonably reliable method. If anyone wants to disagree, please make your own estimates and re-calculate the rest.

Full-blown tetanus always hurt, and it would certainly be a bad disease even today. Previously, 50% of deaths were reported due to respiratory or cardiac failure. However, tetanus did not develop in humans after an incubation period of several hours, but within 3-4 days. Today we will definitely have the opportunity to treat the disease at the onset of the disease and at least mitigate its course. However, of course, there would not be zero. Unfortunately, there are no precise data on the risk of heart failure in advanced tetanus, although the only reported cause of death is strangulation and paralysis of the respiratory muscles.

The doctor makes a diagnosis of tetanus based on an examination of the patient, medical and vaccination history, as well as recording symptoms (presence of spasms, cramps, pain, muscle stiffness). Laboratory tests are rarely used to diagnose tetanus. Other than vaccinations, there is no approved treatment for tetanus. Available therapeutic options usually focus on proper wound care, medications to relieve pain and cramps, and supportive care.

When you receive a wound, you must immediately clean it of foreign objects, soil, and dead tissue.

Treatment of tetanus usually done with an antitoxin, such as tetanus immunoglobulin. However, the antitoxin neutralizes only those toxins that are not associated with nerve tissue. Antibiotics are prescribed either orally or by injection. This helps fight tetanus bacteria.

Another method of treatment and prevention is vaccination. Receiving the vaccine makes a person immune to tetanus in the future.

Sedatives. The sedative effects of sedatives help control muscle spasms.

In addition, to relieve symptoms, your doctor may prescribe magnesium sulfate and certain types of beta blockers, which help regulate involuntary muscle activity to normalize your heartbeat and breathing. For the same purposes, in rare cases, drugs containing morphine are used.

Maintenance therapy for tetanus

Tetanus infection often requires long-term treatment in intensive care. The use of sedatives can lead to shallow breathing and even connection to a ventilator.

Puncture wounds or other deep breaks in the skin, as well as animal bites, increase the risk of contracting tetanus. It is better to leave a deep, dirty wound open until you see a doctor, since bacteria will multiply faster under the bandage.

Prevention of tetanus consists primarily of the following measures:

• bleeding control. It is necessary to stop the bleeding by using a tourniquet or pressing the area above the wound with your hands;
• keeping the wound clean. Once the bleeding has stopped, wash the wound with water or saline (if available), and clean the area around the wound with soap and a washcloth. If debris cannot be removed from the wound, you should seek the help of a doctor;
• use of antibiotics. After cleaning the wound, apply a thin layer of antibacterial ointment or any antibiotic cream. Antibiotics will not speed up wound healing, but will help stop the proliferation of bacteria and the spread of infection;
• After cleaning, cover the wound with a sterile bandage. If the wound is dirty, there is no need to cover it to prevent bacteria from growing under the bandage.
• Frequently changing dressings will help the wound heal faster.

Vaccination, however, is the simplest and most effective way to prevent tetanus. It is precisely those people who get tetanus who have never received tetanus serum or who have not been vaccinated in the last 10 years.

The tetanus vaccine is usually given to children as part of diphtheria and pertussis (DTP) prevention. Vaccination provides protection against three diseases: throat and respiratory infections (such as diphtheria), whooping cough and tetanus. The DTP vaccine is given in five stages, usually injected into the arm or thigh.

People whose profession or occupation involves travel should first take care of a booster dose of the tetanus vaccine.

Based on materials:
Mayo Foundation for Medical Education
and Research, Charles Patrick Davis, MD,
PhD Melissa Conrad Stoppler, MD

This is an infectious disease caused by the bacterium Clostridium tetani, with an acute course and primary damage to the nervous system. Spores of the causative agent of tetanus can persist for a long time in soil, water and on any objects. Human infection occurs when clostridia penetrate through damaged skin or mucous membranes. The basis of the clinical picture of tetanus is tonic muscle spasms of the limbs and torso, increasing muscle tension, and opistatonicus. Days 10-14 of the disease are considered the most critical. High probability of death.

General information

This is an infectious disease caused by the bacterium Clostridium tetani, with an acute course and primary damage to the nervous system. Tetanus is classified depending on the nature of the entry point of infection (post-traumatic, post-inflammatory and cryptogenic tetanus), as well as on the prevalence of the process (generalized and local). Local tetanus is an extremely rare form of the disease.

Characteristics of the pathogen

Clostridium tetani is a Gram-positive, motile, obligate anaerobic and spore-forming rod-shaped bacterium. It looks like drumsticks or tennis rackets due to the spores located at the end. It is extremely stable in the environment: in the form of spores it can remain viable for years, at a temperature of 90 ° C - for about two hours. Spores are converted into vegetative forms at a temperature of 37 ° C under anaerobic conditions and in the presence of aerobic flora (for example, staphylococcal). Vegetative forms of clostridia are sensitive to boiling and die within a few minutes. Antiseptic and disinfectants act on these microorganisms for 3-6 hours.

Clostridium tetani produces an exotoxin (tetanospasmin) and a cytotoxin (tetanolysin) that affects the human nervous system. Tetanospasmin is a powerful toxin; it penetrates the processes of nerve cells and enters the central nervous system, suppressing inhibitory signals at synapses (preventing the release of inhibitory transmitters). At first, the effect of the toxin extends only to peripheral synapses, causing tetanic convulsions.

Tetanolysin has a destructive effect on blood cells, tissue of the heart sac and membranes, and causes local necrosis. The reservoir and source of spread of tetanus are rodents, birds, herbivores and people. The pathogen is contained in the intestines of the carrier and is released into the environment with feces.

Due to the possibility of prolonged existence in the form of spores in soil, water bodies, and on objects, the tetanus pathogen can enter with dust and dirt in almost any room, and be found on any materials (including medical instruments and dressings). The route of infection is contact. Bacteria enter the body through damaged skin or mucous membrane (contamination from bruises and abrasions, splinters, animal bites, etc.).

If the necessary aseptic and antiseptic measures are not observed, infection may occur during the treatment of burns, frostbite, injuries, and surgical wounds. Direct transmission of infection from a sick person to a healthy person is impossible. Human susceptibility to tetanus is high, immunity is not formed, since a very small dose of tetanospasmin is sufficient to develop the disease, which is unable to cause an immune response.

Tetanus symptoms

The incubation period for tetanus can range from several days to a month. Sometimes the disease begins with prodromal phenomena (muscle tension and tremors in the area of ​​infection, headache, sweating, irritability), but, as a rule, the first sign of tetanus is a dull, pulling pain at the site where the pathogen enters the body, even if the wound has completely healed . Then the characteristic symptoms of tetanus develop: trismus (convulsive contraction and tension of the masticatory muscles, making it difficult to tear off the mouth), dysphagia (difficulty swallowing), stiff neck (not accompanied by other meningeal symptoms), “sardonic smile” (specific tension of the facial muscles: wrinkled forehead, narrowed palpebral fissures, lips stretched, corners of the mouth drooping).

If the critical phase of the disease is transferred, the clinical signs gradually subside and a convalescence phase begins, lasting about one and a half to two months until the symptoms completely disappear. Tetanus can occur with varying degrees of severity, which is determined by the totality and severity of symptoms.

A mild course is characterized by an incubation period of more than 20 days, moderate opisthotonus and severity of facial spasm, absence of tonic convulsions (or their insignificant intensity and frequency). The temperature remains within normal or subfebrile limits. The increase in symptoms of the disease usually takes 5-6 days. In moderate cases, the incubation period is 15-20 days, the increase in symptoms takes from 3 to 4 days, convulsions occur several times a day, low-grade fever and moderate tachycardia are noted.

A severe form of tetanus is manifested by a shortened incubation period (from one to two weeks), a rapid increase in symptoms (within one to two days), a typical clinical picture with frequent convulsions, severe sweating, tachycardia, and fever. There is also a very severe form of tetanus (fulminant), in which the incubation period is no more than a week, the clinic develops within several hours, tonic convulsions occur every 3-5 minutes, pronounced disorders of organs and systems, cyanosis, threat of asphyxia, cardiac paralysis etc.

A particularly severe course is noted with bulbar, descending Brunner's tetanus, in which the maximum damage covers the muscles of the face, neck, vocal cords, respiratory and swallowing muscle groups, and the diaphragm. This form is characterized by damage to the respiratory and vasomotor nuclei of the vagus nerve, which is fraught with neurogenic cardiac and respiratory arrest.

In developing countries, neonatal tetanus (infection occurs when the tetanus bacillus enters a wound after cutting the umbilical cord) is one of the common causes of infant mortality. Sometimes (in rare cases) ascending tetanus may occur, starting with painful twitching of peripheral muscles and gradually generalizing with the development of typical symptoms. Also rare forms include local tetanus, which occurs with head wounds and is characterized by paralysis of the facial muscles of the “sardonic smile” type with stiff neck and bilateral (sometimes the damage to the side of the wound is more pronounced) paresis of the cranial nerves (facial paralytic tetanus Rose).

Complications of tetanus

Severe complications of tetanus with a high probability of death are asphyxia and cardiac arrest. In addition, tetanus can contribute to the occurrence of bone fractures, muscle ruptures, and compression deformation of the spinal column. A common complication of tetanus is pneumonia, and coronary spasm and myocardial infarction may develop.

During recovery, contractures and paralysis of the third, sixth and seventh pairs of cranial nerves are sometimes noted. In newborns, tetanus can be complicated by sepsis.

Diagnosis of tetanus

The clinical picture of tetanus is specific enough to make a diagnosis. Corpse autopsy materials, dressings and sutures, swabs from surgical instruments, dust, soil, and air can be examined to identify the pathogen.

Isolation of the pathogen is usually possible from the site of infection (scraping or discharge at the site of skin damage). Sometimes there is a need for swabs from the nose and mucous membrane of the pharynx, vagina and uterus (for postpartum or post-abortion tetanus). By examining the obtained biological material, tetanus exotoxin is isolated and a biological test is performed on mice.

Treatment of tetanus

Treatment of patients with tetanus is carried out in intensive care units with the participation of an anesthesiologist-resuscitator, since the disease is extremely dangerous in terms of mortality. The patient is given the maximum possible in terms of stimuli from the sensory organs, rest, feeding is carried out using a gastric tube, and in case of paresis of the digestive tract - parenterally.

Prevention of bedsores is carried out (turning the patient, straightening and timely changing of linen, toileting the skin). The wound, which is the entry point for infection, is injected with antitetanus serum (even if it has already healed). To create access of oxygen to the area where the pathogen is localized, wide incisions are made when performing an autopsy, revision, and surgical treatment of the wound. Existing foreign bodies, contaminants and foci of necrosis are removed. Treatment of the wound, in order to avoid convulsions, is performed under anesthesia. Subsequently, proteolytic enzymes (trypsin, chymotrypsin) are used in wound management.

Etiological treatment involves the earliest possible administration of intramuscular antitetanus serum or specific immunoglobulin, after a preliminary sensitivity test. Symptomatic treatment consists of the use of muscle relaxants, neuroleptics, narcotics and sedatives. In particular, diazepam has recently found widespread use, which is prescribed intravenously in severe cases.

A mixture of chlorpromazine with trimeperidine and diphenhydramine (sometimes with the addition of a solution of scopolamine hydrobromide) has a good effect. In addition, barbiturates, diazepam, and sodium hydroxybutyrate are used. In severe cases - fentanyl, droperidol, peripheral muscle relaxants with curare-like action (pancuronium, d-tubocurarine), and in the case of a labile nervous system - a- and beta-blockers.

In case of respiratory depression, intubation is performed and the patient is transferred to mechanical ventilation with humidified oxygen, the airways are cleared using an aspirator. There is evidence of the positive effect of hyperbaric oxygen therapy.

If there are difficulties in the functioning of the intestines and urinary system, a gas outlet tube is inserted and the bladder is catheterized in women and men, and laxatives are prescribed. Antibiotic therapy is used to prevent infection. Metabolic acidosis and dehydration are corrected by intravenous infusion of solutions of dextran, albumin, salts, and plasma.

Forecast

The prognosis of tetanus depends on the form of the course, which is more severe the shorter the incubation period and the faster the development of clinical symptoms. Severe and fulminant forms of tetanus are characterized by an unfavorable prognosis; if timely assistance is not provided, death is possible. Mild forms of tetanus can be successfully treated with proper therapy.

Prevention of tetanus

Nonspecific tetanus prevention measures include compliance with sanitary and hygienic standards in everyday life (especially in medical institutions) and reducing injuries. Individual prevention includes thorough disinfection treatment of injuries and timely consultation with a doctor for specific prevention in case of contamination of wounds, abrasions, etc. Specific prevention consists of a planned step-by-step vaccination of children with the DPT vaccine and subsequent revaccinations every 10 years with ADS, AS and ADS-M.

Emergency prevention in cases of likelihood of infection (in case of injury and contamination of the wound, burns, frostbite of the third and fourth degree, etc.) consists of treating the wound and administering anti-tetanus serum or immunoglobulin. Often, passive immunization for emergency prophylaxis is combined with the administration of an AC drug to stimulate one’s own immunity. It is advisable to carry out emergency prevention of tetanus as early as possible.