Tetanus in humans is an acute and life-threatening disease that has a very wide range of different manifestations. Emergency medical and preventive measures can save lives if diagnosed in time. Therefore, it is important to know the symptoms of tetanus and how the disease manifests itself in different stages infection.

How do you get tetanus?

Tetanus is a zoonotic disease, that is, the disease is inherent in both animals and humans. The infection can be in the soil, in the feces of animals and birds, in dust particles long time. The tetanus virus is highly resistant to survival in various environments - it tolerates disinfection, high and low temperatures.

The infection enters the human body exclusively through contact, penetrating through wounds (scratches, burns, cracks) on the skin of any origin.

Main routes of infection:

• Burn and surgical wounds;
• Dental wounds;
• Frostbite wounds;
• Stab and gunshot wounds;
• Ulcers, cracks, injuries on the leg, feet;
• Open fractures, injuries with bone fragmentation;
• Infection through the umbilical wound in newborns;
• Wounds after a dog bite (cat bite).

The risk group for contracting tetanus includes agricultural workers and livestock breeders - people who have frequent contact with soil, children under 10 years of age (due to the high level of injuries), newborns who violate the rules of antiseptics during childbirth.

Tetanus is called “bare foot disease” because... More than half of the cases of infection occur through damaged feet (wounds, scratches, cracks) from the soil.

Main symptoms

The incubation period from the moment of infection to the first symptoms can range from one to 15 days. The duration of the incubation period and the rate of development of the disease depend on the depth of the wound, the location of the wound through which infection occurred, and the amount of virus.

Important! Main symptom tetanus - twitching facial muscles. Such manifestations occur in different periods time, which makes diagnosing the disease difficult.

Main symptoms:

• Contraction of the muscles on the face (appearance of a “sardonic” smile);
• Difficulty swallowing;
• The appearance of muscle soreness;
• Difficulty breathing;
• Heavy sweating;
• Increased muscle tone;
• Salivation;
• Difficulty breathing;
• Fever;
• Disturbances in defecation and urination.

The acute course of tetanus is accompanied by symptoms in which spasm of various muscle fibers is observed.

The onset of the infectious process is characterized by pain and “twitching” directly at the site of infection. Afterwards, the course of the disease can be divided into several periods:

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

Symptoms of the incubation period

During this period, the infection does not manifest itself with pronounced symptoms; the disease can only be detected through tests.

The severity of manifestations depends on the duration of the latent stage - the shorter incubation period, the less pronounced the signs of tetanus.

Signs of the initial stage:

• The appearance of migraine;
• Aches;
• Muscle tension in the area of ​​injury;
• Feeling of irritation and discomfort;
• Increased sweating.

The average duration of the period is 12 days, but can reach up to a month. In this case, most often the disease begins unexpectedly for a person, especially in cases where the site of infection has not been identified.

Symptoms of the initial stage

This period lasts for 1-2 days and is characterized by the appearance of pain in the area of ​​the wound through which the infection occurred, even if this place has already begun to heal.

Specific signs appear:

• Muscle contraction above the wound site.
• Trismus – tonic spasm in the muscles of the temporomandibular region, limiting chewing functions.
• A sardonic smile - the facial muscles contract: the corners of the mouth are stretched, the eyes are squinted, the forehead is wrinkled (see photo).
• Dysphagia is a specific contraction of the pharyngeal muscles, accompanied by pain.

Important! Dysphagia, trismus and sardonic smile are specific symptoms characteristic only of tetanus.

There may be spasm of the muscles of the back of the head, which makes it difficult to tilt the head to the chest.

High period symptoms

This period marks the peak development of tetanus symptoms; the height of the disease can last 1.5-2 weeks, depending on the severity of the course.

Characteristic manifestations:

• Convulsive contractions cover the entire body, as if descending from head to feet. Convulsions appear unexpectedly, their increase is gradual, and the duration can be from several seconds to a minute. The intensity of the cramps is so strong that it literally “breaks” a person - it twists joints and bones, tears tendons.
• Muscle tonic tension reaches a peak and does not weaken even at night, accompanied by severe pain. Tetanus opisthotonus is observed (pictured): the stomach hardens, the torso bends in an arched manner, the arms bend at the elbows, and the legs are stretched out like a string.
• Breathing due to disturbances in the diaphragm becomes difficult, signs of asphyxia appear.

All these processes are accompanied by fever, profuse salivation, disturbances in defecation and urination.

Convulsions become more frequent - they can appear dozens of times during the day. In this case, the person’s face acquires a bluish tint, expresses pain and suffering, the person’s temperature may rise and arterial pressure. The patient screams, groans, grinds his teeth, and chokes.

The muscle contraction is so strong that it can lead to vertebral fractures, muscle and ligament rupture.

Important! With intense symptoms of tetanus without treatment and timely assistance, death most often occurs.

Symptoms of the recovery period

The recovery period begins depending on the severity of the disease by the end of 2-3 weeks. The frequency of seizures gradually decreases, muscle tone decreases, and general condition improves.

The process of complete recovery is very long and can take 2-3 months. In the absence of complications, the disease can be cured.

Forms of tetanus and their symptoms

The course of the disease, symptoms and treatment of tetanus depend on the form of the disease:

• Light form. The incubation period can be over 20 days. There is a slight increase in temperature, mild symptoms of tetanus (trismus, dysphagia, sardonic smile). Symptoms may not manifest themselves at all, because... there is a hidden and latent course of pathology. If treatment is not carried out, a transition to acute phase diseases.
• Moderate form. Develops within 15-20 days, while clinical symptoms grow in 3-4 days. Typical symptoms (dysphagia, trismus, sardonic smile) become pronounced, convulsions become more frequent, and the temperature can reach 39 degrees. An increased heart rate occurs, blood pressure rises, and increased sweating appears.
• Severe form. The course of the disease occurs over 7-14 days, symptoms increase during the day. Muscle tension is pronounced, cramps occur several times per hour. There are sharp surges in pressure, temperature increases, and tachycardia.
• Very severe form. A rapid form of tetanus, most often ending in death. The incubation period is only a few days, the symptoms increase right before our eyes: the convulsions practically do not stop, the temperature exceeds 40 degrees. Resuscitation measures are required.

Local form

There is also a local form of tetanus, in which symptoms are expressed locally, and the characteristic signs of the disease are often invisible.

Symptoms of tetanus in adults with local form depend on the affected area:

• Local twitching in the area of ​​infection without the addition of other specific manifestations of tetanus.
• Muscle soreness at the wound site.

In this case, the infection does not penetrate very deeply, so the lesion does not affect internal organs. Death with this form of tetanus can only occur due to allergic complications.

Neonatal tetanus

A rather rare form of the disease, which most often ends in the death of the child. The course of the disease is very severe, the newborn child suffers only from acute forms of tetanus

In newborns, the disease manifests itself as impaired swallowing and sucking, the appearance of a sardonic smile, and contraction of the facial muscles. An attack of seizures in children with low weight may manifest itself as arching in only one direction.

Complications of tetanus

The disease can be complicated by various processes in which treatment of tetanus can take several months. The most dangerous complication is suffocation (asphyxia), which causes depression of cardiac activity and a possible heart attack.

Other complications of tetanus:

• Heart failure;
• Rupture of muscles and ligaments;
• Fractures of the spine and bones;
• Bronchitis and pneumonia;
• Sepsis;
• Pain shock.

In children, complications from tetanus manifest themselves in the form of pneumonia, in more cases later diseases - anemia, digestive system disorders.

The prognosis of tetanus depends on the form of the course and the severity of the process. In severe stages of the disease with a rapidly developing clinical picture, death most often occurs as a result of delay in providing assistance.

Tetanus is quite severe, so it is better to prevent the occurrence of the disease. For this purpose, vaccination of the population is carried out, in which both adults and children participate. After getting a tetanus shot, the risk of contracting the infection is minimized.

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Tetanus

What is Tetanus -

Tetanus (lat. Tetanus)- zooanthroponotic bacterial acute infectious disease 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.

Brief historical information

The disease has been known since ancient times; its occurrence has long been associated with injuries and wounds. The name of the disease and the first description of its clinical manifestations were given by Hippocrates. Tetanus bacillus was first discovered by N.D. Monastyrsky (1883) in the corpses of dead people and A. Nikolayer (1884) in abscesses in experimental tetanus in animals. A pure culture of the pathogen was isolated by the Japanese bacteriologist Sh. Kitazato (1887). Later, he obtained tetanus toxin (1890) and, together with E. Bering, proposed an antitoxic serum for the treatment of tetanus. The French immunologist G. Ramon developed a method for producing tetanus toxoid (1923-1926), which is still used to prevent the disease.

What provokes / Causes of Tetanus:

Pathogen- obligate anaerobic gram-positive spore-forming motile rod Clostridium tetani of the Bacillaceae family. The spores are located terminally, giving the bacteria the appearance of “ drumsticks"or "tennis rackets." C. tetani produces a potent exotoxin (tetanospasmin), a cytotoxin (tetanolysin) and a so-called low molecular weight fraction. In soil, feces and on various objects, spores can persist for years. Maintain a temperature of 90 ° C for 2 hours. Under anaerobic conditions, at a temperature of 37 ° C, sufficient humidity and in the presence of aerobic bacteria (for example, staphylococci), spores germinate into vegetative forms. Vegetative forms of tetanus bacillus die within a few minutes when boiled, after 30 minutes - at 80 ° C. Antiseptics and disinfectants kill the tetanus pathogen within 3-6 hours. In countries with warm climates, spores can grow directly in the soil. In C. tetani, two types of antigens are detected: somatic (O-antigen) and flagellar (H-antigen). Based on the structures of flagellar antigens, 10 serovars are distinguished. All serovars produce tetanospasmin and tetanolysin, which are identical in antigenic properties.

• Tetanospasmin- one of the most powerful biological poisons. It is a polypeptide with a “distanced” mechanism of action, since bacteria rarely leave the primary site of infection. The toxin is fixed on the surface of the processes nerve cells, penetrates them (due to ligand-mediated endocytosis) and enters the central nervous system through retrograde axonal transport. The mechanism of action is associated with suppression of the release of inhibitory neurotransmitters (in particular, glycine and y-aminobutyric acid) in synapses (the toxin binds to synaptic proteins synaptobrevin and cellubrevin). Initially, the toxin acts on peripheral nerves, causing local tetanic muscle contractions. In cultures, the toxin appears on the 2nd day, reaching its peak formation by the 5-7th day.
• Tetanolysin exhibits hemolytic, cardiotoxic and lethal effects, causes the development of local necrotic lesions. This toxin plays less of a role in the pathogenesis of the disease. important role. The maximum accumulation of the toxin in the culture is observed after 20-30 hours. The processes of its formation are not associated with the synthesis of tetanospasmin. The low molecular weight fraction enhances the secretion of mediators at neuromuscular synapses.

Epidemiology

Reservoir and source of infection- herbivores, rodents, birds and humans, in whose intestines the pathogen lives; the latter is released into the external environment with feces. Tetanus bacillus is also widespread in soil and other objects external environment, where it can multiply and persist for a long time. Thus, the pathogen has two interconnected and mutually enriching habitats, and, consequently, two sources of the pathogen - the intestines of warm-blooded animals and the soil. The significance of a particular source is apparently largely determined by the climatic and geographical conditions of the area. The most favorable soils for vegetation and preservation of the microorganism are chernozem and red soil soils rich in humus, as well as soils well fertilized with organic matter. From soil with dust, bacteria can enter any premises (including dressing rooms and operating rooms), onto various objects and materials used in surgical practice (various powders, gypsum, talc, medicinal clay and mud, cotton wool, etc.).

The frequency of carriage of tetanus bacillus spores by humans varies from 5-7 to 40%, and an increased degree of carriage is noted among persons who professionally or at home come into contact with soil or animals (agricultural workers, grooms, milkmaids, sewer workers, greenhouse workers, etc.). C. tetani is found in the intestinal contents of cows, pigs, sheep, camels, goats, rabbits, guinea pigs, rats, mice, ducks, chickens and other animals with a frequency of 9-64%. The contamination of sheep droppings reaches 25-40%, which is of particular epidemiological significance in connection with the use small intestine sheep for the production of surgical catgut.

Transmission mechanism- contact; The pathogen penetrates through damaged skin and mucous membranes (wounds, burns, frostbite). Infection of umbilical wounds if asepsis is not observed during childbirth can cause neonatal tetanus. The location of the pathogen's entrance gate can be different in nature and location open wounds(punctures, splinters, cuts, abrasions, crushes, open fractures, burns, frostbite, bites, necrosis, inflammatory processes); in these cases, post-traumatic tetanus develops. Surgical wounds, especially on the colon and ischemic extremities, can become an entry point for infection with the subsequent development of postoperative tetanus. Abortion interventions outside of health care facilities may cause post-abortion tetanus. Possibility of pathogen transmission from a patient healthy person absent.

Natural sensitivity of people high. Those who have recovered from tetanus do not develop immunity to the disease, since a very small dose of the toxin that can cause the disease is not sufficient to ensure an immunological response.

Basic epidemiological signs. The incidence is sporadic in the form of unrelated cases. The zonal spread of infection is determined by both climatic and geographical and socio-economic factors. The seasonality of the disease is spring and summer. Among the cases, residents of rural areas, children and the elderly predominate; It is in these groups that the majority of deaths are recorded. Due to the widespread implementation of active immunization, tetanus in newborns is not currently registered. The presence of a permanent reservoir of infection in the soil determines the possibility of infection as a result of minor household injuries. There are still cases of nosocomial infection with tetanus during operations on the extremities, gynecological operations and surgical interventions on the gastrointestinal tract.

Pathogenesis (what happens?) during Tetanus:

The pathogen in the form of spores enters the human body through damaged skin and mucous membranes. Under anaerobic conditions (deep puncture wounds, wounds with deep pockets or necrotization of crushed tissue), the development and reproduction of vegetative forms occurs in wounds, accompanied by the release of exotoxin. Along motor fibers peripheral nerves and with the blood flow, tetanospasmin penetrates into the spinal cord, medulla oblongata and reticular formation of the trunk, where it is fixed mainly in polysynaptic interneurons reflex arcs. The bound toxin cannot be neutralized. Paralysis of interneurons develops with suppression of all types of their synaptic inhibitory effect on motor neurons. As a result, the uncoordinated flow of motor impulses from motor neurons to muscles through neuromuscular synapses increases. The throughput of the latter increases due to increased secretion of acetylcholine under the influence of the low molecular weight fraction. A continuous flow of efferent impulses maintains constant tonic tension in the skeletal muscles.

At the same time, afferent impulses increase in response to the influence of tactile, auditory, visual, olfactory, gustatory, temperature and barometric stimuli. In this case, tetanic convulsions periodically occur.

Muscle tension leads to the development of metabolic acidosis. Against this background, both tonic and tetanic convulsions intensify, cardiac activity worsens, and preconditions are created for secondary bacterial complications. Cardiovascular disorders (tachycardia, arterial hypertension, arrhythmia, ventricular fibrillation) are aggravated due to the hyperactivity of the sympathetic nervous system that develops during tetanus. The excitability of the cortex and reticular structures of the brain increases. Possible damage to the respiratory and vasomotor centers and nuclei vagus nerve(bulbar tetanus), which often leads to the death of patients. Other causes of death may be associated with asphyxia due to seizures and the development of complications (pneumonia, sepsis).

Post-infectious immunity does not develop in tetanus. Specific pathological changes are scant (venous stagnation, minor hemorrhages, in rare cases, muscle ruptures and muscle hematomas).

Symptoms of Tetanus:

Taking into account the entrance gates of infection, they are distinguished:

• traumatic tetanus;
• tetanus, which developed as a result of inflammatory and destructive processes;
• cryptogenic tetanus (with unknown portal of entry).

According to the prevalence of the process, the disease is divided into general (generalized) and local tetanus. The latter is rarely observed.

Incubation period varies from several days to 1 month, on average not exceeding 1-2 weeks. The disease begins acutely, only sometimes prodromal phenomena are noted in the form of tension and muscle twitching at the site of injury, malaise, headache, sweating, and irritability.

IN initial period of tetanus in some cases it may manifest itself most early sign- stupid nagging pain in the area of ​​the entrance gate of infection, even in already completely healed wounds. The main specific symptoms that occur during this period are trismus, sardonic smile, dysphagia and stiff neck. These signs appear early and almost simultaneously.

• Lockjaw- tension and convulsive contraction of the masticatory muscles, which leads to difficulty opening the mouth.
• Tonic spasms of facial muscles are expressed in a “sardonic smile” (risus sardonicus), which gives the patient’s face a peculiar expression: wrinkled forehead, narrowed palpebral fissures, stretched lips, drooping corners of the mouth.
• Dysphagia (difficulty and painful swallowing) caused by convulsive spasm of the pharyngeal muscles. The combination of trismus, “sardonic smile” and dysphagia is characteristic only of tetanus.
• Stiff neck, caused by tonic spasms of skeletal muscles, in tetanus is not a meningeal symptom and is not combined with other meningeal signs (Kernig's, Brudzinsky's symptoms, etc.).

IN the height of the disease painful tonic spasms spread to the muscles of the trunk and limbs (without involving the hands and feet). Tonic muscle tension is constant; muscle relaxation, as a rule, does not occur even in sleep. The contours of large skeletal muscles are clearly outlined, especially in men. From the 3-4th day of muscle illness abdominal wall they become hard as a board, the legs are often extended, and movements in them are limited. At the same time, the intercostal muscles and diaphragm are involved in the process, breathing becomes shallow and rapid. Tonic tension of the perineal muscles leads to difficulty defecating and urinating. As a result of severe tension and soreness of the back muscles in severe tetanus, opisthotonus develops: when the patient is positioned on his back, his head is thrown back, the lumbar part of the body is raised above the bed in such a way that you can stick your hand between the back and the bed.

Against the background of constant tonic tension of the skeletal muscles, tetanic convulsions occur periodically with varying frequencies. Their duration initially ranges from a few seconds to a minute. Most often they are provoked by auditory, visual and tactile stimuli. In mild cases of the disease, 1-2 attacks of convulsions per day are observed; in severe cases of tetanus, they can be repeated up to tens of times within an hour, becoming longer and more widespread. Seizure attacks occur suddenly. In this case, the patient’s face takes on a pained expression and becomes cyanotic, the contours of the muscles are more clearly outlined, and opisthotonus increases. Patients moan and scream because of the pain, trying to grab the headboard of the bed with their hands to ease their breathing. Body temperature rises, the skin (especially the face) becomes covered with large drops of sweat, hypersalivation, tachycardia, shortness of breath are noted, heart sounds are loud, blood pressure tends to increase. The convulsive syndrome develops and intensifies while the patient maintains a clear consciousness; confused consciousness and delirium appear only shortly before death.

The period from the end of the first week to the 10-14th day of illness is the most dangerous for the patient’s life. Metabolic acidosis and a sharp increase in metabolism cause hyperpyrexia, increased sweating. It is difficult to produce sputum because coughing provokes tetanic convulsions. Deterioration of pulmonary ventilation often contributes to the development of secondary bacterial pneumonia. The heart is dilated due to both ventricles, the sounds are loud. The liver and spleen are not enlarged. Deep intoxication of the brain stem causes depression and arrhythmia of breathing, weakening of cardiac activity; possible cardiac paralysis. Due to frequent and prolonged tonic convulsions, painful insomnia and irritability develop, and the threat of asphyxia increases.

In cases of a favorable outcome, the period of convalescence is long; gradually weakening clinical manifestations the diseases persist for 2-4 weeks, recovery is delayed up to 1.5-2 months.

The severity of tetanus is determined by a combination of several indicators.

• At mild current The disease incubation period often exceeds 20 days. Trismus, “sardonic smile” and opisthotonus are moderate, hypertonicity of other muscle groups is weak. Tonic convulsions are absent or insignificant, body temperature is normal or subfebrile. Symptoms of the disease develop within 5-6 days.
• In cases moderate course the incubation period is 15-20 days. Basic Clinical signs diseases increase over 3-4 days. Convulsions occur several times a day, tachycardia and sweating are moderate, body temperature is low-grade or (less frequently) high.
• Severe form Tetanus is characterized by a shortened incubation period to 7-14 days, a rapid (over 1-2 days) increase in symptoms, a typical clinical picture with frequent and intense tetanic convulsions (several times within an hour), expressed by sweating and tachycardia, high fever.
• Very severe course are distinguished by a shortened (less than a week) incubation period and fulminant development of the disease. Tonic convulsions occur several times within 3-5 minutes. They are accompanied by hyperpyrexia, severe tachycardia and tachypnea, cyanosis, and threatening asphyxia.

One of the most severe forms of generalized descending tetanus is Brunner's cephalic (“bulbar”) tetanus. It occurs with primary damage to the muscles of the face, neck and pharynx, with spasms of the swallowing and intercostal muscles, muscles of the glottis and diaphragm. Usually the respiratory, vasomotor centers and vagus nerve nuclei are affected. Gynecological tetanus and neonatal tetanus, which is one of the important causes of child mortality in developing countries, are also distinguished by the severity of their course and unfavorable prognosis. It is associated with unsatisfactory conditions of provision obstetric care and the lack of immunization programs for women.

Ascending tetanus, observed in rare cases, first manifests itself as pain, tension and fibrillary twitching in one group of muscles; later, as new overlying parts of the spinal cord are affected, the disease acquires the typical features of a generalized process.

Local tetanus is rare. One of its typical manifestations, developing after wounds to the face and head, is facial paralytic tetanus Rose. Trismus, stiff neck, and “sardonic smile” occur, accompanied by paresis cranial nerves. The lesion is usually bilateral, more pronounced on the side of the wound.

When determining the prognosis of tetanus, much attention is paid to the period between the appearance of the first signs of the disease (lockjaw, etc.) and the onset of seizures. If this period is less than 48 hours, the prognosis of the disease is extremely unfavorable.

Complications

One of dangerous complications tetanus - asphyxia. At the same time, there is an opinion that asphyxia and cardiac arrest are not complications, but manifestations of a symptom complex of a severe course of the disease. Complications also include pneumonia, muscle ruptures, bone fractures, and compression deformities of the spine. Hypoxia that increases during convulsions can contribute to the development of coronary vascular spasm and myocardial infarction, and cardiac arrest. During the recovery period, muscle contractures and paralysis of the III, VI and VII pairs of cranial nerves are possible. Neonatal tetanus can complicate sepsis.

The prognosis of the disease is always serious.

Diagnosis of Tetanus:

Tetanus should be distinguished from hysteria, epilepsy, strychnine poisoning, tetany, encephalitis and other diseases with convulsive syndrome.

The diagnosis of tetanus is made based on clinical findings. Specific symptoms of tetanus that occur already in its initial period are dull nagging pain in the area of ​​the wound (even already healed), trismus, “sardonic smile”, dysphagia and stiff neck. The combination of these symptoms is characteristic only of tetanus. During the height of the disease, painful tonic convulsions of the muscles of the trunk and limbs (not involving the hands and feet) occur, and against their background - periodic, suddenly occurring tonic convulsions, the frequency and duration of which largely determines the severity of the disease.

Laboratory diagnostics

When the blood thickens due to severe and constant excessive sweating, as well as secondary bacterial complications, neutrophilia is possible. With the development of typical clinical picture Isolation of the pathogen and its identification may not be necessary. Material from a patient or corpse, dressing and suture surgical material, as well as soil, dust and air are subject to examination. Bacteria are usually found at the point of entry into the patient's body. Therefore, it is most rational to study various material taken from the wound site. In cases where the entrance gate is unknown, the patient should be carefully examined to identify abrasions, scratches, catarrhal and inflammatory processes. Particular attention should be paid to old scars after wounds, since the pathogen can persist in them for a long time. In some cases, mucus from the nose, bronchi, pharynx, plaque from the tonsils, as well as discharge from the vagina and uterus (for postpartum or post-abortion tetanus) are examined. At bacteriological research corpses also take into account the possibility of generalization of infection. For analysis, blood (10 ml) and pieces of liver and spleen (20-30 g) are taken. To isolate the pathogen, methods common to obtaining pure cultures of anaerobic bacteria are used.

When examining material taken from a patient or a corpse, in parallel with the bacteriological analysis, tetanus exotoxin is detected in a biological sample on mice. To do this, the material is crushed, double volume is added saline solution, incubate for an hour at room temperature, filter. Part of the filtrate is mixed with antitetanus serum at the rate of 0.5 ml (200 AE/ml) of serum per 1 ml of extract and incubated for 40 minutes. Then one group of animals is injected with the extract without prior incubation with serum, and the other group is injected with the incubated mixture. In the presence of C. tetani, animals of the first group develop symptoms of tetanus.

Treatment of Tetanus:

Treatment of tetanus carried out in the intensive care and resuscitation department with the participation of an anesthesiologist. It is necessary to provide a protective regime that excludes auditory, visual and tactile stimuli. Patients are fed through a tube or parenterally (for gastrointestinal paresis). They carry out the prevention of bedsores: frequently turning the patient in bed, smoothing out crumpled bed and underwear, cleaning them and periodically changing them. Infected wound, even healed, are injected with antitetanus serum (at a dose of 1000-3000 IU), then a thorough inspection and surgical treatment of the wound is carried out with wide striped incisions (to create aerobic conditions), removal foreign bodies, contaminated and necrotic tissues. To prevent seizures, all these manipulations are best performed under anesthesia. In the future, it is advisable to use proteolytic enzymes (trypsin, chymotrypsin, etc.) to treat wounds.

To neutralize tetanus exotoxin in the bloodstream, 50,000 IU of antitetanus serum or 1,500-10,000 IU (average dose 3,000 IU) of specific immunoglobulin is injected intramuscularly once, with preliminary testing of individual sensitivity to them. These drugs should be administered as early as possible, since tetanus toxin circulates freely in the blood for no more than 2-3 days, and the associated toxin is not inactivated, which reduces the therapeutic effect. After administration of heterogeneous antitetanus serum, it is necessary to monitor the patient for 1 hour due to the risk of developing anaphylactic shock.

The fight against convulsive syndrome is carried out using sedatives and narcotics, neuroplegics and muscle relaxants. IN Lately Diazepam 5-10 mg orally every 2-4 hours is widely used; in severe cases, it is administered intravenously at 10-20 mg every 3 hours. For children, the drug is prescribed intravenously or intramuscularly at 0.1-0.3 mg/kg every 6 hours (maximum up to 10-15 mg/kg/day). You can use injections of a mixture of 2.5% solution of aminazine, 1% solution of promedol and 1% solution of diphenhydramine (2 ml of each drug) with the addition of 0.5 ml of 0.05% solution of scopolamine hydrobromide. Also prescribed are seduxen, barbiturates, sodium hydroxybutyrate, and in severe cases, droperidol, fentanyl, curare-like muscle relaxants (pancuronium, d-tubocurarine). In case of lability of the sympathetic nervous system, a- and ß-blockers are sometimes used. In case of breathing disorders, intubation or tracheotomy is performed, muscle relaxation is combined with mechanical ventilation, cleansing respiratory tract aspirator; Patients are given humidified oxygen. There are reports of the effectiveness of hyperbaric oxygen therapy.

Laxatives are prescribed in small doses, gas outlet pipe and catheter in bladder(if necessary). To prevent pneumonia, frequent turning of the patient, forced breathing and coughing are necessary.

To prevent and treat bacterial complications, antibiotics are used - benzylpenicillin 2 million units intravenously at intervals of 6 hours (children up to 200,000 units/kg/day), tetracycline 500 mg 4 times a day (children up to 30-40 mg/kg/day ). The use of antibiotics does not exclude the possibility of developing pneumonia and other secondary infections.

The fight against hyperthermia, acidosis and dehydration is carried out with intravenous infusions of 4% sodium bicarbonate solution, polyionic solutions, hemodez, rheopolyglucin, albumin, plasma.

Prevention of Tetanus:

Epidemiological surveillance

To identify patterns in the spread of tetanus and rational planning of preventive measures, an in-depth epidemiological analysis of the incidence and the preventive measures used is necessary. To assess the quality of medical care for injuries, it is necessary to analyze its timing, volume and nature. When analyzing the effectiveness of emergency prevention, you should pay attention not only to its volume, but also to the timing of its implementation (the time elapsed after the injury and seeking medical help). Analysis is of particular relevance in connection with cases of diseases in previously vaccinated people. immune status sick. Detailed analysis The population is subject to immunization against tetanus, implementation of the vaccination plan for certain age, socio-professional groups, including the rural population. Immunological control is an integral part of epidemiological surveillance of tetanus. It allows you to assess the security of various populations, reliably judge the level of vaccination and the quality of immunization, as well as the duration of immunity, identify the most affected groups of the population and characterize areas with varying degrees of risk of infection.

Preventive actions

Nonspecific prevention of tetanus is aimed at preventing injuries at home and at work, eliminating infection of operating rooms, as well as wounds (umbilical and others), early and thorough surgical treatment. Specific prevention of tetanus is carried out on a planned and emergency basis. In accordance with the vaccination calendar, children from 3 months of life are vaccinated 3 times with 0.5 ml of DTP vaccine with the first revaccination after 12-18 months and subsequent revaccinations every 10 years with associated drugs (ADS or ADS-M) or single drugs (AS) . After the completed course of immunization, the human body within long term(about 10 years) retains the ability to rapidly (within 2-3 days) produce antitoxins in response to repeated administration of drugs containing AC toxoid.

Emergency prevention of tetanus is carried out according to the scheme for any injuries and wounds with a violation of the integrity of the skin and mucous membranes, burns and frostbite of II-IV degrees, animal bites, penetrating intestinal injuries, out-of-hospital abortions, childbirth outside of medical institutions, gangrene or tissue necrosis of any type, long-term current abscesses, carbuncles. Emergency prevention of tetanus includes primary wound treatment and simultaneous specific immunoprophylaxis. Depending on the previous vaccination status of patients, a distinction is made between passive immunization, active-passive prophylaxis, consisting of the simultaneous administration of tetanus serum and toxoid, and emergency revaccination with AS to stimulate immunity in previously vaccinated individuals. Emergency immunoprophylaxis of tetanus should be carried out as early as possible and up to the 20th day from the moment of injury, taking into account the length of the incubation period for tetanus.

Activities in the epidemic outbreak

The patient is hospitalized in specialized (intensive care) departments for treatment. Dispensary observation The person who has recovered from the disease is monitored for 2 years. Separation of contact persons is not carried out, since the patient is not dangerous to others. Disinfection is not carried out in the outbreak.

Which doctors should you contact if you have Tetanus:

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Tetanus is an infectious disease of the sapronosis type (the name comes from the Greek sapros, meaning rotten, and nosos, meaning disease). Characteristic of this group of diseases is the contact mechanism of transmission of the pathogen and its habitat.

The habitat for tetanus bacteria is objects (not the human or animal body) located around us - for example, water, soil, chair, table. Thus, the causative agent of Legionnaires' disease, which belongs to this group of diseases, chose an air conditioner, shower and similar objects as its habitat.

Tetanus is not characterized by an epidemiological nature of spread, since the patient does not pose a danger to others - he is not contagious. Although immunity to tetanus does not develop after illness.

For reference. Tetanus is an acute saprozoonotic infectious disease caused by Clostridium tetani. The pathology is manifested by severe damage to nervous tissues by tetanus toxins, leading to the development of severe muscle hypertonicity and tetanic convulsions.

Tetanus infection is one of the most ancient diseases. First detailed description pathology belongs to Hippocrates. After his son died of tetanus, he compiled a detailed description of this infection, giving it the name tetanus.

The infection is also mentioned in books such as Ayurveda and the Bible. It should be noted that in all descriptions of tetanus, its development was always associated with contamination of the open wound surface with soil. In some countries, soil contaminated with feces was even treated with weapons instead of poisons.

For reference. For a long time tetanus was considered absolutely incurable disease with a 100% mortality rate. On this moment, tetanus is considered a curable disease (subject to early adequate wound treatment and administration of anti-tetanus serum). However, severe tetanus is still accompanied by a high mortality rate. Hospitalization for tetanus is strictly mandatory.

Self-medication is impossible, and the only effective specific remedy against tetanus is antitetanus serum, which must be administered no later than 30 hours from the moment the first symptoms of the disease appear. Later administration of the drug is ineffective.

Why is tetanus dangerous?

For reference. The disease is known all over the world. Sensitivity to tetanus bacillus is high in people of all races and ages. The mortality rate for tetanus (in the absence of timely specific treatment) is ninety-five percent for adults and one hundred percent for newborns.

Before the development of a specific serum by Gaston Ramon (1926), obstetric tetanus was one of the main causes of death in mothers and infants in maternity hospitals.

At the moment, tetanus is quite rare. This is due to the fact that in 1974, WHO introduced a special strategy to reduce the incidence and completely eradicate vaccine-preventable diseases (diphtheria, tetanus, polio, etc.).

Attention. Now high level The incidence of tetanus is observed only in developing countries, with low level economy and insufficient coverage of the population preventive vaccinations. This applies to tourists traveling to such countries.

The leading causes of death in patients with tetanus are:

• respiratory arrest or cardiac arrest at the peak of seizures;
• severe metabolic and microcirculatory disorders leading to multiple organ failure;
• secondary purulent complications, sepsis with septic shock.

The causative agent of tetanus

Clostridium tetani belongs to the large gram+ rods of the genus Clostridium. Tetanus clostridium is a strict obligate anaerobe, that is, for adequate development and reproduction it requires conditions with a complete lack of oxygen access.

Vegetative toxin-producing forms are absolutely not viable in the environment. Therefore, when unfavorable conditions The tetanus bacillus turns into spores that are distinguished by the highest level of resistance to physical and chemical influences.

The tetanus spores themselves are not pathogenic. They are not capable of producing a toxin (tetanospasmin) and, in the absence of favorable conditions, do not cause disease.

This explains the fact that, depending on the area of ​​residence, approximately five to forty percent of people are carriers of tetanus bacilli in the intestines. Such carriage is transient, is not accompanied by clinical symptoms and does not lead to the development of the disease.

However, when exposed to anaerobic (oxygen-free) conditions, spores are able to transform back into pathogenic, toxin-producing forms.

Attention. In terms of toxic properties, tetanospasmin produced by tetanus bacilli is second only to botulinum toxin. This toxin is produced and is considered the strongest poison known.

How can you get tetanus?

The source of infection for tetanus is animals. Clostridia in the form of vegetative forms or spores is found in the stomach and intestines of many ruminants. IN environment The causative agent of tetanus is excreted along with feces.

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In the soil (especially in a humid, warm climate), the pathogen can remain viable for a long time, and under adequate conditions (lack of direct access to oxygen) can actively reproduce. In this regard, soil is the most significant natural reservoir of tetanus bacillus.

Infection occurs when soil containing tetanus spores comes into contact with a damaged skin surface (wound). The highest incidence of tetanus is observed in war time. For shrapnel wounds, crushed and gunshot wounds, the most favorable (oxygen-free) conditions are created, allowing the pathogen to actively reproduce.

For reference. In peacetime, most common reasons tetanus are various foot injuries (puncture of the heel with a rusty nail, thorn, damage to the feet with a rake while working in the country, etc.). Tetanus can also occur when soil gets into a burn wound, frostbite is contaminated, or trophic ulcers, after illegal (out-of-hospital) abortions, etc. In developing countries, there is still a high rate of neonatal tetanus infection due to infection of the umbilical wound.

Susceptibility to the causative agent of tetanus is extremely high in all age groups and does not depend on gender, however, most often the disease is registered in boys under 10 years of age (due to frequent injuries during outdoor games).

How the disease develops

After contact with the wound surface, spore forms of clostridia tetanus remain in it.
Transition to vegetative form, with further development the infectious process is possible only if oxygen-free conditions are created in the wound:

• deep puncture injuries with a long wound channel;
• entry into the wound of pyogenic flora, which actively consumes oxygen;
• unprofessional wound treatment;
• blockage of the wound lumen with crusts, blood clots, etc.

For reference. After the spores transform into pathogenic forms, they begin to actively multiply and produce tetanus toxins (tetanospasmin). Toxins quickly spread throughout the body and accumulate in nerve tissues.

Subsequently, the transmission of inhibitory impulses is blocked, as a result of which the striated muscle tissue Spontaneous exciting impulses begin to flow continuously, causing her tonic tension.

The first signs of tetanus are always manifested by damage to the striated muscles, as close as possible to the wound, as well as facial and masticatory muscles.

Sympathetic signs of tetanus in adults and children include:

• high body temperature,
• high blood pressure,
• severe profuse sweating,
• profuse salivation (against the background of pronounced sweating and salivation, dehydration may develop).

Against the background of constant tonic convulsive syndrome, a severe disturbance of microcirculation occurs in organs and tissues, leading to the development of metabolic acidosis.

For reference. As a result, a vicious circle is formed: metabolic acidosis contributes to increased seizures, and seizures support the progression of metabolic and microcirculatory disorders.

Tetanus – incubation period

The incubation period of tetanus is from one to thirty days. Usually the disease manifests itself a week or two after clostridia enter the wound.

Attention. It must be borne in mind that minor wounds may heal by the time the first symptoms appear, so it is possible to identify the entrance gates for infection only by collecting an anamnesis.

The severity of the disease is directly related to the length of the incubation period. The shorter it is, the more severe the tetanus.

Tetanus symptoms

Most often, the first symptoms of the disease are:

• the appearance of nagging and aching pain in the wound area;
• stiffness and difficulty swallowing;
• slight twitching of muscles in the wound area.

In some cases, there may be a short period of prodromal manifestations, occurring with fever, chills, weakness, irritability, and headaches.

Important. The first highly specific symptom of tetanus is the appearance of chewing trismus (tonic tension of the chewing muscles, leading to difficulty, and subsequently complete impossibility, to open the teeth).

On initial stages diseases, this symptom can be detected with a special technique that provokes muscle spasms: on the teeth lower jaw rest against the spatula and begin to tap on it.

Subsequently, progressive damage to nerve fibers by toxins leads to severe and specific damage to the facial muscles:

• distortion of facial features;
• the appearance of sharp wrinkles on the forehead and around the eyes;
• stretching the mouth in a tense, forced smile;
• raising or lowering the corners of the mouth.

Tetanus is one of the most dangerous infectious diseases, which is characterized by the release of a deadly toxin and an extremely rapid clinical course. To understand the severity of tetanus, it is enough to know that from 30 to 50% of patients die even if they receive a tetanus vaccine. In regions where health care is very poorly developed, patient mortality can reach 85-90%.

Tetanus is caused by bacteria that enter the body through wounds and other injuries. skin. The most favorable conditions for the proliferation of tetanus pathogens are formed in a hot and humid environment, therefore greatest number deaths from tetanus are recorded in the equatorial countries of Africa, Asia and Latin America. However, even in relatively prosperous Europe, tetanus claims thousands of lives every year, so it is not yet possible to talk about its safety for developed regions.

The causative agent of tetanus and routes of infection

The causative agents of tetanus belong to the Bacillaceae family. IN normal conditions Tetanus pathogens multiply in the intestines of animals and humans without causing them any harm. When they enter a wound and there is no oxygen, the previously peaceful bacilli completely change. They begin to actively secrete a toxin, which is considered one of the most powerful bacterial poisons. It acts very quickly, and the first signs of tetanus are observed in a person within a few hours after infection. Note also that the waste products of pathogens are not absorbed through the mucous membrane and are completely safe when swallowed, although when heated and exposed ultraviolet radiation they die very quickly.

As already mentioned, a person may need a tetanus vaccination if there are wounds or damage to the skin or mucous membranes. The most dangerous in this regard are deep puncture wounds, inside which ideal conditions are formed for the development of harmful microorganisms. In addition, the infection can become more active due to burns, frostbite, inflammatory diseases. Tetanus is transmitted to a newborn baby through an umbilical cord cut with poorly processed instruments.

Caution should be observed always and everywhere, because in some cases the infection is introduced into the body even through small wounds that arise, say, when you step on barefoot on a thorny plant or accidentally damage your skin with a splinter.

Clinical picture and symptoms of tetanus

Scientists distinguish 4 periods of the disease.

Symptoms of tetanus during the incubation period– lasts from several hours to 60 days. At this stage, bacteria penetrate the nutrient medium and begin to multiply and release a toxin. Patients may feel headache, sweating, muscle tension, increased irritability, chills, insomnia and other neuropsychiatric disorders.

Symptoms of tetanus in the initial period– patients experience dull, nagging pain in the wound area. At the same time, the first characteristic signs of tetanus appear, for example, trismus - convulsive contraction of the masticatory muscles, due to which it is sometimes impossible to open the mouth.

Symptoms of tetanus during the height of the disease– usually lasts 8-12 days, but in severe cases this period can increase by 2-3 times. The duration of the active phase of tetanus depends on how soon the patient went to the doctor, whether a tetanus vaccination was given, and the extent of the damage to the skin. At this stage in full force The main symptoms of infection appear:

• spasms of facial muscles, as a result of which a person develops a characteristic “smile”;
• difficulty swallowing food;
• severe tension in the muscles of the limbs and abdomen;
• painful cramps;
• profuse sweating;
• persistent insomnia;
• apnea, cyanosis, asphyxia;
• urination and circulatory disorders;
• heat

If the patient is not vaccinated against tetanus, he usually dies from spasm of the respiratory muscles or paralysis of the heart muscle. Other factors also lead to death: myocardial infarction, sepsis, embolism, pneumonia.

Recovery period– if specialists begin to treat tetanus in time, the symptoms gradually disappear. This stage can last for 2 months, and during this time the patient is especially at risk of developing various complications, so it is necessary to constantly monitor his condition.

Treatment of tetanus

All treatments for tetanus should be carried out by experienced doctors in a hospital setting. The course of treatment for tetanus includes:

• combating tetanus pathogens in the area of ​​the primary lesion (opening the wound, removing dead skin, sanitation and aeration);
• administration of antitetanus serum;
• relief of severe cramps;
• maintaining the vital functions of all body systems;
• prevention of complications;
• complete nutrition, rich in vitamins and microelements to strengthen the immune system.

It is advisable to place a patient with tetanus in a separate room to avoid the negative influence of external irritants. A 24-hour post is organized at his bedside to constantly monitor the person’s condition. If the patient cannot eat food on his own, it is administered to him using a special probe. Liquid foods (milk, broths, fruit drinks) are recommended. There should be enough water to replenish fluid lost due to sweating. Treatment of tetanus lasts from 1 to 3 months.

Prevention of tetanus

Prevention of tetanus is carried out in several directions at once. It is especially important to avoid injuries and conduct information work among the population. In addition, children aged 6 months to 17 years receive a tetanus vaccine. If avoided serious injuries failed, emergency tetanus prophylaxis is recommended for all unvaccinated people.

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Tetanus is an acute infectious pathology that is caused by specific bacteria. It has acute course and primarily affects the nervous system. Dangerous risk of development fatal outcome. In this article you will learn everything about what tetanus is, its signs, symptoms and treatment, and its causes.

Pathogen

Tetanus is caused by gram-positive clostridia. They are distinguished by their extreme survivability in environmental conditions: in the form of spores they can live for an extremely long time and can withstand heating in a hot environment up to 90 degrees for two hours. At temperatures close to the human body, the spores transform into viable bacteria.

The vegetative forms of such microorganisms are very stable even under boiling conditions. Disinfectants against tetanus can act on them for 6 hours: this is exactly the time it takes to neutralize the bacterium.

Clostridia secretes a very strong human pathogenic toxin, tetanospasmin and tetanolysin. The most powerful poison is tetanospasmin. It enters nerve tissue and inhibits inhibition signals. The action of such a substance causes tetanic spasms in humans.

Tetanolysin destroys human blood cells, myocardial and pericardial tissue. The action of such a substance leads to the development of local necrosis.

The causative agent of tetanus is carried by rodents, birds, herbivores and humans. The bacterium can also be found in human and animal feces. Routes of infection are from soil, dirty water, and almost all undisinfected surfaces. This disease is not transmitted from person to person. Infection can occur through a cut, abrasion, or wound.

Important! You can become infected through the entry of the tetanus pathogen into the bloodstream through wounds and cuts. If aseptic or antiseptic measures are not followed, the infection can enter the body through untreated surgical wounds. Susceptibility to such a pathogen is extremely high because the immune system Due to extremely small doses of poison entering the body, it is unable to develop an effective immune response.

The main symptoms of the disease

The incubation period ranges from several days to several months. The prodromal period is characterized by the appearance of the following symptoms:

• muscle tremors;
• increased muscle tension;
• pain symptoms in the head and neck area;
• sweating;
• mood changes, sometimes high irritability.

The first sign of tetanus pathology is the appearance of pain in the place where the infection entered the body. As a rule, this is a wound and a cut. This place begins to hurt even if it has healed.

• convulsive contraction of the facial muscles (this phenomenon makes it difficult to open the mouth);
• tension in the chewing muscles;
• swallowing dysfunction;
• neck muscle density;
• tension of the facial muscles, due to which the face acquires a specific expression with a wrinkled forehead, narrow slits in the eyes, elongated lips, drooping corners of the mouth).

These phenomena are typical specifically for tetanus. At the height of the pathology, tonic and very painful muscle spasms of the limbs and torso appear. They can appear at any time of the day, even at night, which creates big problems for a person.

Approximately on the 4th day of progression of this pathology, muscle hardness appears. abdominal cavity. At the same time, the legs are extended, since movements in them are limited. The breathing of a patient with tetanus is severely impaired, weak due to spasms of the diaphragm muscles. Bowel movement and urination become difficult and severely disrupted due to tension in the pelvic muscles. The patient complains of insomnia.

There is a total tension in the back muscles. In this case, a complex of symptoms characteristic of tetanus develops: the patient arches his back unnaturally, and his head throws back. At the same time, the lower back also arches. The patient’s face depicts incredible suffering, while its shade is sharply cyanotic (pale). In this position, the patient tries to hold onto the bed with his hands and has difficulty breathing. The face is covered with large drops of sweat, the amount of saliva increases.

The following phenomena are objectively determined:

Dangerous! Delirium and coma are a sign of imminent death.

The most dangerous period is from 10 to 14 days of progression of the pathology. With increasing metabolic syndrome, the following signs appear:

• increased body temperature;
• hypersalivation;
• increased sweating;
• multiple organ failure;
• severe damage to the cerebral cortex.

At this time, there is a very high risk of myocardial paralysis and suffocation.

After the critical phase, the symptoms of the pathology gradually subside. The patient begins the convalescence phase. Duration – up to two months.

Types of pathology

Doctors distinguish these types of tetanus.

1. The mild form is characterized by a long incubation period. There are no tonic convulsions, and body temperature remains within normal limits.
2. The moderate form is characterized by the fact that the patient has tachycardia and low-grade body temperature.
3. For severe tetanus, the incubation period is only five days, with symptoms worsening within one or two days. Convulsions occur very often, the patient experiences severe tachycardia and sweating.
4. The fulminant form of the clinic can develop within a few hours. The cramps are very severe and occur every 5 minutes. The patient's face is cyanotic. There is a risk of suffocation and cardiac arrest.
5. Brunner's disease affects the respiratory muscles, vocal cords, and neck. Damage to the vagus nerve is typical, which can cause neurogenic arrest of the heart and respiratory center.

Complications

All complications of tetanus and exacerbations of this pathology are very dangerous and can be fatal:

Diagnostics

The picture of the disease is very specific, so diagnosing tetanus is not difficult for an experienced doctor. For diagnosis, surgical dressings, air, and soil can be examined. In some cases, a blood test is prescribed.

In some cases, to diagnose tetanus, a doctor may take scrapings from the nose, throat mucosa, in women - from the vagina, in men - from the urethra.

Treatment

Treatment of such a disease is carried out only in intensive care units, with the participation of a resuscitator. Treatment must begin at an early stage. This is done because tetanus is a particularly dangerous and particularly severe infectious pathology. The patient is placed in a soundproofed room, creating complete peace. Feeding is carried out only with the help of a special gastric tube.

It is extremely important to prevent bedsores and their consequences:

• turning;
• change of linen;
• skin toilet.

The wound is treated with antitetanus serum. Any wound treatment is carried out only with the use of anesthesia to get rid of severe headaches.

For the purpose of therapy, early administration of serum or immunoglobulin is necessary. Symptomatic treatment consists of administering to the patient the following drugs:

• muscle relaxants;
• neuroleptics;
• narcotic sedatives;
• sedative medications.

The most commonly prescribed drugs are Diazepam, Trimeperidine, Diphenhydramine, and barbiturates. In case of severe pathology, Fentanyl, Droperidol, and curare-like drugs are used. In case of respiratory depression, the patient is transferred to mechanical ventilation and hyperbaric oxygenation. To remove urine, catheterization of the bladder is performed.

Treatment folk ways, methods and recipes are impractical and dangerous. First aid (emergency) for tetanus is calling a doctor and transporting to the intensive care unit.

Prevention and prognosis

The prognosis depends on the severity of the pathology. Severe and fulminant forms in adults and children can be fatal. Tetanus during pregnancy can cause the loss of a child. Mild forms of pathology can be cured. If the disease is not treated, it can be fatal.

Preventive measures involve the implementation of hygiene measures. It is mandatory to administer antitetanus serum to adults and children. TO emergency prevention tetanus include the administration of antitetanus immunoglobulin.

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