tetanus syndromes. Tetanus: symptoms, incubation period, complications

Tetanus is one of the most dangerous infectious diseases with a rapid course and frequent deaths. Symptoms of the disease are caused by a toxin, which is secreted by bacteria that enter the body through damage to 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 the sick die. The mortality rate is higher only from rabies and pneumonic plague.

Reasons for the development of the disease

The entry gate for infection is any damage to the skin. These can be both extensive burns and wounds, as well as minor abrasions and punctures that are found on the body of most people. Very often, newborns are infected through the umbilical cord if the hospital does not maintain the necessary cleanliness.

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

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

There are descriptions of tetanus in the ancient doctors of India, China, Greece and Egypt. 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.

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 is fraught with cardiac arrest and breathing. The severity of the course of the disease and the prognosis depend on the depth and extent of damage to the nervous system.

Tetanus Symptoms (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 the toxin, which leads to headaches, sweating, muscle tension, insomnia, chills, and increased irritability. There are also sore throats when swallowing and loss of appetite. But sometimes there are no symptoms.

In the initial period of tetanus, dull and / or pulling pains appear 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 got to the hospital, whether he was vaccinated and how severe the skin damage was during infection. Typical symptoms in this stage:

• "sardonic smile" caused by spasm of facial muscles, and difficulty swallowing;
• tension in the muscles of the limbs and abdomen;
• painful cramps;
• insomnia;
• profuse sweating;
• cyanosis, apnea or even asphyxia;
• disorders of blood circulation and urination;
• high body temperature.

Unvaccinated patients without timely treatment, as a rule, die quickly enough from spasm of the respiratory muscles or paralysis of the heart muscle. Also, embolism, sepsis, pneumonia and myocardial infarction 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 a pleasant climate for him, and to the low level of medical care in many countries of Africa, Asia and Latin America.

If the 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, since complications may develop.

Treatment of the disease

Treatment of tetanus is carried out exclusively in intensive care or intensive care. The patient is provided with a protective regime, which is necessary to exclude any stimuli - visual, auditory, etc. Feeding patients is usually carried out through a tube, and with paresis - intravenously. Prevention of bedsores is necessarily carried out - this is turning a person over, carefully smoothing the linen and its periodic replacement.

The wound through which the infection has entered must be chipped with tetanus toxoid, even if it has already healed. After that, surgical treatment of the wound is carried out with lamp incisions to create aerobic conditions, foreign bodies, contaminated or necrotic tissues are removed. To avoid convulsions, all these manipulations are carried out under anesthesia.

To neutralize tetanus exotoxin, the patient is given a single dose of tetanus toxoid or specific immunoglobulin. Before this, an individual sensitivity test to the drugs is carried out. They must be entered as soon as possible. After using a heterogeneous tetanus toxoid 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 a temperate climate, the peak incidence occurs in early spring and late autumn.

For the treatment of convulsive syndrome, neuroplegic drugs are used: both sedatives and narcotics, as well as muscle relaxants. In severe respiratory disorders, intubation or tracheotomy may be required, often muscle relaxation is combined with mechanical ventilation. For the prevention of pneumonia, it is necessary to force breathing and coughing. If necessary, laxatives, gas tubes and catheters into the bladder are also used.

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

The 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 a decrease in ventilation and an increase in mucus production. Often, patients also suffer from sepsis, when another pathogenic microflora penetrates through the wound.

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

Often, during severe seizures, fracture and deformation of the bones occur, as well as the separation of muscles from their normal place of attachment. Also, after a long tonic contraction, tower contractures may occur.

Prevention of tetanus

Today, there are two areas of 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 from the age of three months are vaccinated against it. In addition, there is an emergency immunoprophylaxis after significant damage to the skin and with the likelihood of infection.

As for the prevention of infection, everything is more complicated here. Tetanus is caused by the bacterium Clostridium tetani, which can be found almost everywhere. The highest chance of infection is if the wound was inflicted by a dirty object with remnants of earth, feces or saliva. Sometimes the infection can get even through very minor damage to the top layer of the skin. Therefore, it is always necessary to treat all wounds, even the smallest ones.
Frequent cases of infection during medical procedures. Sometimes people become infected when they get tattoos and piercings. Therefore, it is always necessary to monitor the sterility of surgical instruments and, if possible, use disposable instruments.

This is an infectious disease caused by the bacterium Clostridium tetani, with an acute course and a predominant lesion of 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 Clostridium penetrates through damaged skin or mucous membranes. The basis of the clinical picture of tetanus is tonic convulsions of the muscles of the limbs and trunk, increasing muscle tension, opistatotonus. The most critical are 10-14 days of illness. High probability of death.

General information

This is an infectious disease caused by the bacterium Clostridium tetani, with an acute course and a predominant lesion of the nervous system. Tetanus is classified depending on the nature of the entrance gate 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.

Exciter characteristic

Clostridium tetani is a Gram-positive, motile, obligately 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 - about two hours. Spores are transformed 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 in a few minutes. Antiseptic and disinfectants act on these microorganisms for 3-6 hours.

Clostridium tetani secretes exotoxin (tetanospasmin) and cytotoxin (tetanolysin) acting on the human nervous system. Tetanospasmin is the strongest toxin, it penetrates into the processes of nerve cells and enters the central nervous system, suppressing inhibitory signals in synapses (preventing the release of inhibitory mediators). At first, the effect of the toxin extends only to peripheral synapses, causing tetanic convulsions.

Tetanolizin has a destructive effect on blood cells, tissue of the heart bag and membranes, causes local necrosis. The reservoir and source of spread of tetanus are rodents, birds, herbivores and humans. The causative agent is contained in the intestines of the carrier and is excreted into the environment with faeces.

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

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

Tetanus symptoms

The incubation period for tetanus can range from a few days to a month. Sometimes the disease begins with prodromal phenomena (tension and tremor of the muscles in the area of ​​​​infection, headache, sweating, irritability), but, as a rule, the first sign of tetanus is pain of a dull, pulling nature at the site of entry into the body of the pathogen, 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), neck stiffness (not accompanied by other meningeal symptoms), "sardonic smile" (specific tension of mimic muscles: wrinkled forehead, narrowed palpebral fissures, lips stretched, corners of the mouth lowered).

In the case of transferring the critical phase of the disease, the clinical signs gradually subside and the convalescence phase begins, lasting about one and a half to two months until the symptoms disappear completely. 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 the severity of mimic spasm, the 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. With a moderate course, the incubation period is 15-20 days, the increase in symptoms takes from 3 to 4 days, convulsions occur several times a day, subfebrile temperature 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 clinic with frequent seizures, 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 a few hours, tonic convulsions occur every 3-5 minutes, severe disorders of organs and systems, cyanosis, the threat of asphyxia, heart paralysis etc.

A particularly severe course is noted with bulbar, descending Brunner's tetanus, in which the maximum lesion 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 tetanus bacillus enters the wound after truncation of the umbilical cord) is one of the common causes of infant mortality. Sometimes (in rare cases) ascending tetanus can be noted, starting with painful twitches of peripheral muscles and gradually generalizing with the deployment of typical symptoms. Also, rare forms include local tetanus that occurs with head injuries and is characterized by paralysis of the facial muscles of the “sardonic smile” type with neck stiffness and bilateral (sometimes the damage to the side of the wound is more pronounced) paresis of the cranial nerves (Rozet's facial paralytic tetanus).

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, compression deformity of the spinal column. A frequent complication of tetanus is pneumonia, coronary spasm and myocardial infarction may develop.

During recovery, contractures, 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 sufficiently specific to make a diagnosis. Materials of the autopsy, dressing and suture material, swabs from surgical instruments, dust, soil, 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 injury). Sometimes there is a need for swabs from the nose and mucous membranes of the pharynx, vagina and uterus (for postpartum or post-abortion tetanus). Investigating the obtained biological material, tetanus exotoxin is isolated and a biological test is performed on mice.

Tetanus treatment

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 created the maximum possible in terms of irritants from the senses, rest, feeding is carried out with the help of a gastric tube, and with paresis of the digestive tract - parenterally.

Pressure sores are prevented (turning the patient, straightening and timely change of linen, skin toilet). The wound, which is the entrance gate of the infection, is chipped with tetanus toxoid (even if it has already healed). To create oxygen access to the area of ​​​​localization of the pathogen, performing an autopsy, revision, surgical treatment of the wound, make wide incisions. Existing foreign bodies, contamination and foci of necrosis are removed. Wound treatment, in order to avoid convulsions, is performed under anesthesia. Subsequently, in the management of wounds, proteolytic enzymes (trypsin, chymotrypsin) are used.

Etiological treatment involves the earliest possible administration of intramuscular tetanus toxoid or specific immunoglobulin, after a preliminary susceptibility test. Symptomatic treatment consists in the use of muscle relaxants, neuroleptics, narcotic and sedative drugs. In particular, diazepam has recently been widely used, 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, sodium oxybutyrate are used. In severe cases - fentanyl, droperidol, peripheral muscle relaxants of curare-like action (pancuronium, d-tubocurarine), and in a labile nervous system - a- and ß-blockers.

In case of respiratory depression, intubation is performed and the patient is transferred to a ventilator with humidified oxygen, the airways are cleaned with an aspirator. There is evidence of a positive effect of the use of hyperbaric oxygen therapy.

In case of difficulties in the work of the intestines and the urinary system, a gas outlet tube is placed and bladder catheterization is performed in women and men, laxatives are prescribed. Antibiotic therapy is used to prevent infection. Metabolic acidosis and dehydration are corrected by infusion intravenous administration of solutions of dextran, albumin, salts, plasma.

Forecast

The prognosis of tetanus depends on the form of the course, which is the 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, a fatal outcome is possible. Mild forms of tetanus with proper therapy are successfully cured.

Prevention of tetanus

Measures of non-specific prevention of tetanus imply compliance with sanitary and hygienic standards in everyday life (especially in medical institutions), reducing injuries. Individual prophylaxis includes thorough disinfection of injuries and a timely visit to a doctor for specific prophylaxis in case of contamination of wounds, abrasions, etc. Specific prophylaxis consists in a planned phased vaccination of children with the DTP vaccine and subsequent revaccinations every 10 years with ADS, AS and ADS-M.

Emergency prophylaxis in cases of the likelihood of infection (in case of injury and contamination of the wound, burns, frostbite of the third and fourth degree, etc.) consists in treating the wound and administering tetanus toxoid or immunoglobulin. Often, passive immunization for emergency prophylaxis is combined with the administration of an AS drug to stimulate one's own immunity. Emergency prophylaxis of tetanus is desirable to be carried out as early as possible.

Tetanus

What is Stolbnyak -

Tetanus (lat. Tetanus)- a 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 are given by Hippocrates. The tetanus bacillus was first discovered by N.D. Monastyrsky (1883) in the corpses of dead people and A. Nikolayer (1884) in abscesses with experimental tetanus in animals. A pure culture of the pathogen was isolated by the Japanese bacteriologist Sh. Kitazato (1887). Later, he received 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 obtaining 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 terminally arranged, giving the bacteria the appearance of "drumsticks" or "tennis rackets". C. tetani form a potent exotoxin (tetanospasmin), a cytotoxin (tetanolysin) and the so-called low molecular weight fraction. In the 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 causative agent of tetanus within 3-6 hours. In countries with a warm climate, spores can grow directly in the soil. Two types of antigens are detected in C. tetani: somatic (O-antigen) and flagella (H-antigen). According to the structures of flagellar antigens, 10 serovars are distinguished. All serovars form tetanospasmin and tetanolysin, identical in antigenic properties.

• Tetanospasmin- one of the most powerful biological poisons. It is a polypeptide with a "remote" mechanism of action, since bacteria rarely leave the primary site of infection. The toxin is fixed on the surface of the processes of nerve cells, penetrates into them (due to ligand-mediated endocytosis) and enters the CNS by retrograde axon transport. The mechanism of action is associated with the 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 the peripheral nerves, causing local tetanic muscle contractions. In cultures, the toxin appears on the 2nd day, reaching the peak of formation by the 5-7th day.
• Tetanolysin exhibits hemolytic, cardiotoxic and lethal effects, causes the development of local necrotic lesions. In the pathogenesis of the disease, this toxin plays a less important role. The maximum accumulation of the toxin in the culture is observed already 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 in neuromuscular synapses.

Epidemiology

Reservoir and source of infection- herbivores, rodents, birds and humans, in the intestines of which the pathogen lives; the latter is excreted into the external environment with faeces. Tetanus bacillus is also widely distributed in soil and other environmental objects, where it can multiply and persist for a long time. Thus, the pathogen has two interconnected and mutually enriched habitats, and, consequently, two sources of the pathogen - the intestines of warm-blooded animals and the soil. The significance of one or another source, apparently, is largely due to the climatic and geographical conditions of the area. The most favorable for vegetation and the preservation of the microorganism are chernozem and red earth 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), various objects and materials used in surgical practice (various powders, gypsum, talc, therapeutic clay and mud, cotton wool, etc.).

The frequency of carriage of tetanus bacillus spores by a person varies from 5-7 to 40%, and an increased degree of carriage is noted in persons who professionally or at home come into contact with soil or animals (agricultural workers, grooms, milkmaids, sewers, 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 litter reaches 25-40%, which is of particular epidemiological significance in connection with the use of the small intestine of sheep for the manufacture of surgical catgut.

Transfer mechanism- contact; the pathogen penetrates through damaged skin and mucous membranes (wounds, burns, frostbite). Infection of umbilical wounds in case of non-compliance with asepsis during childbirth can cause tetanus in newborns. The place of the entrance gate of the pathogen can be open wounds of various nature and localization (punctures, splinters, cuts, abrasions, crush injuries, open fractures, burns, frostbite, bites, necrosis, inflammation); in these cases, post-traumatic tetanus develops. Surgical wounds, especially on the colon and ischemic extremities, can become the entry gate for infection with the subsequent development of postoperative tetanus. Non-medical abortion interventions can cause post-abortion tetanus. There is no possibility of transmitting the pathogen from a sick person to a healthy person.

Natural susceptibility of people high. In those who have had tetanus, immunity to the disease is not formed, since a very small dose of the toxin that can cause the disease is insufficient to provide an immunological response.

Main epidemiological signs. The incidence is sporadic in the form of unrelated cases. The zonal spread of the infection is due to both climatic and geographical and socio-economic factors. Seasonality of the disease is spring-summer. Among the sick, rural residents, children and the elderly prevail; It is in these groups that the majority of deaths are recorded. Due to the widespread use of active immunization, neonatal tetanus is currently not registered. The presence of a permanent reservoir of infection in the soil determines the possibility of infection as a result of minor domestic 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 causative agent in the form of spores enters the human body through damaged skin and mucous membranes. Under anaerobic conditions (deep stab wounds, wounds with deep pockets or necrotization of crushed tissues), the development and reproduction of vegetative forms occurs in the wounds, accompanied by the release of exotoxin. Through the motor fibers of the peripheral nerves and with the blood flow, tetanospasmin penetrates into the spinal cord, medulla oblongata and the reticular formation of the trunk, where it is fixed mainly in the intercalary neurons of the polysynaptic reflex arcs. The bound toxin cannot be neutralized. Paralysis of intercalary neurons develops with suppression of all types of their synaptic inhibitory action on motor neurons. As a result, the uncoordinated flow of motor impulses from motor neurons to the muscles through neuromuscular synapses increases. The throughput of the latter increases due to increased secretion of acetylcholine under the action of the low molecular weight fraction. A continuous stream of efferent impulses maintains a constant tonic tension of the skeletal muscles.

At the same time, afferent impulses also increase in response to the effects of tactile, auditory, visual, olfactory, gustatory, temperature, and barostimuli. At the same time, tetanic convulsions periodically occur.

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

Post-infectious immunity does not develop with tetanus. Specific pathological changes are scarce (venous stasis, minor hemorrhages, in rare cases, muscle tears and muscle hematomas).

Tetanus symptoms:

Taking into account the entrance gate of infection, there are:

• traumatic tetanus;
• tetanus, developed as a result of inflammatory and destructive processes;
• cryptogenic tetanus (with unexplained entrance gate).

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

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 muscle tension and twitching at the site of injury, malaise, headache, sweating, irritability.

AT initial period of tetanus in some cases, its earliest symptom may appear - dull pulling pains in the area of ​​\u200b\u200bthe entrance gate of the infection, even in already completely healed wounds. The main specific symptoms that occur during this period are lockjaw, 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 convulsions of mimic muscles expressed in a "sardonic smile" (risus sardonicus), giving the patient's face a peculiar expression: a wrinkled forehead, narrowed palpebral fissures, stretched lips, lowered corners of the mouth.
• Dysphagia (difficulty painful swallowing) due to convulsive spasm of the muscles of the pharynx. The combination of trismus, "sardonic smile" and dysphagia is characteristic only for tetanus.
• Stiff neck, caused by tonic spasms of skeletal muscles, with tetanus is not a meningeal symptom and is not combined with other meningeal signs (symptoms of Kernig, Brudzinsky, etc.).

AT the height of the disease painful tonic convulsions spread to the muscles of the trunk and limbs (not capturing the hands and feet). Tonic muscle tension is constant, muscle relaxation, as a rule, does not occur even in sleep. Clearly outlined, especially in men, the contours of large skeletal muscles. From the 3-4th day of illness, the muscles of the abdominal wall become hard, like a board, the legs are more often extended, movements in them are limited. At the same time, the intercostal muscles and the diaphragm are involved in the process, breathing becomes shallow and rapid. Tonic tension of the muscles of the perineum leads to difficulty in defecation and urination. As a result of pronounced tension and soreness of the muscles of the back, with 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 a hand can be put between the back and the bed.

Against the background of constant tonic tension of the skeletal muscles, tetanic convulsions periodically occur with varying frequency. Their duration at first 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 common. Seizures come on suddenly. At the same time, the patient's face takes on a pained expression and becomes cyanotic, the contours of the muscles are more clearly outlined, and opisthotonus intensifies. Patients moan and scream because of the pain, try to grab the headboard with their hands to make breathing easier. The 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 maintaining a clear consciousness of the patient, 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. Difficulty in sputum production, as coughing provokes tetanic convulsions. Deterioration of lung ventilation often contributes to the development of secondary bacterial pneumonia. The heart is dilated due to both ventricles, the tones are loud. The liver and spleen are not enlarged. Deep intoxication of the brain stem causes respiratory depression and arrhythmia, weakening of cardiac activity; possible heart failure. Due to frequent and prolonged tonic convulsions, painful insomnia, irritability develop, and the threat of asphyxia increases.

In cases of a favorable outcome, the period of convalescence is long; gradually weakening clinical manifestations of the disease 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 course 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. The main clinical signs of the disease increase in 3-4 days. Convulsions occur several times a day, tachycardia and sweating are moderate, body temperature is subfebrile or (rarely) high.
• severe form tetanus is characterized by a shortened incubation period of up to 7-14 days, a rapid (in 1-2 days) increase in symptoms, a typical clinical picture with frequent and intense tetanic convulsions (several times within an hour), severe sweating and tachycardia, high fever.
• Very heavy flow 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, threatening asphyxia.

One of the most severe forms of generalized descending tetanus is Brunner's head ("bulbar") tetanus. It occurs with a predominant lesion of the muscles of the face, neck and pharynx, with spasms of the swallowing and intercostal muscles, muscles of the glottis and diaphragm. Usually there is a defeat of the respiratory, vasomotor centers and nuclei of the vagus nerve. Gynecological tetanus and neonatal tetanus, which is one of the important causes of infant mortality in developing countries, also differ in severity and poor prognosis. It is associated with poor conditions for the provision of obstetric care and the lack of immunization programs for women.

Ascending tetanus, observed in rare cases, is first manifested by pain, tension and fibrillar twitching in one muscle group, later, as new overlying sections of the spinal cord are affected, the disease acquires typical features of a generalized process.

Local tetanus is rare. One of its typical manifestations, developing after injuries to the face and head, is Rosé's facial paralytic tetanus. There are trismus, stiff neck, "sardonic smile", which are joined by paresis of the cranial nerves. The lesion is usually bilateral, more pronounced on the side of the injury.

When determining the prognosis of tetanus, much attention is paid to the period between the appearance of the first signs of the disease (trismus, 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 the dangerous complications of tetanus is asphyxia. At the same time, there is an opinion that asphyxia and cardiac arrest are not complications, but manifestations of the symptom complex of a severe course of the disease. Complications also include pneumonia, muscle ruptures, bone fractures, compression deformities of the spine. Increasing hypoxia during convulsions can contribute to the development of spasm of the coronary vessels and myocardial infarction, cardiac arrest. During the recovery period, muscle contractures and paralysis of 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 based on clinical findings. Specific symptoms of tetanus that occur already in its initial period are dull pulling pains in the wound area (even already healed), trismus, "sardonic smile", dysphagia and stiff neck. The combination of these symptoms is characteristic only for tetanus. During the height of the disease, painful tonic cramps of the muscles of the trunk and limbs (not involving the hands and feet) join, and against their background - periodic, suddenly occurring tonic convulsions, the frequency and duration of which largely determines the severity of the disease.

Laboratory diagnostics

With thickening of the blood due to severe and persistent excessive sweating, as well as with secondary bacterial complications, neutrophilia is possible. With the development of a typical clinical picture, isolation of the pathogen and its identification may not be required. Material from a patient or a corpse, dressing and suture surgical material, as well as soil, dust and air are subject to research. Bacteria are usually found at the site of entry into the patient's body. Therefore, the most rational study of various material taken at the site of injury. 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 injuries, 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 (with postpartum or post-abortal tetanus) are examined. When bacteriological examination of corpses, the possibility of generalization of infection is also taken into account. For analysis, blood (10 ml) and pieces of the liver and spleen (20-30 g) are taken. To isolate the pathogen, methods common to obtaining pure cultures of anaerobic bacteria are used.

In the study of material taken from a patient or a corpse, in parallel with bacteriological analysis, tetanus exotoxin is detected in a biological sample in mice. To do this, the material is crushed, a double volume of saline is added, incubated for an hour at room temperature, and filtered. Part of the filtrate is mixed with tetanus toxoid serum at the rate of 0.5 ml (200 AU/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 given the proincubated mixture. In the presence of C. tetani, the animals of the first group develop symptoms of tetanus.

Tetanus treatment:

Tetanus treatment carried out in the intensive care unit and resuscitation with the participation of an anesthesiologist. It is necessary to provide a protective regime that excludes auditory, visual and tactile stimuli. Feeding of patients is carried out through a probe or parenterally (with paresis of the gastrointestinal tract). Bed sores are prevented: frequent turning of the patient in bed, smoothing crumpled bed and underwear, cleaning it and periodically changing it. An infected wound, even a healed one, is treated with tetanus toxoid serum (at a dose of 1000-3000 IU), then a thorough revision and surgical treatment of the wound is carried out with wide lamp incisions (to create aerobic conditions), removal of foreign bodies, contaminated and necrotic tissues. To prevent seizures, all these manipulations are best done under anesthesia. Subsequently, it is advisable to use proteolytic enzymes (trypsin, chymotrypsin, etc.) for the treatment of wounds.

To neutralize tetanus exotoxin in the bloodstream, 50,000 IU of antitetanus serum or 1500-10,000 IU (average dose of 3000 IU) of specific immunoglobulin are administered intramuscularly once, with a preliminary check 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 the introduction of heterogeneous antitetanus serum, it is necessary to observe the patient for 1 hour because of the risk of developing anaphylactic shock.

The fight against convulsive syndrome is carried out using sedatives and narcotic, neuroplegic drugs and muscle relaxants. Recently, diazepam 5-10 mg orally every 2-4 hours has been 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 (up to a maximum of 10-15 mg / kg / day). You can use an injection of a mixture of a 2.5% solution of chlorpromazine, 1% solution of promedol and 1% solution of diphenhydramine (2 ml of each drug) with the addition of 0.5 ml of a 0.05% solution of scopolamine hydrobromide. Seduxen, barbiturates, sodium oxybutyrate are also prescribed, in severe cases - droperidol, fentanyl, curare-like muscle relaxants (pancuronium, d-tubocurarine). With the lability of the sympathetic nervous system, a- and ß-blockers are sometimes used. In case of respiratory disorders, intubation or tracheotomy is performed, muscle relaxation is combined with mechanical ventilation, airway cleansing with an aspirator; patients are given humidified oxygen. There are reports of the effectiveness of hyperbaric oxygen therapy.

In small doses, laxatives are prescribed, a gas outlet tube and a catheter are placed in the bladder (if necessary). For the prevention of 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 by intravenous infusions of 4% sodium bicarbonate solution, polyionic solutions, hemodez, rheopolyglucin, albumin, plasma.

Prevention of tetanus:

Epidemiological surveillance

An in-depth epidemiological analysis of the incidence and the preventive measures used is necessary to identify patterns in the spread of tetanus and to rationally plan preventive measures. 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, one 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). Of particular relevance in connection with cases of diseases in previously vaccinated is the analysis of the immune status of the diseased. The immunization of the population against tetanus, the implementation of the vaccination plan for certain age, socio-professional groups, including the rural population, are subject to a detailed analysis. Immunological control is an integral part of the epidemiological surveillance of tetanus. It allows assessing the protection of various contingents, reliably judging the vaccination and quality of the immunization performed, as well as the duration of immunity, identifying the most affected population groups and characterizing areas with varying degrees of risk of infection.

Preventive actions

Nonspecific prophylaxis of tetanus is aimed at preventing injuries in everyday life and at work, excluding infection of operating rooms, as well as wounds (umbilical and other), their early and thorough surgical treatment. Specific prophylaxis of tetanus is carried out in a planned and emergency manner. In accordance with the vaccination schedule, children are vaccinated from 3 months of age 3 times 0.5 ml with DTP vaccine with the first revaccination in 12-18 months and subsequent revaccinations every 10 years with associated drugs (ADS or ADS-M) or monopreparations (AS) . After a completed course of immunization, the human body for a long period (about 10 years) retains the ability to rapidly (within 2-3 days) produce antitoxins in response to repeated administration of preparations containing AS-toxoid.

Emergency prophylaxis of tetanus is carried out according to the scheme for any injuries and wounds with violation of the integrity of the skin and mucous membranes, burns and frostbite II-IV degrees, animal bites, penetrating intestinal injuries, community abortions, childbirth outside medical institutions, gangrene or tissue necrosis of any type, for a long time current abscesses, carbuncles. Emergency prophylaxis of tetanus includes primary wound treatment and simultaneous specific immunoprophylaxis. Depending on the previous vaccination of patients, there are passive immunization, active-passive prophylaxis, consisting of the simultaneous administration of tetanus toxoid and toxoid, and emergency revaccination of AS to stimulate immunity in previously vaccinated individuals. Emergency tetanus immunoprophylaxis 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 disease.

Activities in the epidemic focus

The patient is hospitalized in specialized (reanimation) departments for treatment. Dispensary observation of the ill person is carried out for 2 years. Dissociation in relation to contact persons is not carried out, since the patient is not dangerous to others. Disinfection in the hearth is not carried out.

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

Pathogen

Tetanus is caused by Gram-positive clostridia. They are extremely survivable in environmental conditions: in the form of spores they can live extremely long, withstand heating in a hot environment up to 90 degrees for two hours. At a temperature close to the human body, spores are converted into viable bacteria.

The vegetative forms of such microorganisms are very stable even under boiling conditions. Anti-tetanus disinfectants can act on them for up to 6 hours, which is how long it takes to kill the bacterium.

Clostridium secretes a very strong human pathogenic toxin tetanospasmin and tetanolysin. The most powerful poison is tetanospasmin. It enters the nervous tissue and inhibits inhibitory signals. The action of such a substance causes tetanic spasms in humans.

Tetanolysin destroys blood cells in humans, 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. Ways of infection - from the soil, dirty water, almost all non-disinfected surfaces. This disease is not transmitted from person to person. The infection can get through a cut, abrasions, wounds.

Important! You can become infected through the entry of the causative agent of tetanus into the blood through wounds and cuts,. If aseptic or antiseptic measures are not followed, then the infection can enter the body through untreated surgical wounds. The susceptibility to such a pathogen is extremely high, because the immune system, due to the ingestion of extremely small doses of poison, cannot develop an effective immune response.

The main symptoms of the disease

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

• muscle tremor;
• increased muscle tension;
• pain symptoms in the head and neck;
• 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 from. As a rule, it is a wound and a cut. This place begins to hurt even if it is healed.

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

These phenomena are typical for tetanus. At the height of the pathology, tonic and very painful spasms of the muscles of the limbs and trunk 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 the progression of such a pathology, the hardness of the muscles of the abdominal cavity appears. At the same time, the legs are extended, as movements in them are limited. Respiration in a patient with tetanus is sharply disturbed, weak due to spasms of the muscles of the diaphragm. Difficulty and sharply disrupted bowel movement and urination due to tension in the muscles of the pelvis. The patient complains of insomnia.

There is a total tension of the muscles of the back. In this case, the complex of symptoms characteristic of tetanus develops: the patient arches unnaturally in the back, while the head is thrown back. At the same time, the lower back also arches. The patient's face at the same time depicts incredible suffering, while its shade is sharply cyanotic (pale). In this position, the patient tries to hold on to the bed with his hands, he 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, coma is a sign of an imminent lethal outcome.

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

• increase in body temperature;
• hypersalivation;
• increased sweating;
• multiple organ failure;
• severe lesions of the cerebral cortex.

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

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

Varieties 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, subfebrile body temperature.
3. Before a severe form of tetanus, the incubation period lasts only five days, the symptoms increase within one or two days. Convulsions occur very often, the patient has severe tachycardia and sweating.
4. The fulminant form of the clinic can develop within a few hours. The seizures 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 characteristic, which can cause a neurogenic stoppage of the heart and respiratory center.

Complications

All complications of tetanus and exacerbation of this pathology are very dangerous and fraught with death:

Diagnostics

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

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

Treatment

Treatment of such a disease is carried out only in intensive care units, with the participation of a resuscitator. It is necessary to start treatment from an early stage. This is done because tetanus is one of the most dangerous and especially severe infectious pathologies. The patient is placed in a soundproof room, with the creation of complete rest. 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 tetanus toxoid. Any treatment of wounds is carried out only with the use of anesthesia to get rid of a severe headache.

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

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

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

Treatment with folk methods, methods and recipes is impractical and dangerous. First aid (emergency) for tetanus is a doctor's call and transportation 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 lead to the loss of a child. Mild forms of pathology are cured. If left untreated, the disease can be fatal.

Preventive measures include the implementation of hygiene measures. The introduction of tetanus toxoid is mandatory for adults and children. To emergency prevention of tetanus include the introduction of tetanus immunoglobulin.

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

After the 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 the introduction of toxoid. The sick person himself is not contagious, since the clostridial bacterium requires special conditions for habitation, reproduction and the acquisition of pathogenic properties.

Ways 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 may occur when:

• injuries - stab, cut wounds;
• burns and frostbite;
• during childbirth, through the umbilical cord;
• microtrauma;
• bites from animals or poisonous insects.

The mechanism of action of the toxin:

The tetanus bacterium, getting into 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 a constant tonic contraction of the striated muscles. This tension spreads throughout the body and paralysis of the respiratory and cardiac muscles can occur. With the reduction of the vocal cords, asphyxia occurs.
• tetanolysin - acts on erythrocytes, causing their hemolysis.

During tetanus, 4 stages are distinguished:

• incubation period- the duration can be from several days to a month, it all depends on the distance of the focus from the central nervous system. The further, the longer the period and the easier the disease. During this period, the patient may be disturbed by intermittent headaches, slight twitches in the wound area, and irritability. Before the height 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 pulling pains in the area of ​​the wound, even if it has already completely healed. During this period, the standard symptoms of tetanus (triad) may appear: trismus (tonic contraction of the masticatory muscles without the possibility of opening the mouth), sardonic smile (tonic convulsions of the mimic muscles make a facial expression, either smiling or suffering - the forehead is frowning, 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 the posture of a person lying on the back of the head and heels in the form of an arc).
• peak period - average duration is 8-12 days. There is a distinctly visible triad of symptoms - trismus, sardonic smile and opisthotonus. Muscle tension can reach such a degree that there is complete stiffness of the body, with the exception of the hands and feet. The abdomen is flat to the touch. This period is accompanied by painful cramps that can last up to several minutes. During the attack, sweating increases, the 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. In the periods between convulsive contractions, muscle relaxation does not occur. The patient also notes difficulty in swallowing, defecation and urination. From the side of breathing, apnea can be observed, from the side of the larynx - asphyxia, and due to insufficiency of cardiac activity, cyanosis is visible on the skin.
• recovery period- long up to two months. During this period, muscle strength and the number of seizures slowly decrease. By 4 weeks they stop completely. Restoration of normal activity of the heart occurs by the end of the third month. At this time, complications may join, and if this does not happen, then complete recovery occurs.

The severity is assessed by several indicators:

• mild degree- the triad of symptoms is expressed moderately, spasms, as a rule, are absent or insignificant. Body temperature does not exceed subfebrile numbers. Tachycardia is rarely present. Duration up to two weeks.
• average degree- proceeds with a typical clinical picture, there is tachycardia with a rise in body temperature. Convulsive seizures 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 degree- the symptoms are pronounced, the high temperature is constant, seizures are recorded every 15-30 minutes for up to three minutes. Severe tachycardia and hypoxia are noted. Often accompanied by the addition of complications. Duration over three weeks.

The characteristic signs of tetanus include:

• lockjaw;
• sardonic smile;
• opisthotonus;
• difficulty swallowing, as well as its soreness;
• tachycardia;
• temperature rise;
• 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, does not give results. To determine the presence of exotoxin, material is taken from the wound and inoculated on a nutrient medium, and a biological test is carried out 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 irritants from the outside (light, noise, etc.).

Treatment is carried out according to the following plan:

• The introduction of tetanus toxoid - even if there is just a suspicion, then this item is mandatory.
• Sanitation of the wound - primary surgical treatment, wide opening of tissue flaps to improve aeration, sutures are by no means superimposed.
• Relief of convulsive seizures - injected muscle relaxants.
• Transfer of the patient to artificial lung ventilation (correction of hypoxia), control of the cardiovascular system.
• Dealing with complications.
• Nutrition is high-calorie, tube or parenteral.

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