Tetanus toxin. Tetanus - what is it: symptoms, treatment and prevention of infection

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

How can you get tetanus?

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

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

Routes of transmission

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

The causative agent of tetanus

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

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

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

Classification of forms of the disease

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

Depending on the route of infection

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

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

By localization

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

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

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

According to severity

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

How it manifests itself

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

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

The first signs of tetanus

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

Prodromal signs of infection

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

Specific symptoms

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

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

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

Opisthotonus of muscles

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

Complications of tetanus and prognosis

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

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

Patient survival

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

Diagnostics

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

Treatment of tetanus

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

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

Neutralization of toxin

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

newborn child – 20,000–40,000 IU;

older children – 80,000–100,000 IU;

adults – 100,000–150,000 IU.

Opening and treating the wound

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

Symptomatic treatment

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

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

Preventive actions

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

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

Routine vaccination

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

Nonspecific prevention

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

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

Video

Tetanus is classified in medicine as an acute infectious disease that has a contact mechanism of pathogen transmission. The causative agent of the disease in question is the tetanus bacillus, which can enter the human body through damage to the skin (for example, a puncture, wound, burn, and so on).

Tetanus bacilli, conducting their life activity in the human body, produce toxins. They are real biological poisons and the manifestation of the disease is associated with them. If we talk about tetanus briefly, it is characterized by damage to the central nervous system, manifested by general cramps and severe muscle tension.

Forms of tetanus

In medicine, a conditional division of the disease in question into forms is accepted; the definition of each of them depends on the severity of tetanus.

Light form

Signs of tetanus appear and progress over 5-6 days, while body temperature remains within normal limits or rises slightly. The patient has difficulty opening oral cavity(trismus), tension in the facial muscles (“sardonic smile”), but all this is expressed moderately.

Moderate form

Signs of the disease actively progress within 3-4 days, the patient is worried, which can occur several times a day. With all this, the body temperature of a patient with tetanus rises, but never becomes critically high.

Severe form

Signs of tetanus progress rapidly and appear in full force within the first 2 days from the moment of infection. The patient has pronounced disturbances in swallowing, muscle tone, breathing and facial expressions; he is bothered by convulsions several times an hour (they are always intense). When tetanus develops in a severe form, the patient experiences rapid heartbeat, severe sweating and an increase in temperature up to 40 degrees.

Very severe form

It is characterized by:

• rapid increase in signs of pathology;
• almost constant convulsions (several times within 3-5 minutes);
• hyperthermia, and with critical indicators (40 degrees and above);
• rapid heartbeat;
• pronounced;
• cyanosis of the skin;
• threat of respiratory arrest.

There is another option for dividing the disease in question into forms - along the path of penetration of the tetanus bacillus into the body. The division looks like this:

• tetanus is traumatic, when the pathogen enters the human body during traumatic injuries skin;
• tetanus, which is the result of inflammatory processes that destroy the integrity of the skin - for example, if an infection occurs in a wound when the skin is damaged due to a specific disease;
• tetanus of unknown etiology, when it is impossible to determine the route of infection.

It is worth highlighting several more forms of the disease in question:

1. Local tetanus. Found in medical practice extremely rare, more often diagnosed in previously vaccinated patients. It will be characteristic of him local violations– spasm and slight muscle twitching specifically at the site of injury, a slight increase in temperature (or body temperature remains within normal limits), absence of general cramps. Local tetanus, without proper medical care, often develops into a general form of the disease.
2. Tetanus Rose. This is one of the varieties of local tetanus, it is also diagnosed extremely rarely and is more common when the head or face is wounded. The classic manifestations of this type of tetanus are:
   • difficulty opening the mouth (trismus);
   • signs of cranial nerve damage;
   • "sardonic smile";
   • neck muscle tension.
3. Brunner's tetanus. This is a very severe form of the disease in question, in which there is damage to the muscles of the face, neck and pharynx - the nerves that regulate the activity of all internal organs stop working normally, and the nerve centers that are “responsible” for the activity are adversely affected respiratory system. The prognosis for this form of tetanus is extremely disappointing.
4. Neonatal tetanus. Infection occurs when tetanus bacillus penetrates through umbilical wound. The general manifestations of the disease will not differ from the symptoms characteristic of adult patients. Local changes are noted in the umbilical wound - it becomes wet, acquires a pronounced red color, and purulent contents may be released from it.

Causes of tetanus development

It is well known that the mechanism of transmission of the pathogen is mechanical, that is, the tetanus bacillus can enter the human body only through damage to the skin. The greatest danger is posed by deep damage to the skin and mucous membranes, punctures, since all the vital activity of the tetanus bacillus (growth, reproduction) occurs without access to air.

Infection can also occur if the rules of asepsis and antisepsis are not followed - for example, when carrying out any medical procedures or surgical interventions.

Classic symptoms of tetanus

The following symptoms will be characteristic of the initial period of tetanus:

• dull nagging pain in the place where the infection has entered the wound;
• convulsive contraction or powerful spasm of the masticatory muscles, which leads to the inability to open the mouth;
• excessive tension in the facial muscles, which is manifested by a “sardonic smile”: wrinkled forehead, stretched lips, narrowed eyes, drooping corners of the mouth;
• convulsive spasm of the muscles of the pharynx, which leads to difficulty swallowing.

note: it is the combination of a “sardonic smile”, difficulty swallowing and difficulty opening the mouth that is a sign of tetanus; such a “trio” is not typical for any other pathologies.

If the disease is already actively progressing, then it will have completely different symptoms:

• tension in the muscles of the limbs and torso, which is characterized by intense pain, but does not involve the hands and feet;
• lack of muscle relaxation during sleep;
• the contours of large muscles are clearly drawn, this is especially visible in men;
• on the 4th day of illness, the abdominal muscles become excessively hard, lower limbs by this time they are most often elongated, and their movements are severely limited;
• the respiratory system works with disturbances, which is characterized by shallow and rapid breathing;
• defecation (emptying the rectum) is difficult because the muscles of the perineum are very tense;
• practically no urine comes out;
• when the patient is positioned on his back, his head is thrown back as much as possible, the lumbar part of the body is raised above the bed - opisthotonus;
• sudden convulsions occur that can last from a few seconds to tens of minutes;
• the patient makes strong screams and moans due to intense pain;
• body temperature is high, there is increased sweating and copious discharge saliva.

Diagnostic measures

In general, tetanus is diagnosed only upon examination of the patient - the symptoms of this disease are too characteristic. After the diagnosis is made, the doctor must conduct an epidemiological history - when and how the infection entered the body, if there are wounds, what were inflicted and how long ago they were received, is there a possibility of soil, glass or rust getting into the wound.

Laboratory tests of the patient's blood allow the identification of tetanus bacillus.

Treatment of tetanus

There is a clear algorithm for diagnosing tetanus:

In addition, doctors often immediately prescribe a course of antibacterial medications, which helps prevent the development of inflammatory processes directly at the site of infection and in the lungs. Patients are fed through a special tube, or by injecting nutrients into a vein.

Traditional medicine in the treatment of tetanus

We warn you right away: under no circumstances should you ignore the signs of the disease in question and trust recipes from the “ ethnoscience"! It is imperative that you first receive qualified medical care, and only then, during the recovery period, you can use traditional recipes.

Oral preparations

Baths in the recovery period after tetanus

Baths with the addition of medicinal plants. You can prepare a chamomile bath - half a kilogram of flowers is poured with water so that the raw material is completely covered, boiled for 10 minutes and added to a warm bath. Pine baths also have a good effect, for which you need to pour pine cones and branches with water in the proportion of 500 grams of raw materials per liter of water, boil for 10 minutes and leave, covered with a towel, for 12 hours. To take one bath you will need one and a half liters of ready-made folk remedy.

Note:After suffering from tetanus, the patient must be observed by his attending physician. Seek advice from this specialist regarding the advisability of using folk remedies.

Possible complications of tetanus

The disease is quite serious and poses a danger to all human systems and organs. It is not surprising that some complications may develop:

• with pulmonary edema;
• formation in large and small blood vessels;
• injury to bones, joints and muscle tissue during convulsions;
• spine fracture;
• ruptures and separations of muscles from the spine;
• deterioration in muscle and joint mobility;
• changes in the shape and curvature of the spine;
• complete or partial loss of nerve conduction in certain areas of the body.

Preventive actions

There are two types of tetanus prophylaxis:

1. Nonspecific prevention . It is to prevent wounds and injuries to the skin at home and at work, correct processing operating units to prevent infection during surgical interventions. This implies careful debridement wound
2. Specific prevention. A scheduled injection is carried out, which allows the body to quickly produce substances against toxins - this will be a response to the repeated introduction of toxoids.

In addition, emergency prophylaxis is carried out for any injuries and wounds in which the likelihood of infection with tetanus bacillus is too high. Emergency prevention includes:

• primary treatment of the wound by a doctor;
• carrying out specific immunoprophylaxis.

Note:immunity against tetanus is not developed, so emergency prophylaxis is carried out upon each admission to the trauma department.

Tetanus – dangerous disease, which is a threat to human life. Only qualified medical care increases the chances of saving the patient.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category

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

A person with tetanus is not dangerous to others

The causative agent of tetanus

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

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

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

The causative agent of tetanus is a spore-forming bacterium. In no favorable conditions external environment, bacteria form spores that are extremely resistant to a number of chemical factors, disinfectants and antiseptics. Clostridium tetani persists as spores for many years.

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

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

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

Prevalence and incidence rate

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

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

Epidemiology of tetanus

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

The gates of infection are:

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

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

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

Rice. 5. Injuries, abrasions and splinters of the skin are the main entry points for bacteria.

A sick person is not a spreader of infection.

Pathogenesis of tetanus

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

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

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

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

Signs and symptoms of tetanus

Signs and symptoms of tetanus during the incubation period

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

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

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

Signs and symptoms of tetanus in the initial period

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

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

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

Signs and symptoms of tetanus during the height of the disease

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

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

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

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

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

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

Signs and symptoms of tetanus during recovery

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

Severity and prevalence of tetanus

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

Rice. 11. The photo shows facial paralytic tetanus.

Complications of tetanus

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

After recovery, the patient is bothered for a long time by general weakness, weakening cardiovascular activity and skeletal muscle stiffness.

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

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

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

Diagnosis of tetanus

Epidemiological history

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

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

Rice. 13. The photo shows tetanus in adults.

Laboratory diagnostics

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

To diagnose the disease, microscopy of smears, histological examination of the material and culture of wound discharge on nutrient media are used.

Clostridia- mobile gram-positive spore-forming anaerobic rods. The discovery of clostridia belongs to L. Pasteur (1861).

According to environmental characteristics, 3 groups of clostridia are distinguished: pathogens fermentation processes, causative agents of putrefactive processes, which are saprophytes, and pathogenic species.

Currently, 15 species of pathogenic clostridia are known. Highest value in human pathology have C. botulinum - the causative agent of botulism, C. tetani - the causative agent of tetanus, C. perfringens - the causative agent of gas gangrene, food toxic infections and necrotic enteritis, C. hystoliticum - the causative agent of gas gangrene, C. difficile - the causative agent of pseudomembranous colitis that develops in background of antibiotic therapy.

Tetanus- spicy infectious disease from the group of saprozoonoses with a contact mechanism of pathogen transmission. The pathogenesis is based on the action of the pathogen toxin on the central nervous system. Clinically manifested by attacks of generalized convulsions that occur against the background of muscle hypertonicity.

History and distribution

Tetanus has been known since ancient times. A clear description of its clinical picture was given by Hippocrates. The connection between the disease and injuries was also known. The pathogen was discovered in 1883 by N.D. Monastyrsky and almost simultaneously by A. Nikolaier, and was isolated in pure culture by S. Kitazato. He, together with E. Bering, isolated tetanus toxin in 1890 and prepared an antitoxic serum for the treatment of patients.

Tetanus toxoid, used for vaccination against tetanus, was obtained by G. Ramon in 1926 by treating the toxin with formaldehyde. In the past, due to widespread trauma, tetanus was most common during wars. Despite vaccination, according to WHO, about 1.5 million people die from tetanus every year, mostly newborns in developing countries.

Etiology of tetanus

The causative agent of tetanus, Clostidium tetani, is a large gram-positive rod with flagella. It is an obligate anaerobe. When exposed to oxygen, it forms spores that are extremely resistant to physical and chemical factors. In dry form, the spores die at 155 °C after 20 minutes; in a 1% solution of sublimate they remain viable for 8-10 hours.

Tetanus bacillus has flagellar and somatic antigens. Based on the flagellar antigen, 10 serovars of the pathogen are distinguished. During its life, the tetanus bacillus produces 3 toxic substances. Pathogenicity of the pathogen and all clinical manifestations diseases are associated with tetanospasmin, which is a protein with a molecular weight of 150,000, which is a powerful poison, second only to botulinum toxin in toxicity.

Epidemiology

The source of the pathogen is many species of animals (especially ruminants), in which spores and vegetative forms of the pathogen are found in the digestive tract. The pathogen can also be found in the human intestine. However, the toxin produced is not absorbed. Getting into the soil with feces, tetanus bacillus spores remain in it for years, and under favorable temperature conditions, the absence of oxygen or its consumption by aerobic flora, they germinate, which leads to the accumulation of spores. Thus, the soil serves as a natural reservoir of the pathogen.

Infection occurs when the pathogen penetrates tissue during wounds, especially shrapnel, household and industrial injuries (usually agricultural), together with soil particles and foreign bodies. Often the cause of infection is minor leg injuries. Tetanus may occur after burns, frostbite, out-of-hospital abortions, operations, childbirth, and inflammatory processes. Sometimes the entrance gate of infection cannot be established (“cryptogenic tetanus”).

Susceptibility to tetanus is high. In countries with temperate climates, summer seasonality is observed (agricultural injuries).

After an illness, immunity is not developed.

Pathogenesis and pathomorphology of tetanus

Entering the body through damage to the outer integument, the spores of the pathogen remain at the entrance gate. Under anaerobic conditions (necrotic tissue, ischemia, foreign bodies, flora that consumes oxygen), the spores germinate and intensive production of tetanus toxin begins, which is fixed on the surface of the processes of nerve cells, penetrates them and reaches the central nervous system through retrograde axonal transport.

The mechanism of action is associated with the binding of the toxin to synaptic proteins (synaptobrevin and cellubrevin) and suppression of the action of glycine and gamma-aminobutyric acid, inhibiting the transmission of nerve impulses. The motor cells of the anterior horns of the spinal cord are affected, in particular the interneurons of the efferent polysynaptic arches, which have an inhibitory effect. The result is a flow of uncontrolled nerve impulses to the muscles, which leads to their tonic tension.

Against this background, generalized seizures, caused by an increase in not only efferent, but also afferent impulses to sound, light, tactile and other types of stimuli. In tetanus, the process also involves the dining room part of the brain and nervus vagus. Tissue acidosis and hypoxia developing during an attack of convulsions contribute to the strengthening of the convulsive syndrome and worsen cardiac activity. Death occurs from asphyxia, paralysis of the heart muscle or secondary complications.

There are no pathological specific changes in tetanus. Bone fractures are detected, in particular compression fractures of the vertebrae, ruptures of muscles and tendons, dystrophic and necrotic changes in brain tissue, often pneumonia.

Yushchuk N.D., Vengerov Yu.Ya.