Tetanus is an acute infectious pathology of a bacterial nature, which, even with proper treatment, does not exclude a lethal outcome. The development of the disease occurs as a result of the action on the body of such a toxin as tetanus bacillus. As a result, not only convulsions and tension of the skeletal muscles of a tonic nature are observed, but also damage to the entire central nervous system. The main thing is to diagnose tetanus in humans in time and determine the method of therapy.
It is worth noting that the patient is completely harmless to others. Therefore, no one ever conducts any epidemiological measures in the focus of the disease: they are simply useless. In this article we will talk about the etiology of tetanus, pathogenesis, clinic, diagnosis and treatment of this dangerous disease.
A bit of history
According to the documents, the first description of tetanus was given by Hippocrates. At that time, his son died of this disease, and the father gave a detailed description of the infection,symptoms of the disease and the causes of its development. By the way, Hippocrates called this infection "tetanus", which in Greek means "pull out" or "pull".
In the 19th century, German surgeon Theodor Billroth and Russian surgeon Nikolai Ivanovich Pirogov put forward a hypothesis about the infectious nature of such a disease as tetanus. Moreover, both versions were made independently of each other, although they sounded almost at the same time. Laboratory diagnosis of tetanus was out of the question at the time.
Scientific study of tetanus infection began only in the second half of the 20th century. It was during this period that the causative agent of tetanus was discovered. This happened thanks to the scientific research of the Russian surgeon N. D. Monastyrsky in 1883 and the German scientist Arthur Nikolayer in 1884. The pure culture of the microorganism was isolated by the Japanese bacteriologist Shibasaburo Kitasato in 1887, who, three years later, in collaboration with the German doctor Emil Behring, created a real tetanus toxoid serum. And in 1923, the French immunologist Gaston Ramon created a toxoid, which they began to use as a prophylaxis against tetanus.
What is the causative agent of tetanus
The causative agent of tetanus is a mobile spore-like bacillus with a width of 0.3 to 0.8 microns and a length of 4 to 8 microns, which "feels great" in an oxygen-free environment. This inhabitant of the human (or animal) intestine belongs to the microorganisms of the opportunistic pathogencharacter, is called clostridia and can create about 20 long flagella.
As a result of the activity of the pathogen, tetanus exotoxin is formed, which, by the strength of its negative effect on the body, is not inferior to such a poison as botulinum. Moreover, this "poison" is not able to be absorbed through the intestinal mucosa: therefore, it is absolutely safe if swallowed.
Features of the causative agent of tetanus
Before talking about the diagnosis of tetanus, let's dwell on its features:
- Spores can withstand temperatures up to 90°C (or 150°C when dry) for 2 hours.
- Pathogens withstand boiling for 1-3 hours and exposure to s alt water for up to 6 months.
- In soil and feces can persist for a century. By the way, spores are resistant to antiseptics and disinfectants.
The destruction of the toxin occurs under the influence of an alkaline environment and sunlight, for more than 3-5 days.
Mechanism of action
Laboratory diagnosis of tetanus is extremely important, but many are interested in the process of development of the disease in the human body. Let's dwell on this point in more detail.
After getting tetanus spores in the wound, they remain for some time near the entrance gate. Further, in the presence of favorable conditions, the causative agent of the disease begins to multiply quite actively, while producing a toxin, which, with the blood flow and through peripheral fibersnerves penetrate the spinal cord and medulla oblongata, as well as in the region of the brain stem, which is called the reticular formation.
Important! Deep, and even stab wounds represent the main danger in terms of tetanus infection. It is in them that those anaerobic conditions that are so well suited for the reproduction of the causative agent of tetanus can be created. If the wound (or abrasion) is superficial, that is, it has access to oxygen and is well treated, then most likely it is not dangerous.
Tetanus toxin consists of tetanohemolysin, which causes hemolysis of red blood cells, and tetanospasmin. It is he who causes contractions of the tonic nature of the striated muscles, that is, it affects the human nervous system.
As a result of paralysis, impulses to the muscles begin to flow in an uncoordinated way. Next comes the tension of the skeletal muscles and convulsions. All this contributes to an increase in the excitability of the cerebral cortex, damage to the respiratory center and even the occurrence of heart paralysis.
How can you get tetanus
If you are informed about the ways in which the disease is transmitted, then you may not need a tetanus diagnosis. Remember: the causative agent of the disease acquires its pathogenic properties only when spores enter the tissues of a living organism that are damaged, that is, the transmission mechanism is contact. Moreover, a prerequisite for the development of tetanus is the absence of any access to oxygen.
Tetanus transmission routes:
- Shrapnel wounds (especially deep,having all the conditions of anaerobiosis), which are often observed in people in areas of combat operations or armed conflicts. Important! The likelihood of contracting tetanus in the presence of a wound may be due to its depth, the correctness of its treatment from a medical point of view, as well as the state of the person's immune system.
- Injuries to mucous membranes and skin.
- Burns over large areas of tissue.
- Frostbite.
- The process of childbirth. Cutting the umbilical cord in newborns with a non-sterile instrument, as well as umbilical wounds (although this is more common for children born in countries where mothers are often not vaccinated against tetanus).
- The actions of obstetricians who carry out so-called criminal abortions, that is, they do it outside of medical hospitals.
- Inflammatory pathologies in which there is direct contact of the focus of inflammation with the environment (that is, we are talking, for example, about an abscess, gangrene, bedsores or ulcers).
- All kinds of injuries to the feet and legs, such as injuries from working with a rake or a shovel, pricks from a rusty nail or other sharp, dirty objects.
- Herbivorous animals and birds, with the feces of which tetanus spores enter the soil, remaining in it for years.
- Getting spores from clothing or dressing wounds with unclean rags or bandages.
Note! Tetanus spores are rarely found in human faeces. Most often, this can only be observed among grooms, milkmaids and representatives of other similar professions.
Who on thisdisease is at risk? First of all, it includes adolescents who are often injured, as well as agricultural workers who are in direct contact with soil, animals and sewage.
Important! After the bites of cats, dogs, foxes and others like them, infection with such a dangerous disease as tetanus cannot occur, since the pathogen is simply not contained in the saliva. In this case, rabies may develop, but tetanus is unlikely.
Classification of tetanus
Before proceeding to the description of the process of diagnosing tetanus, let's try to deal with the existing types of this disease. Depending on how the infection occurred, the following forms of the disease are distinguished:
- Traumatic. Uniform obtained through childbirth, wounds, surgery or injections, as well as frostbite, burns or electrical injury.
- Cryptogenic, that is, not associated with tissue or mucosal injury. As a rule, this form can occur as a result of the presence of microtraumas that were not noticed before.
- Pathology that has formed as a result of certain inflammatory or other destructive processes.
Depending on the place of development of the disease in the body, tetanus is distinguished:
- Generalized (or generic). It includes primary pathology, as well as its descending and ascending forms.
- Local or limited (eg head tetanus Rosé or facial).
Degrees of severitythe development of the disease are distinguished as follows:
- Easy. As a rule, it is observed in people who have been vaccinated before. Symptoms are mild, temperature is either normal or slightly elevated.
- Medium. There is moderate and infrequent muscle tension, mild fever, and seizures.
- Heavy. The intensity and frequency of seizures increases. There is an increase in temperature and a characteristic facial expression.
- Especially severe (that is, the encephalatic form). This is Brunner's tetanus, characterized by significant damage to the cardiovascular system, the respiratory center and the nucleus of the vagus nerve.
According to how long the development of the disease occurs, the following forms are distinguished:
- lightning fast (develops during the day);
- spicy;
- subacute;
- chronic.
Tetanus developmental stages
Diagnosis of tetanus allows you to determine at what stage of its development the pathology is. In total, four stages of the disease are distinguished:
- Hatchery. This phase of the disease can last from one day to a month (on average, it is about 1-2 weeks). Moreover, the shorter the incubation period, the more severe the disease is and the higher the likelihood that everything will end in death. Immediately before the onset of this stage of the disease, symptoms such as insomnia, pain in the back and larynx (when swallowing), chills, loss of appetite, irritability, twitching in the wound area and yawning can be observed. On thenote! Very rarely, the incubation period can proceed without the presence of certain symptoms.
- Initial. This phase can last for about two days. The most characteristic symptom of this period is the presence of pain of a pulling nature in the area of the wound. Moreover, she herself can already completely heal and drag on. And only after 1-2 days trismus can begin, that is, convulsive contraction and tension of the masticatory muscles, which makes it much more difficult to open the mouth (and sometimes the inability to open it at all).
- The stage of pathology development. This stage can last from 1-1.5 weeks to 2-3 weeks. Remember: the duration of this phase depends on how quickly you contact a medical institution for help, how soon treatment begins, on your immunity and the presence of certain vaccinations in the period that preceded the disease. The symptoms of this stage will be described below in the next section.
- The stage of recovery. It can last about 2-2.5 months. The number of cramps and muscle tension is reduced. Yes, their power is waning. Various complications may develop.
Tetanus symptoms in humans
How and when do symptoms of tetanus begin to develop in humans (we will discuss diagnosis and treatment below)? This happens at the moment when the spores take on a vegetative form and begin to actively produce exotoxin, that is, a poison that begins to spread throughout the body, negatively affecting the entire human central nervous system. Here are the main symptoms of tetanus:
- The mostthe first symptom is trismus, that is, a contraction of the masticatory muscles of a tonic nature, as well as convulsions of the facial muscles. As a result, something like a smile appears on the patient's face: the mouth is stretched wide, its corners are lowered, and the eyebrows are raised up. Swallowing is difficult, taking water or food is simply impossible. On a note! Spasm of the muscles of the larynx can cause asphyxia.
- There is twitching, tension and dull pain in the area in close proximity to the wound. For example, if she is on her leg, then the muscles of the thigh and lower leg will begin to contract first.
- Painful tension (rigidity) of the neck muscles appears.
- Next there are spasms in the muscles of the neck, limbs, abdomen (it becomes very hard) and back. Sometimes there is total stiffness of the entire body (except for the feet and hands).
- Profuse salivation and sweating begin, leading to dehydration.
- Headache and anxiety appear.
- Due to pronounced muscle tension, the patient is unable to move independently, he has difficulty with the process of urination and defecation.
- As a result of the tension of one or another muscle group, the patient's body can take rather bizarre poses. For example, the patient may arch, relying solely on the back of the head and heels. Some people with tetanus prefer to lie on their stomachs with their hands, head, and feet barely touching the surface of the bed.
- Sick people are afraid, gnash their teeth, scream and moan in pain.
- Respiratory dysfunction occurs.
- The body temperature rises sharply, sometimes up to 41-42 °C.
- There is chills, yawning and insomnia.
In the period between convulsions, no muscle relaxation is observed. But the patient is conscious.
All of the above symptoms can, in addition to the disorders already listed, cause malfunction of the heart muscle and lead to death.
Methods for diagnosing a disease
It is hardly worth talking about the early diagnosis of tetanus, since it is almost impossible to detect the toxin in the plasma at the initial stage of the disease, due to the fact that there is no increase in antibody titers. Even if their small content is found, this simply indicates that the person was vaccinated against tetanus at one time.
Note! Even a dose of poison sufficient to cause death is not a significant irritant for the appearance of an adequate immune response.
Only with the help of bacteriological diagnosis of tetanus can the pathogen be identified. This method includes not only the study of tissues for histology, which were selected during the surgical treatment of wounds, but also the study of impression smears under a microscope. Moreover, the dressing (or suture) surgical material is also sent for research, and in some cases even soil and dust. All selected materials are examined strictly under anaerobic conditions.
Microbiological diagnosis of tetanus involves a biological test formice to detect poison in the material from the patient. During the study, one group of animals is injected with an extract obtained without prior incubation with serum, and the other with a mixture that has undergone incubation. In the presence of tetanus toxin, mice from the first group begin to develop symptoms of the disease.
At the stage of active development of the disease, there are no problems with the clinic of tetanus and its diagnosis. Everything is there, so to speak. But what is typical: any deviations in the body in terms of the state of blood, cerebrospinal fluid, urine, as well as the work of the brain or internal organs are completely absent.
To summarize everything, we can say that the method of diagnosing tetanus at an early stage of the disease turned out to be completely ineffective, since the human immune system does not react to tetanus toxin in any way. The causative agent of the disease can be confirmed exclusively by the bacteriological method, that is, when the selected material is sown from the wound. Nothing else.
Important! At the first sign of illness, immediately seek help from a medical institution. Timely diagnosis and treatment of tetanus by a doctor can save your life. Remember this. Don't delay seeing a specialist.
First Aid
Diagnosis and treatment of tetanus in the clinic. But in order to prevent the development of the disease, it is important to properly treat the wound:
- Carefully wash the damage with hydrogen peroxide. Moreover, the resulting foam should drain.
- We make leather processingaround the wound with an antiseptic such as iodine or brilliant green (that is, a brilliant green solution).
- Apply a sterile dressing. It should not be tight.
After providing first aid, be sure to contact a medical facility, such as an emergency room.
Treatment of disease
Diagnosis and treatment of tetanus in the clinic is carried out exclusively in a stationary mode for 1-3 months. Moreover, the patient is placed in a separate room, in which the possibility of exposure to such external stimuli as light, noise or sound is excluded. A patient who cannot get out of bed is under constant monitoring by medical professionals. Once diagnosed, tetanus is treated as follows:
- First, the wound is surgically treated, that is, it is opened, sanitized and aerated. Excision of tissues affected by tetanus bacillus is mandatory.
- Next, tetanus toxoid is administered to neutralize the poison.
- Then, anticonvulsant therapy begins, which consists in prescribing drugs of a narcotic, neuroleptic and sedative nature.
- Antibacterial therapy is needed to minimize the possibility of any complications.
- Steps are being taken to manage dehydration, high blood pressure, heart and respiratory problems, and fever.
- It is impossible to do without the therapy of possible concomitantcomplications (eg, thrombosis).
- Nutrition and care play an important role in the fight against tetanus. Patients are fed liquid foods (eg, broths), amino acids, and mixtures of emulsions. They are on high-calorie diets and drink plenty of water.
All these activities are effective only for the first 4-5 days. Therefore, the sooner you seek help from medical professionals, the better. The introduction of tetanus toxoid does not give a person protection against a new similar infection. A small amount of the toxin is enough for the disease to develop again. Therefore, all people who have had a clinical form of tetanus, or who have been diagnosed with this disease, must be subjected to mandatory immunization with tetanus toxoid.
Complications
After we talked about the etiology, pathogenesis, clinic, diagnosis and treatment of tetanus, it is worth talking about the possible complications that may arise after this dangerous disease. This is primarily sepsis, pneumonia, vein thrombosis, pulmonary edema and myocardial infarction. In addition, cramps can lead to a fracture of the spine or bones, as well as cause rupture of tendons and muscles.
Disease prevention
Prevention of tetanus in humans (diagnosis and treatment described above) is carried out in three directions:
- Sanitary education work among the population of the country.
- Vaccination of children from the age of three months and up to 17 years, in a planned manner according tovaccination calendar. And then revaccination every 10 years.
- Emergency measures in case of injury.
In order not to have to deal with the diagnosis and treatment of tetanus in the clinic, prevention should not be ignored. Stay he althy!
