Tetanus is an acute infectious pathology of a bacterial nature, which even with proper treatment does not exclude a fatal 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 the defeat of the entire central nervous system. The main thing is to timely diagnose a person’s tetanus and determine the treatment methodology.
It is worth noting that the patient is completely harmless to others. Therefore, no one ever in the focus of the disease does not carry out any epidemiological measures: they simply do not need anything. In this article we will talk about the etiology of tetanus, pathogenesis, clinical features, diagnosis and treatment of this dangerous disease.
A bit of history
According to documents, the first description of tetanus was given by Hippocrates. At that time, his son died from this ailment, and his father gave a detailed description of the infection, the symptoms of the disease and the reasons for its development. By the way, Hippocrates called this infection “tetanus”, which in Greek means “pulling” or “pulling”.
In the XIX century, the German surgeon Theodor Billroth and the 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. There was no question about laboratory diagnosis of tetanus at that time.
The 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 scientist from Germany Arthur Nikolaier in 1884. A pure microorganism culture was isolated by a bacteriologist from Japan Sibasaburo Kitasato in 1887, who, just three years later, created a real anti-tetanus serum in collaboration with a doctor from Germany, Emil Bering. And in 1923, an immunologist from France, Gaston Ramon, created an toxoid, which they began to use as prophylaxis of tetanus.
What is the causative agent of tetanus
The causative agent of tetanus is a mobile, spore-shaped rod 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 refers to microorganisms of a conditionally pathogenic nature, called clostridia and can create about 20 long flagella.
As a result of the activity of the pathogen, tetanus exotoxin is formed, which, in terms of its negative effect on the body, is not inferior to such 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, we dwell on its features:
- Spores can withstand heat up to 90 ° C (and in the dry state up to 150 ° C) for 2 hours.
- Pathogens can withstand boiling for 1-3 hours and being in salt water for up to 6 months.
- In soil and feces can persist for over 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 development of the disease in the human body. Let us dwell on this moment in more detail.
After tetanus spores get into the wound, they remain for some time in the area of the entrance gate. Further, in the presence of favorable conditions, the causative agent of the disease begins to multiply quite actively, producing a toxin, which with the flow of blood and through the fibers of the peripheral nerves penetrates the spinal cord and the medulla oblongata, as well as in the area of the brain stem, which is called the reticular formation.
Important! Deep, and even puncture wounds represent the main danger in terms of tetanus infection. It is in them that those anaerobic conditions can be created that are so well suited for the multiplication of the tetanus pathogen. 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 erythrocyte hemolysis, and tetanospasmin. It is he who causes contractions of the tonic nature of the striated muscle, that is, it affects the human nervous system.
As a result of paralysis, impulses to the muscles begin to arrive in an uncoordinated manner. Next, skeletal muscle tension and cramps occur. All this contributes to an increase in the excitability of the cerebral cortex, damage to the respiratory center and even the occurrence of paralysis of the heart.
How can you get tetanus?
If you are informed about the ways of contracting the disease, then maybe you will not need a tetanus diagnosis. Remember: the causative agent of the disease acquires its pathogenic properties only when spores get on 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 oxygen access.
Ways of infection with tetanus:
- Shrapnel wounds (especially deep, having all the conditions of anaerobiosis), which are often observed in people in areas of military operations or armed conflicts. Important! The probability of tetanus infection 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 human immune system.
- Damage to the mucous membranes and skin.
- Burns on large areas of fabric.
- Frostbite.
- The birth process. Circumcision of 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 the so-called criminal abortion, that is, 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 an ulcer).
- All kinds of injuries of the feet and legs, for example, injuries when working with a rake or a shovel, injections with a rusty nail or other sharp, dirty objects.
- Herbivores and birds, with feces of which tetanus spores fall into the soil, remaining in it for years.
- Getting spores from clothing or dressing wounds with unclean rags or bandages.
On a note! In human feces, tetanus spores are extremely rare. Most often, this can only be observed among grooms, milkmaids and representatives of other similar professions.
Who is at risk for this disease? 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 ailment as tetanus cannot occur, since the pathogen is simply not contained in the saliva. In this case, rabies may develop, but tetanus is unlikely.
Tetanus classification
Before proceeding to the description of the process of diagnosis of tetanus, we will try to understand the existing types of this ailment. Depending on how the infection occurred, the following forms of the disease are distinguished:
- Traumatic. A form obtained during childbirth, wounds, surgery or injections, as well as frostbite, burns or electrical injuries.
- Cryptogenic, that is, not associated with trauma to tissues or mucous membranes. As a rule, this form may result from the presence of microtraumas that were not seen before.
- Pathology, which was 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 general). It includes primary pathology, as well as its descending and ascending forms.
- Local or limited (for example, head rose or facial tetanus).
The severity of the development of the disease is distinguished as follows:
- Easy. It is usually observed in people who have been vaccinated before. Symptoms are not pronounced, the temperature is either normal or slightly elevated.
- Moderate There is moderate and infrequent muscle tension, a slight increase in temperature, as well as cramps.
- Heavy. The intensity and frequency of seizures increases. There is an increase in temperature and a characteristic facial expression.
- Particularly severe (i.e., encephalatic form). This is Brunner's tetanus, characterized by significant lesions of the cardiovascular system, respiratory center and vagus nucleus.
According to how long the development of the disease takes place, the following forms are distinguished:
- fulminant (develops during the day);
- spicy;
- subacute;
- chronic
Tetanus developmental stages
Diagnosis of tetanus allows you to establish at what stage of its development the pathology is. There are four stages of the disease:
- Incubation. 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 harder the disease progresses 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 and yawning can be observed. On a note! Very rarely, the incubation period can occur without the presence of certain symptoms.
- Initial. This phase can last about two days. The most characteristic symptom of this period is the presence of pulling pain in the wound area. Moreover, she herself can already completely heal and drag on. And only after 1–2 days trismus can begin, that is, a convulsive contraction and tension of the masticatory muscles, which greatly complicates the opening of the mouth (and, sometimes, the inability to open it at all).
- Stage of development of pathology. 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 will begin, on your immunity and the availability of certain vaccinations in the period that preceded the disease. Symptoms of this stage will be described later in the next section.
- Stage of recovery. It can last about 2-2.5 months. The number of cramps and muscle tension is reduced. And their strength is weakening. Perhaps the development of various complications.
Symptoms of tetanus in humans
How and when does a person begin to develop tetanus symptoms (we will discuss the diagnosis and treatment below)? This happens at the moment when the spores take a vegetative form and begin to actively produce exotoxin, that is, poison that begins to spread throughout the body, negatively affecting the entire central nervous system. Here are the main symptoms of tetanus:
- The very first symptom is trismus, that is, a contraction of the masticatory muscles of the tonic nature, as well as cramps of the facial muscles. As a result, something like a smile appears on the patient’s face: his mouth is wide, his corners are down, and his eyebrows are raised. Swallowing is difficult; water or food intake is simply not possible. On a note! A spasm of the muscles of the larynx can cause asphyxiation.
- Twitching, tension and dull pain are observed in the area located in the immediate vicinity of the wound. For example, if it is on the leg, the muscles of the thigh and lower leg will begin to contract first.
- Painful tension (stiffness) of the muscles of the neck appears.
- Then spasms appear in the muscles of the neck, limbs, abdomen (it becomes very hard) and the back. Sometimes there comes a total stiffness of the entire body (except for the feet and hands).
- Abundant salivation and sweating begin, leading to dehydration.
- Headache and anxiety appear.
- Due to the pronounced muscle tension, the patient is not able to move independently, he experiences difficulties with the process of urination and defecation.
- As a result of the tension of a particular muscle group, the patient’s body can take rather bizarre poses. For example, a patient may bend in an arc, relying solely on the back of the head and heels. Some people with tetanus are preferable to lie on their stomach, while their hands, head and legs practically do not touch the surface of the bed.
- Patients experience fear, grind their teeth, scream and groan in pain.
- Respiratory dysfunction occurs.
- Body temperature rises sharply, sometimes up to 41–42 ° C.
- Chills, yawning, and insomnia are observed.
In the period between seizures, no muscle relaxation is observed. But the patient is conscious.
All of the above symptoms can, in addition to the disorders already listed, cause a malfunction in the heart muscle and lead to death.
Diagnosis Methods
It is hardly worth talking about an early diagnosis of tetanus, since it is almost impossible to detect toxin in 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, it simply indicates that the person was vaccinated in due time from tetanus.
On a note! Even a dose of poison sufficient for death is not a significant irritant for the appearance of an adequate immune response.
Only with the help of bacteriological diagnostics of tetanus can the pathogen be identified. This method includes not only the histological examination of the tissues that were selected during the surgical treatment of the wounds, but also the examination of smear impressions under a microscope. Moreover, dressings (or suture) surgical material, and in some cases even soil and dust, are sent for research. All selected materials are examined strictly under anaerobic conditions.
Microbiological diagnosis of tetanus involves a biological test in mice to detect poison in the material from the patient. During the study, one group of animals is injected with an extract obtained without preliminary incubation with serum, and the other with a mixture that has been incubated. 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, so to speak, is there. But what is characteristic: 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.
If we summarize everything, we can say that the method of diagnosing tetanus at an early stage of the disease was completely ineffective, since the human immune system does not react to tetanus toxin. The causative agent of the disease can be confirmed exclusively by the bacteriological method, that is, when the selection of the selected material from the wound is carried out. And no other way.
Important! At the first sign of an illness, immediately seek help from a medical facility. A timely diagnosis by a doctor of tetanus and its treatment can save your life. Remember this. Do not delay going to 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:
- Thoroughly rinse the damage with hydrogen peroxide. Moreover, the resulting foam should drain.
- We treat the skin around the wound with an antiseptic such as iodine or "green" (that is, a brilliant green solution).
- We apply a sterile dressing. It should not be tight.
After first aid, we always turn to a medical institution, for example, an emergency room.
Treatment of ailment
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 ward, in which the possibility of exposure to such external stimuli as light, noise or sound is excluded. A patient who is not allowed to get out of bed is constantly monitored by medical personnel. After the diagnosis, tetanus treatment is carried out as follows:
- First, surgical treatment of the wound is performed, that is, it is opened, debridement and aeration. Excision of tissues affected by tetanus sticks is mandatory.
- Next, tetanus toxoid is administered so that the poison is neutralized.
- Then they begin to carry out anticonvulsant therapy, which consists in prescribing drugs of a narcotic, antipsychotic and sedative nature.
- Antibacterial therapy is necessary in order to exclude the possibility of any complications.
- Measures are being taken to cope with dehydration, high blood pressure, disorders of the heart muscle and respiratory function, as well as febrile syndrome.
- You can not do without the treatment of possible concomitant complications (for example, thrombosis).
- Nutrition and care play an important role in the process of controlling tetanus. Patients are fed with liquid products (for example, broths), amino acids and mixtures of emulsions. They are on high-calorie diets, drink a lot of water.
All these activities are effective only the first 4-5 days. Therefore, the sooner you seek medical attention for help, the better. The introduction of tetanus toxoid does not give a person protection against a new similar infection. A small amount of toxin is enough for the disease to develop again. Therefore, all people who have undergone the clinical form of tetanus, or who have been diagnosed with this disease, must be immunized 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 ailment. This is primarily sepsis, pneumonia, venous thrombosis, pulmonary edema and myocardial infarction. In addition, cramps can lead to fracture of the spine or bones, as well as cause rupture of tendons and muscles.
Prevention of ailment
Prevention of tetanus in humans (diagnosis and treatment described above) is carried out in three directions:
- Sanitary education among the country's population.
- Vaccination of children from the age of three months and up to 17 years, in a planned manner according to the vaccination calendar. And then revaccination every 10 years.
- Emergency measures in case of injury.
So that you do not have to face the diagnosis and treatment of tetanus in the clinic, prevention should not be ignored. Be healthy!