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Tetanus - Infectious disease characterized nj by tonic tension of skeletal muscle and attacks tetanycheskyh seizures caused by central nervous system toxin pathogen. In rare cases of the disease nj are recorded. Pathogen-Clostridium tetani - mobile hrampolozhytelnaya coli, anaerobes, forms spores under aerobic conditions capable of long time (years or even decades) tolerate nj adverse nj conditions; boiling controversy die only after 60 minutes. Highlights exotoxin, which is one of the strongest biological poisons.
The source of pathogen are animals (horses, cows, sheep, goats, pigs, donkeys, monkeys, rabbits, rats, mice) and the man in the gut pathogen often resides in the vegetative form, but they allocated toxin intestinal wall is not absorbed. Pathogen widely scattered faeces in the environment, especially in soil. Infection occurs only when the penetration of the pathogen into the body through a defect nj in the skin or mucous membranes - wounds, burns, frostbite, minor trauma, domestic and other patients with tetanus is not contagious.
The clinical picture. The incubation period - an average of 6-14 days, with a range from 1 day to 1 month. The shorter the incubation period, the heavier flows disease. nj There trismus (lockjaw tic), tonic tension of facial muscles, mouth stretched nj corners omitted in forehead nj wrinkles, eyebrows raised (so called sardonic smile), difficulty swallowing or inability to complete (dysphagia) by swallowing nj muscle tension, constant tonic muscle tension neck, chest, diaphragm, abdomen, nj back from opystotonusom - patient bends on the bed, leaning on her heels and only the back, limbs (no involvement in the muscles of the fingers and toes). Against this background, in 1-5 days recurring general nj (tetanycheskye) seizures lasting from a few seconds to 1-3 minutes. Characterized by persistent muscle pain, excessive sweating, especially nj people, nj which increases nj with convulsions. In patients have tachycardia, shortness of breath due to respiratory muscle hypertonicity, nj difficulty in urination and defecation due to hypertonicity perineal muscles and external sphincter, sensitivity nj to various stimuli. nj This consciousness is preserved. There have fever up to hyperthermia, the recovery of tendon reflexes, muscle stiffness in the neck, a symptom kerning hypersensitivity skin. With a favorable result of illness duration is 2 - 4 weeks, with the first stop seizures, and muscle hypertonicity nj disappears. The most common complication is pneumonia. Possible sepsis, with strong convulsions - muscle tears. The main cause of death - asphyxia.
Diagnosis is the characteristic symptom - trismus, sardonic smile, difficulty swallowing, tonic muscle tension, generalized seizures nj in clear consciousness. Equally important is a history of trauma (obtained 1 month before the illness).
Treatment. Hospitalization nj is required. The patient was placed in the hospital, which has the ICU. The range of therapeutic interventions are primary debridement; neutralization of toxin by intramuscular injection of 50 000-100 000 ME tetanus toxoid or 900 ME specific gamma globulin and tetanus toxoid nj active immunization in a dose of 0.5 ml at 3 - 5 days withdrawal seizures through the use of neuroleptics and anticonvulsants, hyperbaric nj oxygenation; treatment nj of respiratory failure, until the transfer of patients with artificial ventilation; correction of fluid and electrolyte balance, acid-base balance, feeding nj and care.
Prevention is conducting planned (preventive) vaccination and emergency vaccination nj of children and adults with injuries in violation of the integrity of the skin and mucous membranes, burns and frostbite II and III, biting animal community-acquired abortion. Regardless of the severity of the injury vaccinated against tetanus subcutaneously administered 0.5 ml of tetanus toxoid, unvaccinated ml -1, and intramuscular injection of tetanus human immunoglobulin. In the absence of the latter after intradermal nj tests injected subcutaneously at a dose of tetanus toxoid 3000 ME. Che Res 4 - 6 weeks subcutaneously administered 0.5 ml of tetanus toxoid, and after 9 - 12 months - another 0.5 ml of tetanus toxoid.
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