Tetanus in humans: diagnosis, treatment and prevention

Tetanus is an infectious disease, the main symptom of which is convulsive muscle contraction. The infectious agent penetrates the body through the wound surface (cracks, burns, wounds, scrapes, punctures, etc.). The treatment gives good results under the condition of early diagnosis, in some cases a fatal outcome is possible. But the disease can be prevented with the help of a complex of vaccinations.

About the causes and symptoms of the disease you have already learned from the article of the same name, now let's talk about the diagnosis, treatment and methods of preventing tetanus in humans.

Diagnostics

Tetanus is a disease in which the correct diagnosis is made only on the available clinical symptoms. It is important to have a history of damage to the skin and mucous membranes (surgery, bites, abortions, genera, deep cracks, etc.), received during the previous 30 days (occasionally - 60 days). It should be borne in mind that the trauma could go unnoticed and have time to fully heal by the time the symptoms of tetanus appear.

Symptoms such as pulling the pain in the wound, twitching the muscles above the injury site, reducing the chewing muscles when striking a spatula lying on the teeth of the lower jaw, should be alerted to a possible tetanus. When there is trismus, a sardonic smile and dysphagia, the totality of which is typical only for tetanus, the diagnosis becomes clear. Following a typical triad, generalized tonic tension of the whole body appears and periodic convulsions with an increase in temperature and sweating. These symptoms finally dispel all doubts (but this is a late diagnosis).

Laboratory methods of diagnostics practically do not play a role in the diagnosis. When the first symptoms of tetanus appear, exotoxin, excreted by the pathogen, is already in the central nervous system and it is simply impossible to detect it in the blood. It is possible to detect clostridia of tetanus in the wound by examining the smears-prints from the wound under the microscope and bacteriological method (flushes from the wound are sown to nutrient media and artificially grown bacteria). However, according to the time frame, this often does not matter, since the clinical picture of the disease is no longer in doubt at this time.

Sometimes, together with bacteriological methods, a biological test is used in mice to confirm the presence of exotoxin. One group of mice are injected with flushes from the wound together with a specific antitetanus serum (which neutralizes the exotoxin), and the other - the same flushes, but without serum. The second group of mice develop tetanus, which confirms the diagnosis.

Treatment

Treatment of tetanus is carried out in conditions of intensive care unit, since at any time a life-threatening condition may occur. The patient is not dangerous to others, does not represent a source of infection, so contacting persons are not subjected to any additional measures, and disinfection in the outbreak is not carried out.

The patient must comply with bed rest.

All measures should be implemented almost simultaneously, in order to "have time" to eliminate exotoxin and its harmful effects on the body.

The earlier treatment is started, including specific therapy with tetanus antitetanus or immunoglobulin, the more favorable outcome and more hope for healing.

The whole complex of measures for tetanus can be systematized as follows:

• protective mode;
• fight with the pathogen at the site of entry into the body (in the wound);
• detoxification of a toxin;
• treatment of seizures;
• maintenance of vital body functions (breathing, cardiac activity);
• symptomatic treatment (decrease in body temperature, recovery of circulating blood volume);
• prevention and treatment of complications;
• organization of care for the sick.

The protective regime consists in creating the most sparing conditions for the patient, avoiding the effects of sounds, light, sharp odors, and a minimal amount of touch. This is necessary not to provoke cramps.

Fighting the pathogen at the site of entry into the body is a surgical treatment of the wound with its anti-tetanus serum (1000-3000 IU).Surgical treatment of the wound consists in the removal of foreign bodies, dead tissue, the so-called Lamp (along the wound) cuts to create oxygen access to deeper located tissues. This is done in order to create disastrous conditions for clostridia, since in the presence of oxygen they do not develop. If the wound has already healed by the time of the development of tetanus, this place is still chewed with antitetanus serum to neutralize the remaining vegetative forms. All these activities are conducted under anesthesia, so as not to provoke cramps in the patient.

The toxin is neutralized with antitoxic antitetanus horse serum. Since exotoxin in tetanus has the ability to firmly fix on nerve cells (and after that it is impossible to neutralize in any way), the introduction of serum should begin as soon as possible after the diagnosis is established. Before the introduction of serum, a sample must be made to detect a possible allergy to it. To do this, 0.1 ml of serum diluted 1: 100 is injected intradermally into the middle of the forearm. After 20 minutes, assess the place of administration: if redness and swelling less than 1 cm, the sample is considered negative (no allergies), if 1 cm and more - then positive (in this case, the introduction of serum is possible only for vital indications against the background of special anti-shock therapy). With a negative sample, 0.1 ml of undiluted serum is injected intramuscularly and the patient is observed for 30 minutes-1 hour. If there are no complications, then inject the entire dose of 10, 00-15, 00 IU intramuscularly. Serum is administered once and lasts about 3 weeks.

Because of the likelihood of anaphylactic shock (acute allergic reaction, which threatens the patient's life) within an hour after the introduction of the patient's serum is subject to careful medical observation with measurement of parameters of blood pressure, palpitation, temperature, etc. Instead of tetanus horse serum can be used anti-tetanus immunoglobulin rights in a dose of 3000-6000 units (part of the dose cut off the wound). It is indicated with a positive allergic test for the introduction of horse serum.

Treatment for seizures is carried out using sedatives (tranquilizers), neuroplegic substances, narcotic drugs and muscle relaxants (remedyto relax the muscles). Apply Diazepam (Sibazon, Relanium) inside of 5-10 mg every 2-4 hours, with the inability to swallow - intravenously 10-20 mg up to 8 times a day; Chloral hydrate in enema up to 6 g / day (for 3-4 injections); Aminazine up to 600 mg / day. Effective is the so-called lytic mixture: 2 ml of a 2.5% solution of Aminazine with 1-2 ml of 1% Promedol solution, 2 ml of 1% solution of Dimedrol and 0.5-1 ml of 0.05% Scopolamine hydrobromide solution. In severe tetanus with frequent convulsions, it is necessary to use muscle relaxants (Tubokurarin) in combination with Diazepam, sodium oxybutyrate on the background of artificial ventilation (IVL). Sometimes the patient is on the ventilator for 2-3 weeks.

Maintaining vital functions is to correct high blood pressure, cardiovascular violations, maintenance of adequate parameters of oxygenation of the blood (sometimes it is possible only on the ventilator). Reduction of blood pressure, reduction of heart rate is achieved by the use of β-blockers (Obsidan, Anaprilin), α-adrenoblockers (Fentolamine).

Symptomatic treatment involves fighting with dehydration, acidosis (shifting the acid-base balance towards increasing acidity). To do this, use a 4% solution of sodium bicarbonate, Reopoliglyukin, Reosorbilakt, Reomacrodex, Refortan, Stabilizol, Plazmalit, Ionosteril, Ringer's solution, Trisol, plasma. A sufficient supply of fluid into the body provides a normal volume of circulating blood, does not allow the temperature to rise even higher. And this reduces the risk of complications.

Since tetanus is impaired lung ventilation (due to muscle tension), then to prevent the development of pneumonia (pneumonia) apply antibiotics of various groups (macrolides, penicillin group, cephalosporins, tetracyclines). Antibiotic is prescribed for 1-2 weeks in high doses. Preventive measures include the use of heparin subcutaneously to prevent thrombosis.

To prevent the development of pressure sores, the patient must often turn in bed, ensure the purity of the body and bedding, it is possible to use special anti-decubitus devices (rollers, pillows, rings, etc.). Since muscle tension leads to a violation of urination and defecation, you may need a catheterization of the bladder and regular cleansing enemas.

Because tetanus is difficult to eat due to trismus, dysphagia and general muscle tension, and sometimes even impossible, the important role is played by the organization of the patient's nutrition. With the preserved ability to swallow the patient give a liquid, wiped high-calorie food. Sometimes feeding should be done through a probe or even parenterally (intravenous application of special nutrient solutions).

In some cases (especially with late treatment of patients and delayed diagnosis), all medical measures are ineffective and the patient dies. The current mortality rate for tetanus is about 30%! Therefore, much attention is paid to the prevention of the disease.

Prevention

Prophylaxis of tetanus can be:

• nonspecific: prevention of injuries, contamination of wounds, health education, thorough surgical treatment with timely dressings, observance of rules of aseptic and antiseptic in hospital establishments;
• specific: vaccination.

Specific prevention, in turn, can be planned and emergency.

Planned prophylaxis of tetanus

It consists in carrying out the vaccination. To ensure the development of immunity against tetanus, tetanus toxoid (AC-toxoid) is used.
It is a part of combined vaccines DTP, ADS-M. Vaccinations are administered to children aged 3, 4.5, 6, 18 months, then 6 years and 14-16 years of age intramuscularly into the thigh or shoulder area. In the future, throughout the entire life, revaccinations are shown every 10 years. It is believed that after the administration of AC-toxoid in a dose of 0.5 ml for 10 years, the body retains the ability to produce antibodies to exotoxin tetanus within 2-3 days, subject to repeated administration of AS-anatoxin (emergency prophylaxis).

If immunization in childhood was not performed, i.e. the adult is not vaccinated against tetanus, then this contingent of the population use AC-anatoxin in a dose of 0.5 ml twice with an interval of 1 month, and then in a year. Such a triple injection of the drug provides the formation of immunity for 10 years. In the following also, revaccinations are necessary every 10 years (counting from the last injection).

Emergency prophylaxis of tetanus

This type of prevention is carried out with any kind of injury with damage to the skin or mucous membranes, with animal bites, community-acquired childbirth and abortion, frostbite and burns, penetrating wounds of the abdomen, long-running local purulent processes (abscesses, carbuncles). It is carried out within a period of up to 20 days inclusive from the time of injury (the earlier, the better).

There are the following types of emergency prevention:

• active - is carried out before the vaccinated persons. To do this, use 0.5 ml of AC-anatoxin. Such a technique is used for vaccinated children without the last age-specific revaccination (provided there is a confirmatory documentation), vaccinated adults, who had the last vaccination period more than 5 years ago. Accordingly, children who have a full schedule of vaccinations by age and adults with the latest booster vaccination less than 5 years ago, do not enter AS-toxoid;
• active-passive - is carried out by unvaccinated persons or who received a previously incomplete vaccination course. In this case, 0.5 ml of AC-anatoxin and 250 IU of tetanus antitetanus immunoglobulin or , 00 IU of tetanus antiserum (with the setting before injection of the allergic probe). After carrying out active-passive prophylaxis it is necessary to continue the introduction of AS-anatoxin in a month and a year later to form immunity to tetanus.

From all of the above, we can conclude that tetanus is a disease that is much easier to prevent than treat. Timely vaccination reduces the risk of the disease to almost zero. And 30% of deaths from developing tetanus speak for themselves. Remember when you were last grafted from tetanus? If more than 10 years have passed, then visit the health facility, spend 5 minutes on vaccination. By such actions you will secure your life.

"Inter" TV channel, "Doctor Komarovsky's School" program on "Diphtheria and tetanus"

Diphtheria and tetanus - Dr. Komarovsky's School - Int

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