What is tetanus? Symptoms and treatment methods of tetanus
Tetanus, a potentially fatal disease, manifested by the constant painful contraction of the muscles, was the subject of curiosity. Citizens who want to get information about tetanus research, wants to get healthy information about the subject. So, what is tetanus? What are the symptoms of tetanus?
As most people think, tetanus doesn't just pass through a rusty nail, but everyone is at risk of tetanus. Any injury involving soil and dust can lead to this disease. Here, in the light of information published by the General Directorate of Public Health 'What is tetanus?' The answer to the question ...
Definition: Tetanus or ıklı piled fever gram is an infectious disease which is characterized by painful and tonic contractions of muscles and high mortality rate caused by toxin of Clostridium tetani, which is a gram positive, anaerobic bacillus that enter the body as a result of various injuries. .
Clostridium tetani is commonly found in nature in soil, animal and human faeces, resistant to external factors, in spore form. Nail spikes, splinters, soil contaminated instrument injuries, traffic accidents and especially inadequate wound care carry risks in terms of tetanus infection.
Clinical Findings
Tetanus; incubation period until the first symptoms after injury 2 - 60 (average 7-14) days.but dirty and necrosis, foreign bodies containing tetanus in the wounds, the incubation period is short because of the formation of too much toxin.
The initial symptoms are restlessness, weakness, headache, pain at the wound site. The symptoms gradually appear and primarily the facial muscles strain and chew difficulty. Pain in the jaw muscles contractions, (trismus) as a result of inability to open the mouth, as a result of stretching the muscles of the face risus sardonicus (sarcastic smile) occurs in the back, trunk and extremities.
Tetanus: There are four different clinical forms: generalized tetanus, localized tetanus, cephalic tetanus and neonatal tetanus. The most common form is generalized tetanus.
Generalized tetanus: It is the most common form. After general symptoms such as weakness, headache, pain at the wound site, the disease starts with trismus characterized by the contraction of the maseter muscles and cannot open its mouth in chewing and swallowing difficulties. Contractions are passed to the facial muscles, risus sardonicus, opistotonus with the contraction of the nape and back muscles respectively, and defenses occur due to contractions in the abdominal muscles. In some severe cases, diaphragm, intercostal, laryngeal muscles contract and upper respiratory tract obstruction and related asphyxia develop death. Patients have severe pain and even bone fractures in each contraction. The patients are conscious. Fever is normal; Elevated fever should suggest complications such as pneumonia, atelectasis, wound infection. Neuromuscular blockade results from autonomic dysfunction; sweating, labile hypertension, hypotension, tachycardia, cardiac rhythm disorders. trismus (jaw locking), difficulty swallowing, posture of opistotonus, muscle stiffness, spasms persist for 3-4 weeks; Full recovery may take months.
Local tetanus: There is rigidity in muscle groups close to the site of injury; rigidity is mild. The muscles involved are painful. Partial immunity to tetanospasm may prevent hematogenous spread of toxin and prevent the disease from converting into a generalized form. Unless antitoxin is given, there is a risk of local tetanus turning into a generalized form.
Cephalic tetanus: A rare form of tetanus after head injuries and ear infections. It develops in the muscles innervated by the head nerves. Ophthalmoplegic tetanus may be seen in the form of lower motor neuron lesions due to weakness and paralysis of the facial nerve, difficulty in swallowing, and involvement of extraocular muscles. Cephalic tetanus is severe.
Neonatal tetanus: develops as a result of infection of the umbilical cord that has been cut under inappropriate conditions. Lack of sufficient immunity of the mother is also effective. It develops within the first 12-14 days after birth. Sucking and feeding difficulties, muscle stiffness and spasm are seen late. The mortality rate is very high in infants younger than 10 days that develop in less than 5 days. Apnea is the main cause of death in the first week. Sepsis causes death in the second week.
What should be done for diagnosis: Diagnosis is made with clinical symptoms. Laboratory findings and bacteriological examinations are useless for diagnosis. Wound displacement culture and staining do not yield results.
Under intensive care support; wound care, antitoxin administration, treatment of muscle spasms, monitoring and control of autonomic dysfunction, antibiotic therapy.
First, the patient is taken to a dim, calm and quiet room. Sound and noise stimuli are tried to be kept away.
Benzodiazepines, which are GABA agonists, are used to ensure continuity of preventive measures against muscle spasms. Diazepem and long-acting lorezepem are the most commonly used drugs. When diazepem is administered slowly (250 mg / day or more) intravenously, spasms are prevented. In cases where these are insufficient, neuromuscular blockade should be provided by administering vecuronium (6-8 mg / hour).
In the first 24 hours for immunotherapy 500 UI human immune globulin IM. Applied. 0.5 ml Tetanus toxoid vaccine is administered separately.
Tetanus effective antimicrobial drugs are used in the wound site. metronidazole 500 mg IV every 6 hours is administered for 7 - 10 days.
If necessary, debridement of the wound site is provided.
The necessary carbohydrates and proteins are given enterally and parenterally by taking precautions that will not create contractions for feeding. Psychotherapy is applied to patients when necessary.
What should be considered after treatment:
The second tetanus vaccine is administered before the patient is discharged. After 4 weeks, the third vaccine is administered and active immunization is achieved. Physical therapy may be needed when spasms disappear. Most patients receive psychological treatment.
In the event of any injury, the patient is decided according to the condition of the wound by prior immunization and immunization. The wound is thoroughly washed with soapy water and oxygenated water, if any foreign objects are thoroughly cleaned.
Passive and active immunization should be used together in individuals who have no or no previous active immunization.
In cases of immunoprophylaxis injury, 5 to 5 years of immunization and immunodeficiency, 250-500 UI of human tetanus immune globulin is performed and active immunization is applied. Antibiotic prophylaxis is applied in all cases to prevent infection as well as wound cleaning.
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