Tetanus-what is tetanus?
Tetanus is acute tetanus clostridial wound infections, toxic infectious diseases. The tetanus bacteria and their toxins invade normal skin and mucous membranes, so tetanus after injury. All open injury may have occurred tetanus.
Tetanus (tetanus) are breeding to produce temporary functional changes of the central nervous system caused by the exotoxin of tetanus bacilli in the purulent infection of the wound. The clinical manifestations of tetanus persistent tonic and clonic spasm can occur in severe laryngeal spasm of suffocation, lung infection and failure for the whole body skeletal muscle. The tetanus bacteria invade wounds in hypoxic conditions (Clostridium tetani is an obligate anaerobes) will be able to multiply rapidly and produce toxins in the local. [Tetanus is a preventable disease, with emphasis on the prevention of tetanus, the use of effective preventive measures can greatly reduce the incidence of tetanus.
Tetanus - classificationTetanus, Clostridium "A33", "neonatal tetanus"X01 "A33.", "Neonatal tetanus""A34," "obstetrical tetanus"A34, X51 Computer Microprocessors "," postpartum (puerperal) (childbirth) tetanus. "A34, X52 "," tetanus associated with miscarriage or ectopic pregnancy"A35", "tetanus"A35. X01 "," tetanus in other aspects of unspecified "X51 Computer Microprocessors "A35.", "Ankylosing tetanusTetanus - etiologyTetanus is a longer history of Clostridium infection tetanus (Clostridiumtetani) into the human body wounds, growth and reproduction, and produce the toxin can cause an acute specific infection. The tetanus bacteria and their toxins can not invade normal skin and mucous membranes, tetanus is often the trauma associated with a specific infection, in addition may occur in a variety of post-traumatic, but also may occur in unclean conditions, birth mothers and newborns. Bacteria tetanus, Clostridium, obligate anaerobic, Gram stain-positive. Usually present in the intestines of humans and animals, excreted with the feces, Bacillus state is distributed in nature, especially in the soil is common. The bacteria on the environment has a strong resistance, the ability to boil.Traumatic wound contamination rate is high, up to 25% ~ 80% contamination rate in the battlefield. 1% to 2% of the incidence of tetanus only polluters, suggesting that incidence must be other factors, the main factor is the hypoxic environment.Trauma, tetanus, Clostridium may contaminate deep tissue (eg, blind tubes trauma, deep stab wounds, etc.). If the wound is smaller outside the mouth, the necrotic tissue within the wound, blood clots, fill, or packing too tight, and ischemia, the formation of a hypoxic environment for the growth of this breed. If both the aerobic infection, which will consume the residual oxygen within the wound, and more prone to the disease.Tetanus - pathological analysisTetanus spasm toxin in a hypoxic environment, tetanus, Clostridium spores and development of the adenoids, multiply rapidly and produce large amounts of exotoxin, mainly spasm toxins give rise to a series of clinical symptoms and signs. Bacteria and its toxin, the local does not cause significant pathological changes, wound or even no significant acute inflammation or may be healed. Spasm toxin absorption to the spinal cord, brain stem, etc., contact the synapses of nerve cells, inhibit synaptic release of inhibitory transfer medium. Motor neurons lost central inhibition enhanced excitability, resulting in involuntary muscle tension and spasm. Tetanus toxin can also block the spinal cord of the sympathetic nervous system suppression, resulting in sympathetic overactivity, caused by high blood pressure, heart rate, elevated body temperature, spontaneous perspiration.Tetanus - clinical performanceTetanus - the incubation periodThe incubation period of tetanus an average of 6 to 10 days, also shorter than 24 hours or as long as 20 to 30, or even months, or only in removal of foreign bodies such as retention of the body for many years before occurrence of tetanus after a bullet or shrapnel. Neonatal tetanus is generally around 7 days off the umbilical cord disease, it is commonly known as the "seven wind. In general, the duration of the incubation period or prodromal symptoms, the shorter, the more serious symptoms, the higher the mortality.Tetanus - the incidence of symptomsPatients first, fatigue, dizziness, headache, masseter muscle tension soreness, restlessness, yawning and other prodromal symptoms.The prodrome usually lasts 12 to 24 hours, then the typical muscle contraction strongly, initially the masseter muscle, after the sequence of facial muscles, neck muscles, back of the abdominal muscles, limb muscles, diaphragm and intercostal muscles.The patient began to feel the chewing inconvenience, trismus, followed by trismus; facial expression muscles paroxysmal spasm, so that the patient has a unique "smile" expression.Neck muscle spasm, stiff neck, head slightly to the back, can not do the nodding action. Back contraction of the abdominal muscles at the same time, but the back muscles stronger, so that the lumbar lordosis, head and foot flexion, the formation of the dorsal arch, known as "opisthotonos" shape.Powerful extensor of flexor by tetanus limbs, muscle contraction, limb can occur knees, elbow, half-fist gesture. On the basis of the sustained tension of contraction, any slight stimulation, such as light, sound, vibration or touch the patient's body, can induce whole body muscle spasms and convulsions. Each episode lasted a few seconds to a few minutes, the patient looking cyanosis, shortness of breath, froth at the mouth, salivation, bruxism, head back frequently, limbs twitching more than body sweating, very painful. During the onset of intermittent pain subsides a little, but the muscle is still not completely relaxed.Intense muscle cramps, and sometimes can make the muscle rupture, or even fracture. Bladder the hand sphincter spasm can also cause urinary retention. Persistent respiratory muscles and diaphragm spasm that can cause respiratory arrest, resulting in the patient's death. Disease during the patient mind always clear, generally without fever. The emergence of high fever often suggesting the occurrence of pneumonia.Course of the disease is generally 3 to 4 weeks. Since the second week, with the extension of the course, the symptoms gradually lessened. But recovered after a long period of time, some muscles are sometimes still the phenomenon of tension and hyperreflexia.A small number of patients present with local tetanus. The only injury sustained pregnant tonic muscles, a few weeks to several months, then gradually subside. But sometimes also the development of generalized tetanus. Better prognosis of local tetanus.ComplicationIn addition to fracture, urinary retention, choking, and breathing to stop, but can still occur, the following complications:Respiratory complications as difficulty breathing, choking is a major cause of death. On this basis, expectoration difficulties, respiratory poor, Yi secondary pulmonary atelectasis and pneumonia.2, water and electrolyte imbalance in the respiratory tract is poor, hypoventilation may cause respiratory acidosis. Muscle spasm, hypoxia and fasting in vivo metabolic insufficiency, acidic metabolites siltation, resulting in metabolic acidosis. Due to lack of difficulty in feeding and supplement often hypokalemia caused by bloating. And sweating may also add to the ion imbalance.3, hypoxia, poisoning, can occur tachycardia, it takes too long can lead to heart failure, and even shock or cardiac arrest.Neurological symptoms mainlyA muscle spasm, and cranial nerve palsyThe early clinical symptoms: the masseter muscle spasm, trismus, due to the expression of muscle tightening, the face was the smile face. The majority of patients due to muscle spasm attack or ankylosing convulsions showed opisthotonus, laryngospasm, respiratory difficulties, or even suffocation. Vaccinated with tetanus toxoid or patients infected with the lighter, the short term, produce spasm of the limitations or miscarriage, or the local or the twitch of a limb. Tetanus, about 3% to 4% of patients with head injuries, the occurrence of facial paralysis, facial muscle spasm associated with contralateral, but rarely III, VI, VII cranial nerve at the expense of2, the central nervous system dysfunctionHeavy often appear a series of symptoms and signs, and that sympathetic hyperfunction. V. patients with palpitations, sweating, increased body temperature, pale distal limbs, blood pressure, especially systolic blood pressure; increased catecholamine excretion in the urine, high blood sugar.Tetanus - diagnosisLaboratory examination of pyogenic bacteria, Clostridium tetani be seen that the total number of leukocytes and neutrophils, cells with mild increased. The anaerobic culture Clostridium tetani. Wound pus culture can nurture today aureus or E. coli.DiagnosisPatients with open injury, infection, or neonatal umbilical cord disinfection strictly, puerperal infection, history of surgery.(2) the performance of the prodromal period fatigue, headache, tongue stiff, not comfortable swallowing inconvenience and head and neck rotation.Typical muscle persistent tonic contraction and convulsive fits, first appeared chewing inconvenience, masticatory muscle tension, pain, stiffness, difficulty in opening mouth, smile face, difficulty swallowing, neck stiffness, opisthotonus, difficulty breathing, tension , or even suffocation.4 mild irritation (light, wind, sound and vibration, etc.), can induce epileptic seizures.Local type tetanus, tonic contraction of the muscle is limited in wounds near the injured limb, usually long incubation period, mild symptoms, the prognosis is good.Differential diagnosisA purulent meningitis. Although "opisthotonos" shape and neck stiffness and other symptoms, but no paroxysmal spasms, the patient had severe headache, high fever vomiting, consciousness is sometimes unclear, CSF pressure increased, the increase in white blood cell count.(2) rabies. Mad dog cat bite history, to the swallowing muscles twitch, pharynx muscle stress enhanced patient heard the sound of water or visible water pharyngeal bone immediately spasm, pain drink plenty of water can not swallow and profuse saliva.(3) other. Such as the temporomandibular jaw arthritis, eclampsia, hysteria.InspectionPatients with open injury, infection, or neonatal umbilical cord disinfection strictly, puerperal infection, history of surgery.(2) the performance of the prodromal period fatigue, headache, tongue stiff, not comfortable swallowing inconvenience and head and neck rotation.Typical muscle persistent tonic contraction and convulsive fits, first appeared chewing inconvenience, masticatory muscle tension, pain, stiffness, difficulty in opening mouth, smile face, difficulty swallowing, neck stiffness, opisthotonus, difficulty breathing, tension , or even suffocation.4 mild irritation (light, wind, sound and vibration, etc.), can induce epileptic seizures.Local type tetanus, tonic contraction of the muscle is limited in wounds near the injured limb, usually long incubation period, mild symptoms, the prognosis is good.Clostridium tetani in the wound of local growth, reproduction, exotoxin produced by tetanus is caused by reasons. Exotoxin spasm toxin and hemolytic toxin two, the former is the main cause symptoms toxins have a special affinity nerve, which can cause muscle spasms; the latter can cause local tissue necrosis and myocardial damage. The tetanus spasm toxins from the blood circulation and lymphatic system, together with co-serum globulin to reach the spinal cord anterior horn gray matter or brainstem motor nucleus to reach the central nervous system toxins, synaptic membrane in the gray matter ganglion glycosides fat, so that it can not release the inhibitory neurotransmitter (glycine or aminobutyric acid), so that α motor neuron loss of normal inhibition, causing tension of the body of the characteristics of the striated muscle contraction or clonic spasm. The toxins can also affect the sympathetic nerve, causing sweating, unstable blood pressure and heart rate growth. Tetanus is a toxemia.Assistant examinationTetanus only in accordance with the check box to limit the "A" can be.Tetanus - first aid methodsJudgmentA history of trauma, had a traumatic history of infection, even a little wound or wound healing, childbirth, abortion, surgical, confinements strict disinfection can be caused by the break.The initial patient difficulty in opening mouth, anxiety, headache, dizziness, and fatigue. Worse muscle tonic spasm, trismus, was the smile face, neck, trunk, lower extremity muscle spasm, there waist on the very bow neck known as "opisthotonos" phenomenon. Stimulation of the severe cases, the case of sound, light, ring, dysphagia, choking. May also occur in the muscle tear, joint dislocation, fracture, and tongue bite.3, the incubation period of patients over 10 days, the onset is slow, attack about 3 times a day, prompt treatment prognosis is good. If the incubation period is not more than 7 days within 3 days, frequent seizures, the number of symptom onset, suggesting a poor prognosis.First aid1, patients live in indoor quiet, warm, to avoid the sound, light, wind and other ring. Personal care, fall prevention bumps.Deep wound around the first 1 to 2 million units of tetanus antitoxin (ideal is 250 to 500 units of intramuscular injection of tetanus immune globulin) closed after injection, and then wound the soil of foreign bodies, necrotic tissue, the bone is completely cleaned up non-closure of open wounds. With 3% hydrogen peroxide or 1:1000 potassium permanganate and strive to the upper reaches of the solution repeatedly washed.3, immediately intramuscular injection of tetanus antitoxin (TAT) to 30,000 international units, neonatal injection of 500 international units (before the injection should be done allergy tests). The earlier the injection the more and travel rate of tetanus exotoxin.4, the speed was conveyed to hospital or call for help medical staff came to symptomatic treatment.5, the most reliable prevention of tetanus is tetanus toxoid. Children with whooping cough, diphtheria, tetanus vaccination, to ensure that 5 to 10 years not this glass.
Tetanus - TreatmentTetanus immune globulin tetanus is a very serious disease, to take an active comprehensive treatment measures, including the source of the elimination of toxins, and free of toxins, control and spasm, maintain airway patency and prevention of complications. The tetanus disability rate of about 10%.(A) to eliminate the toxin source (treating wounds): wounds need to be under the control of spasms, thorough debridement. Removal of necrotic tissue and foreign body, open wound in order to facilitate drainage, and 3% hydrogen peroxide or 1:1000 potassium permanganate dissolved rinse and often wet dressing. Such as the original wound has healed, you generally do not need debridement in the onset.(B) the use of tetanus antitoxin and free of toxins: Due to the toxin of tetanus antitoxin and human tetanus immune globulin no and in combination with nerve tissue, so as soon as possible to use, and free of toxins. General use by adding 5% glucose solution 500 ~ 1000ml 20000 to 50000 IU antitoxin by the intravenous slow trickle: the dose should not be too large, so as not to cause a serum response. Debridement is not thorough enough patients and seriously ill patients, after a day and then 10 000 to 20 000 IU of antitoxin, for intramuscular or intravenous infusion of 3 to 5 days. Neonatal tetanus 20 000 IU of antitoxin available, in addition, for Cullen injected by intravenous drip. There will antitoxin 5000 ~ 1000 IU for the treatment of subarachnoid injection method that enables anti-toxin directly into the brain tissue, the effect is good, and can no longer systemic antitoxin. Such as at the same time plus prednisolone 12.5mg, can reduce the inflammation and edema of the reaction caused by this injection. If human tetanus immune globulin, or auto-immune serum, instead of tetanus antitoxin. Human tetanus immune globulin is generally a single injection of a dose of 3000 ~ 6000U.(C) control and relieve spasm: the patient should live in a single ward, the environment should be quiet, to prevent the photoacoustic stimulation. Attention to prevent the occurrence of the attached bed or pressure sores. Control and spasm is a very important part of the course of treatment if they can do, to a large extent, prevent the occurrence of asphyxia and lung infection, and reduce deaths.A mild, use of tranquilizers and sleeping pills to reduce the sensitivity of patients to external stimuli. But avoid using large doses in order to avoid patients with deep coma. Diazepam (5mg oral, 10mg intravenous injection of 3 to 4 times daily) to control and relieve spasm, the better. Can also be used pentobarbital sodium (0.1 to 0.2g, intramuscular injection) or 10% chloral hydrate (15ml oral or 20 ~ 40ml rectal infusion, 3 times daily).2, severe illness, can be used chlorpromazine 50 ~ 100mg, 5% glucose solution 250ml intravenous slow trickle, 4 times a day.3, severe convulsions, and even not for the treatment and care available thiopental 0.5g for intramuscular injection (to be alert to the occurrence of laryngospasm, for the tracheotomy patients, relatively safe), paraldehyde 2 ~ 4ml intramuscular injection (paraldehyde side effects of irritation to respiratory tract and lung infections should not be used), or muscle relaxants, such as chloride amber choline chloride tubocurarine alkaline, San Juan, PR show ammonium phenol, ammonia choline (tracheotomy and controlled breathing conditions). Complicated by high fever, coma, can be added with adrenal cortex hormones: prednisone 30mg orally or hydrocortisone 200 to 400mg, intravenous infusion, day 1.(D) to prevent complications: water and electrolyte supplementation to correct the strong muscle spasms, sweating, and can not eat, cited chi, water and electrolyte metabolism disorders, such as water scarcity, acidosis. Patients with mild, they strive to feed themselves during the intermittent seizures. Severe symptoms, can not eat or poor feeding, should be under the control of anti-spasm drugs or tracheotomy tube placement tube feeding. Also can be used for total parenteral nutrition.Penicillin (800,000 to 1 million U intramuscular injection every 4 to 6 hours) inhibit the tetanus bacillus, and contribute to the prevention of infection, early use. Can also metronidazole 500mg orally, every 6 hours or 1g, rectum administered every 8 hours, last 7 to 10 days. Better than penicillin, metronidazole on the efficacy of tetanus reported in the literature. In addition, to maintain airway patency convulsions frequent and patients with difficult to control with drugs, sharp early for tracheotomy should be equipped with suction, artificial respiration and oxygen, in order to first aid; bedside.
Tetanus - preventionTetanus basic methods1, the correct handling of the wound. General wound with tap water or well water outside the wound mud, gray rinse. Conditional, and can be wound coated with a disinfectant such as iodine, and then the superstructure of a clean cloth, gently bandage the wound and then to the hospital for further treatment. Wound with a clean cloth to suppress the wound, and then quickly go to the hospital for treatment.Attention to maternal health.3, vaccination.4, internal medicine.Prevention of neonatal tetanusNeonatal tetanus, also known as the "46 Style" umbilical Wind "," seven wind ", is an infection caused by Clostridium tetani from umbilical invasive disease. The leading cause of morbidity midwife when without strict sterile scissors to cut the umbilical cord, or midwife who with dirty hands, or do not pay attention to the cleaning and disinfection of the umbilicus after birth, resulting in tetanus caused by intrusion from the umbilical.The disease mostly occurs 4-6 days after birth, early disease often irritability, crying, can occur after breast pump is not tight, trismus, convulsions, eye fission, hemifacial spasm, and the emergence of frown, lift outward traction amount of mouth, wrinkled lips pursed into a smile face; neck and torso, limbs, muscle spasms, reproduction fist with both hands, arms tough, heads thrown back, showed opisthotonus-like; severe respiratory muscle spasm , lips cyanosis, or even suffocation; any slight stimulation, such as sound, light, vibration can cause seizures; the majority of patients have a fever, but can also be no heat or low heat.The disease is completely preventable.1, pregnant women should receive tetanus immunization.Midwives, childbirth should be used for the new law science.Present at the birth strict aseptic technique, attention to the cleaning of the umbilical side, is a fundamental measure to prevent the disease. In case of emergency production but have no time uses a sterile delivery kits, you can use scissors in the red-hot fire, and the umbilical cord stump to leave 4-5 cm, according to strict disinfection operations and within 24 hours of the umbilical cord, remote and then cut period of re-disinfection ligation. Proximal hydrogen peroxide solution with 1:4000 potassium permanganate solution or 3% over cleaning, apply a 2.5% iodine. At the same time, neonatal intramuscular injection of tetanus antitoxin and penicillin, can prevent infection.Tetanus - nursingThe prevention of tetanus, including auto-immunity, passive immunization and after the injury, debridement and perinatal protection.Active immunizationChina has long been the pertussis vaccine, diphtheria toxoid and tetanus toxoid mixed triple vaccine included in the child immunization. Inoculation for 3 to 5-month-old children, 1 subcutaneous injection 0.25ml, 0.5ml and 0.5ml three times an interval of 4 weeks. 2 years subcutaneous injection 0.5ml 1 and a half years old to 2 years and then revaccination 1. After every two years to enhance injection 1ml 1, before entering in order to maintain antibody levels. Did not conduct tetanus active immunization of military personnel and professional workers vulnerable, can be aluminum phosphate adsorbed purified tetanus toxoid population immunity, effective economic security. Intramuscular injection for 1 year 2 times, each 0.5ml 4 to 8 weeks apart. 2 years intramuscular injection of 0.5ml, every 5 to 10 years after booster shots 1 to maintain an effective antibody levels. An additional injection of an injury can also enhance antibody levels to reach. Tetanus toxoid immunity after vaccination success rate, few vaccination after onset. In areas with high tetanus, promoting tetanus immunization of pregnant women in late pregnancy. Method for each tetanus toxoid 0.5ml intramuscular injection, injected three times, an interval of one month, the last injection before delivery a month. This can not only maintain the parturients have higher antibody levels, but there are enough antibodies passed to the baby, to achieve effective protection of a preventive effect. World Health Organization has been widely implemented in the global children's tetanus immunization programs, basically eliminated tetanus in the world in 2000. Unfortunately, this goal is still far from being achieved. EPI monitoring reports from the United States, Britain and other countries show that tetanus protective antibodies, age and gradually decreased. Only about 60% of people who have protective antibodies in adults. Therefore, how to protect the elderly and to further universal tetanus immunization programs in developing countries is still to be done.Passive immunizationMainly for not tetanus autoimmune wounded. The tetanus antitoxin the TAT. 1000 ~ 2000U injection. Injection of skin test before, such as the skin test positive should be changed to give the points of the desensitization injections. Can be maintained for the protection of about 10 days after injection. Can the employer tetanus immune globulin HTIG500 ~ 1000U intramuscular injection, can be maintained for three to four weeks of the period of protection. In order to strengthen the protective effect, it is best to start building the active immunization. After passive immunization, may still be some people the disease, but usually a long incubation period, the condition is also lighter.
Wound treatmentTimely and thorough wound debridement and treatment, can effectively prevent infection and reproduction of the tetanus bacteria. Including strict disinfection, have a positive preventive effect of maternal birth process. In addition, such as deep wounds or serious pollution, as soon as possible the choice of appropriate antibiotics to prevent and control infection. General idea of the injured in 6h application of the best course of 3 to 5 days. The main purpose of the control of aerobic pyogenic bacteria infection, and thus avoid causing anaerobic micro-environment, to achieve the purpose of control and prevention of tetanus, Clostridium growth and reproduction.Now learning to use the passive immunization method is refined from the injected animal (cow or horse) serum tetanus antitoxin (TAT). It is a foreign protein, antigenicity, can cause allergic reactions, but not long remain in human memory, after 6 by the body to remove. Therefore, the tetanus antitoxin is not ideal. The ideal products of human tetanus immune globulin, allergic reactions, injection lifetime of 4 to 5 weeks in the human body, the immune rural than the tetanus toxin in more than 10 times. Preventive dose of 250 ~ 500U, intramuscular injection. Human tetanus immune protein sources less complex preparation, the case is still not widely applied, the injection of tetanus antitoxin is still a major passive immunization.
Injury as soon as possible after the intramuscular injection of the tetanus antibiotics 1 500 IU (1ml). Serious wound contamination or injured more than 12 hours, the dose may be doubled. The same dose of adults and children. If necessary, in 2 to 3 days after injection.
Before each injection of antitoxin should be asked whether a history of allergies, and for intradermal allergy test: 0.1ml anti-toxins, plus isotonic saline diluted to 1ml. Injection in the forearm flexor dough dilution liquid 0.1ml; another in the same parts of the contralateral forearm, such as flushing, lumps, slightly elevated compared to positive should be carried out desensitization injections. However, this method can not completely avoid an allergic reaction occurs, it is best do not have this anti-toxin injection. Desensitization injections Antitoxin 1ml isotonic saline was diluted 10 times divided into 1, 2, 3, 4 ml, followed by subcutaneous injection once every half hour. Observe whether the reaction after each injection. If a patient occurred pale face, weakness, hives or skin itching, sneezing, coughing, joint pain and even shock those who should be immediately subcutaneous ephedrine 50mg or epinephrine 1mg (adult dose), and stop the anti-toxin injection.
