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Tetanus


Acute infectious disease with hypertonic skeletal muscles, occasional seizures, increased excitability, symptoms of general intoxication, high mortality.
The causative agent of the disease is a large anaerobic bacillus. This form of the microorganism is capable of producing the strongest toxin (poison) that causes an increase in secretion in neuromuscular compounds. The microorganism is widely distributed in nature, persists in the soil for many years. It is a frequent harmless inhabitant of the intestines of many domestic animals. The source of infection is animals, the transmission factor is soil.
Symptoms and course:
The incubation period is on average 5-14 days. The smaller it is, the harder the disease is. The disease begins with discomfort in the wound area (pulling pain, muscle twitching around the wound); possible general malaise, anxiety, irritability, loss of appetite, headache, chills, low-grade fever. Because of the cramps in the masticatory muscles (trismus), it is difficult for a patient to open his mouth, sometimes it is even impossible.
A spasm of swallowing muscles causes the appearance of a "sardonic smile" on the face, and also makes swallowing difficult. These early symptoms are characteristic only for tetanus.
Later, stiffness of the occipital muscles, long back muscles with increased back pain develops: a person is forced to lie in a typical position with his head thrown back and the lumbar part of the body raised above the bed. By 3-4 days there is tension in the abdominal muscles: the legs are extended, the movements in them are sharply limited, the movements of the arms are somewhat freer. Due to the sharp tension of the abdominal muscles and diaphragm, breathing is shallow and rapid.
Due to the contraction of the perineal muscles, urination and defecation are difficult. There are general convulsions lasting from a few seconds to a minute or more of different frequencies, often triggered by external stimuli (touching the bed, etc.). The face of the patient becomes blue and expresses suffering. Asphyxia, asphyxia, paralysis of heart activity and breathing may occur. Consciousness throughout the illness and even during convulsions saved. Tetanus is usually accompanied by fever and constant sweating (in many cases from the addition of pneumonia and even sepsis). The higher the temperature, the worse the prognosis.
If there is a positive outcome, the clinical manifestations of the disease continue for 3-4 weeks or more, but usually on the 10-12th day the state of health improves significantly. Those who have had tetanus for a long time may experience general weakness, stiffness of muscles, and weakness of cardiovascular activity.
Complications: pneumonia, muscle tear, spinal compression fracture.
Treatment of tetanus complex. 1. Surgical wound treatment. 2. Providing complete rest to the patient. 3. Neutralization of the toxin circulating in the blood. 4. Reduction or withdrawal of convulsive syndrome. 5. Prevention and treatment of complications, especially pneumonia and sepsis. 6. Maintenance of normal gas composition of blood, acid-base and water-electrolyte balances. 7. Fight against hyperthermia. 8. Maintain adequate cardiovascular activity. 9. Improve ventilation of the lungs. 10. Proper nutrition of the patient. Ii. Control over the functions of the body, careful patient care.
Conduct a radical excision of the wound edges, creating a good outflow, with prophylactic purposes prescribed antibiotics (benzylpenicillin, oxytetracycline). Unvaccinated conduct active-passive prophylaxis (APP) by introducing into different parts of the body 20 U of tetanus toxoid and 3000 IU of tetanus toxoid. Only 10 U of tetanus toxoid are administered to vaccinated persons. Recently, a specific gammaglobulin obtained from donors has been used (the dose of the drug for prophylaxis is 3 ml intramuscularly once, for treatment b 6 ml once). Adsorbed tetanus toxoid is administered intramuscularly 3 times in 0.5 ml every 3-5 days. All of these drugs serve as a means of influencing the toxin circulating in the blood. Central to the intensive care of tetanus is the reduction or complete removal of tonic and tetanic seizures. For this purpose, peyroleptics (aminazin, prolazil, droperidol) and tranquilizers are used. To eliminate seizures in severe form use muscle relaxants (tubarip, diplacin). Treatment of respiratory failure is provided by well-developed methods of respiratory resuscitation.
Forecast. Mortality in tetanus is very high, the prognosis is serious.
Prevention:
Routine immunization of the population with tetanus toxoid. Prevention of occupational and household injuries.