Symptoms of tetanus

Tetanus has an incubation period, which is from 1 to 31 days (an average of 1-2 weeks), i.e. Symptoms of tetanus with minor injuries (splinter, rubbing, etc.) occur after their complete healing. It is proved that the shorter the incubation period, the more severe the disease.

By the severity of the flow, a mild, moderate, severe and very severe form of the disease is isolated. The prevalence of the process distinguishes between generalized and local tetanus.

The onset of the disease depends on the severity of its course. The more severe the disease, the faster the symptoms of tetanus unfold. In some cases, prodromal phenomena are possible in the form of general malaise, feelings of stiffness, difficulty in swallowing, cognition, irritability. In the area of the entrance gate, more often the limb, dull pulling pains appear, fibrillar twitching of the muscles.

The first symptom with an important diagnostic significance is trism - the tonic tension of the masticatory muscles, which first obstructs the opening of the mouth, and then makes it impossible to open the teeth. At the very beginning of the disease, this symptom can be identified by a special technique: tapping on a spatula resting on the teeth of the lower jaw provokes a reduction in the masticatory muscle. Further, the increase in muscle tone extends to the facial muscles, facial features distorted, wrinkles appear on the forehead and around the eyes, the mouth stretches, its corners drop or rise, giving the face a distinctive expression of both crying and an ironic smile (sardonic smile, risus sardonicus). Almost simultaneously, dysphagia appears - difficulty swallowing due to spasm of the swallowing muscles. Trism, a sardonic smile and dysphagia are the symptoms of tetanus, which are not found in severe diseases and allows early diagnosis of tetanus.

Within two to four days, the tone of the muscles of the occiput, back, abdomen, and proximal parts of the extremities, especially the lower ones, increases. Hypertonus spreads in a descending type. There is stiff neck muscles, the patient's body assumes bizarre postures, often the patients lie on their backs, touching the bed only with the back of the head and with the heels (opisthotonus), rarely the trunk is bent forward (emprostotonus) with the abdominal press strongly developed. There is a complete stiffness, the possibility of movement is preserved only in the hands and feet, the muscles of which increase in tone does not spread, which has differential diagnostic value.

Tonic tension captures intercostal muscles, a diaphragm and a vocal cavity, resulting in a decrease in the minute volume of respiration, hypoxia and hypercapnia occur. Features of the defeat of the muscular system in tetanus are a permanent (without relaxation) hypertension of muscles, involvement = the process of only large muscles of the limbs, pronounced muscular pains. At the height of the disease, against this background, under the influence of any tactile, auditory stimuli (even insignificant in strength), there are common tetanic convulsions lasting from a few seconds to 1 minute.

It should be emphasized that generalized tetanic cramps differ from clonic ones in that the muscles do not relax after an attack. Cramps are extremely painful, during the attack there are cyanosis, hypersalivation, tachycardia, sweating is increased, blood pressure rises. It is difficult to urinate and defecate due to spasm of the muscles of the perineum. During the attack, death from asystole may occur, asphyxia, aspiration of the contents of the oropharynx, muscle rupture, tendon rupture, fracture of bones may occur.

Body temperature in uncomplicated cases is normal or subfebrile. In severe, hyperthermia is possible. As a result of the disturbed act of swallowing, fasting and dehydration, promoted by increased sweating, occur. Hyperthermia and hypersalivation. From the side of the cardiovascular system, tachycardia is noted, an increase in blood pressure. As the disease progresses, the deafness of heart sounds increases, and arrhythmia arises.

There are no specific changes from internal organs. Consciousness remains clear throughout the course of the disease. Patients are worried about persistent insomnia. The mild form of tetanus is infrequent, mainly in individuals with partial immunity. Moreover, the incubation period exceeds 20 days. The classic symptoms of tetanus are poorly expressed. Muscular tone increases gradually within 5-6 days, hypertonicity is expressed moderately, patients have the opportunity to drink and eat. Seizures are either absent at all, or occur several times during the day. Body temperature is normal or subfebrile, tachycardia is rarely detected. Duration of the disease - up to 2 weeks.

With an average form, the incubation period is 15-20 days, the symptoms of tetanus grow more rapidly - 3-4 days. The moderate form of the disease is characterized by the defeat of muscles with typical symptoms, tachycardia and a rise in body temperature to 38-39 ° C. The frequency of seizures does not exceed 1-2 times per hour, and their duration is not more than 15-30 seconds. There are no complications, and the duration of the acute period of the disease is up to 3 weeks.

For a severe form, the shorter incubation period is 7-14 days, the symptoms of the disease grow rapidly (within 2 days), seizures are frequent, prolonged, body temperature up to 40 ° C. In very severe form, the incubation does not exceed 7 days. Within a day from the onset of the disease all symptoms reach full development. Seizures are accompanied by signs of asphyxia, body temperature rises to 40-42 ° C. With the development of convulsive syndrome, there is a lesion of the vasomotor center (tachyarrhythmias, unstable blood pressure); as a rule, pneumonia is attached. Such forms always require intensive therapy, the period of the severe condition lasts not less than 3 weeks. With a favorable course of tetanus, seizure attacks become more and more rare and by the 3-4th week of the disease stop completely, but tonic muscle tension persists for about a week after their disappearance. Other symptoms of tetanus regress gradually. In the period of late convalescence, signs of myocardial damage (tachycardia, arrhythmia, extrasystole, cardiac tone, moderate expansion of the heart boundaries) and asthenovegetative syndrome, persisting for 1-3 months are revealed. In the absence of complications, a full recovery occurs.

There are also local tetanus, which initially causes pain and tonic tension of the muscles at the entrance gate, then local convulsions join, new muscle groups are subsequently involved, and the process is generalized. A unique variant of local tetanus is the paralytic tetanus of Rose, which occurs when injuries, head and face injuries. Against the backdrop of trism, a sardonic smile, stiffness of the occiput muscles, there appears a one-sided paresis of the facial, rarely diverting and oculomotor nerve. Spasm of pharyngeal muscle resembles a clinical picture of rabies. Often the process is generalized.

Severe headache (bulbar) tetanus of Brunner, which affects the upper parts of the spinal cord and the medulla oblongata. Death occurs as a result of paralysis of the heart or breathing.

Adverse due to frequent bacterial complications and sepsis, gynecological tetanus occurs after community-acquired abortion or childbirth.

To severe forms of the disease include tetanus of the newborns, which accounts for the bulk of cases of disease in developing countries, since in the absence of postvaccinal immunity in mothers, newborns do not have passive immunity. Violation of the rules of asepsis and antiseptics in the treatment of umbilical wound can cause infection with spores of the pathogen. The incubation period is 3-8 days. In connection with trismus the child is restless, refuses to take the breast, infringes the nipple between the gums, the act of sucking becomes impossible. Soon tetanic convulsions join, which are accompanied by screaming, tremor of the lower lip, chin and tongue, involuntary urination and defecation. During an attack, cyanosis increases, and blepharospasm appears. Characterized by a rapid drop in body weight, respiratory disorders, early accession of pneumonia and high mortality. Symptoms of tetanus unfold during the day.

The total duration of the disease with a favorable outcome does not exceed 2-4 weeks, but after 10-15 days tetanic convulsions occur less often and become less prolonged, and from the 17-18th day they stop completely. Muscle hypertension persists longer (up to 22-25 days), the last one disappears trism. Tachycardia persists for 1.5-2 months. For several months, tetanus can recover various manifestations of autonomic dysfunction. Relapses of the disease are rare. In severe cases, leukocytosis is found due to blood clotting and increased hematocrit, metabolic acidosis (lactate acidosis), hypoxemia and hypercapnia.

[1], [2], [3]

Complications of tetanus

Among complications, secondary bacterial infections are most often detected: pneumonia, pyelonephritis, sepsis, atelectasis of the lungs. When extensive wounds often against the background of tetanus, there are purulent complications in the form of abscesses and phlegmon in the area of the infection gate. The strength of muscle contraction during seizures is so great that it can cause compression fractures of vertebral bodies, detachment of muscles from attachment sites, rupture of the muscles of the anterior abdominal canal and limbs. As a result of prolonged tonic muscle tension, muscle contractures develop, which requires special treatment.

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Mortality and causes of death

A fatal outcome can occur at the height of seizures from asphyxia, which develops as a result of spasm of the muscles of the larynx and is combined with a decrease in pulmonary ventilation due to the tension of the intercostal muscles and diaphragm. Most often, the cause of death is direct damage to the brain stem, accompanied by a stopping of breathing or cessation of cardiac activity. There is also a possible lethal outcome by the end of the month that has passed since the onset of the disease, with the development of multiple organ failure.