What is tetanus?
Tetanus is an acute, specific infection caused by Clostridium tetani infection, in which the tetanus bacterium invades the body, grows and multiplies, and produces toxins. Tetanus is a toxaemia. In addition, there is a special kind of tetanus, which is caused by the umbilical cord of newborns, generally 4-7 days onset, so also known as “four or six wind”, “umbilical wind”, “seven days wind” and so on.
What is the current situation of tetanus? What kind of people are prone to tetanus? Are there any geographical characteristics in the incidence of this disease?
According to the World Health Organization, about 1 million people die of tetanus each year worldwide, and the incidence is especially high among farmers. According to the Ministry of Health, the national tetanus incidence rate has increased, especially neonatal tetanus replaces epidemic meningitis B into the top five. Therefore, newborns delivered illegally and farmers are the susceptible group. The incidence of tetanus strictly speaking does not have a certain geographic location, all open injuries, all have the possibility of tetanus. Relatively speaking, it is mainly concentrated in rural areas with low awareness and level of health care and in cities with a large foreign population.
What causes tetanus?
Bacillus tetani spores are widely distributed in nature (especially in soil and human and animal feces), and generally do not cause disease; when Bacillus tetani invades the skin or mucous membrane with wounds, especially with aerobic bacteria and anaerobic bacteria infection at the same time, or when there are many necrotic tissues, soil or foreign bodies contamination of the wound and the formation of local ischemia, hypoxia and local anaerobic environment, Bacillus tetani grows and multiplies locally in the wound, producing Two kinds of exotoxins: one is spasmotoxin, which has a special affinity for nerves and acts on the anterior horn cells of the spinal cord or the neuromuscular end plate, causing the characteristic whole body transverse muscle continuous contraction or paroxysmal spasm; the other is hemolytic toxin, which can cause local tissue necrosis and myocardial damage.
What are the ways of transmission of tetanus? What factors can cause a person to develop tetanus? What factors can induce tetanus?
Tetanus bacillus is a Gram-positive anaerobic bacillus, 2-5 microns long. The bacterium is easy to be killed, and the bacillus is very resistant to the external environment, existing in the soil for several years is still infectious, need to be boiled for 1 hour, or in high-pressure steam for 10 minutes, or in a 5% solution of carbolic acid soaked in 10-12 hours, in order to kill it. Tetanus bacteria are mostly present in the intestinal tract of humans and animals, with feces and into the soil and dust, can fly with the dust, so it is widely dispersed. So the way of transmission can be thought of: first, tetanus bacillus with the dust flying into the wound; second, tetanus bacillus by the wound-causing devices, objects directly into the wound. The most common causes of tetanus are traumatic injuries and umbilical cord breakage in newborns. The prerequisite for tetanus infection is that the tetanus bacterium has invaded the human wound and that the wound is anaerobic.
What are the clinical symptoms of tetanus when a person has tetanus? What are the usual signs and symptoms?
After the incubation period, the prodromal phase: weakness, dizziness, headache, weakness in chewing, hyperreflexia, irritability, local pain, muscle pulling, twitching and tonicity, jaw tension, and difficulty in opening the mouth. Seizure phase: This may be followed by strong muscle contractions, initially in the masticatory muscles, later in the order of face, neck, back, abdomen, extremities, and finally in the diaphragm and intercostal muscles. If the facial muscles spasm, the patient will have difficulty in opening the mouth and closing the teeth; if the expression muscles spasm, the patient will have a “bitter smile”; if the back muscles spasm, the head will be tilted back and the so-called “corkscrew” will appear; if the respiratory muscles spasm occurs, it can cause respiratory arrest.
This generalized muscle spasm lasts for a variable period of time and recurs at intervals. It can be triggered by any slight stimulus such as light, sound, talking, or blowing wind. The patient is always clear and does not feel abnormal. There is usually no high fever.
How is tetanus diagnosed clinically? Are there any simple clinical criteria for diagnosis?
1. Inquire in detail about the history of trauma and surgery, the time and place of injury, the treatment after injury, the time of onset, the development of the disease, and the history of tetanus vaccination; for female patients, the history of delivery or abortion should be inquired in detail; in the case of newborns, the history of delivery and the treatment of the umbilical cord should be inquired. Only in a very few cases, there is no clear history of injury, and no obvious trauma is seen.
2.Check the injury site, the condition of the wound, whether there is spasm and twitching of the muscles around the wound, and pay attention to whether the rectus abdominis muscle is tonic.
3.Observe whether the patient has closed teeth, paroxysmal twitching, bitter smile, coracoacusis, generalized tonicity and paroxysmal spasm, pay special attention to whether the airway is open and whether there is laryngeal spasm.
Early detection method of tetanus? How can we find out if a patient is infected with tetanus bacillus at an early stage?
For tetanus patients, the key to resuscitation is early detection.
The early symptom of tetanus is muscle spasm, which is often referred to as “cramps”. The earliest symptom of most patients is facial muscle spasm, which is mainly manifested by the inability to open the mouth, chewing food, the muscle spasm pain in front of both ears. Many patients go to the dentist mistaking it for dental disease. The more you ask the patient to open the mouth, the more the patient can not open, and even the more closed the tighter. At this time, if a little negligence, not to be delayed, but if you have the knowledge of this diagnosis, think of tetanus and timely treatment, most can be cured. Once the whole body muscle spasms and twitching, and then turn to think about tetanus, the prognosis is very bad.
The early diagnosis of tetanus is the tongue compression test method. The test method is: for tetanus suspected patients, a tongue depressor or other disinfected smooth small wooden board, or even chopsticks, spoons, etc., gently placed in the middle of its mouth tongue, force down the pressure. If the patient immediately appears to close his teeth and bite the tongue depressor, which is not easy to pull out, it is positive and can be judged as an early manifestation of tetanus. These individuals will all develop typical tetanus symptoms within 4-30 hours.
What do I need to pay attention to when giving tetanus vaccination to pediatric patients? What type of pediatric patients should not be given tetanus vaccine?
Parents should give their children a bath and a change of clean clothes before vaccination and tell the doctor about the health condition of the child, and only after the doctor’s examination that there is no “contraindication” to vaccination, avoid strenuous activities after vaccination and pay attention to observation: if there is often local redness and pain after injection, there may be mild fever and general discomfort within two days. There may be mild fever and general discomfort for two days, and occasional loss of appetite, vomiting, and mild dysentery, which usually recover in 2-3 days. If the fever is 38.5℃ or above, please give your baby fever-reducing medicine. If the fever is 39.5℃ or above, you should take your baby to the doctor as soon as possible. People with central nervous system diseases, such as encephalopathy, epilepsy, etc., or with a past medical history, as well as those who belong to the allergic group, should not be vaccinated.
Can pregnant women receive tetanus vaccination?
Pregnant women who are not immune should receive tetanus toxoid or tetanus vaccine in time to prevent infection. The toxoid injection will produce antibodies, which will also protect the newborn, so it can be said that one person will benefit from the injection for two.
Is facial palsy related to tetanus?
Facial palsy, also known as orofacial palsy, is a very common disease in China and can be divided into two types, central facial palsy and peripheral facial palsy, depending on the patient’s pathogenic factors. The most common is peripheral facial palsy, which is mainly caused by nerve irritation. Most of the peripheral facial palsy is caused by wind blowing. Viral facial palsy develops mostly due to cut viral infections, such as otitis media. If mood swings, shock, cold, long-term fatigue, etc. occur, the patient’s condition can be aggravated, and it can be cured with regular and early treatment. Facial palsy occurs in about 3-4% of patients with tetanus from head injury.