How does infection occur?
The spores of the pathogen are extremely stable and persist in the soil for years. They germinate where there is little oxygen: in the depths of a puncture wound, under the crust of a contaminated abrasion, in dead tissue from a burn or frostbite, in a wound from a rusty nail or splinter. Animal bites, deep scratches when gardening, gunshot wounds and crush injuries are also dangerous. Tetanus is not transmitted from person to person. The disease does not leave immunity, so even after recovery, vaccination is necessary.
- Puncture wounds, including from nails and splinters
- Wounds contaminated with soil and manure
- Burns, frostbite, crushed tissue
- Animal bites and deep scratches
- Umbilical wound in a newborn during delivery outside the hospital
- There is no person-to-person transmission
Symptoms
The time between injury and the first signs usually ranges from several days to two weeks, sometimes longer; the shorter this period, the more severe the course. The first symptom is often trismus - it is difficult to open the mouth due to spasm of the masticatory muscles. Then the spasm seizes the facial muscles, giving the face the characteristic expression of a forced smile, and spreads to the neck, back and abdomen: the muscles become hard, the back arches. Against this background, attacks of painful convulsions occur, which are provoked by bright light, loud sound, or touch. At the same time, consciousness remains clear, which makes the disease especially painful.
- Trismus - difficulty opening the mouth
- Spasm of facial muscles
- Tension in the muscles of the neck, back, abdomen
- Seizures from light, sound, touch
- Difficulty swallowing and breathing
- Sweating, rapid heartbeat, blood pressure fluctuations
- Consciousness preserved
What to do with the wound right away
The wound is washed with clean running water and soap, visible dirt and foreign bodies are removed from the surface, treated with an antiseptic and covered with a clean bandage. Deep, puncture and contaminated wounds cannot be tightly closed: they need access to air and surgical treatment. Be sure to consult a doctor if the wound is deep, caused by a rusty or dirty object, there is an animal bite, there is earth, wood chips or glass left in the wound, and also if more than six hours have passed before treatment. The doctor will evaluate the wound and vaccination status and decide on emergency prophylaxis.
- Wash the wound with soap and water
- Remove surface contaminants without going deeper into the wound
- Treat with an antiseptic and apply a clean bandage.
- Do not tape a deep puncture wound tightly
- See a doctor on the same day
- Tell your doctor the date of your last tetanus shot.
Emergency prevention and vaccinations
Tactics depend on the nature of the wound and when the person was vaccinated. If the vaccination course is completed and little time has passed since the last revaccination, additional measures are usually not required. In case of an unknown or incomplete vaccination history and a contaminated wound, a vaccine is administered, and in case of high risk, an additional tetanus immunoglobulin or serum is administered, which neutralizes the toxin before it binds to the nervous tissue. Planned protection is based on childhood vaccinations according to the calendar and revaccination of adults approximately once every ten years. For pregnant women, vaccination against tetanus is carried out on the recommendation of a doctor and also protects the newborn.
- Assessment of the wound and vaccination history by a physician
- Administration of the vaccine during an incomplete course
- Tetanus immunoglobulin or serum if high risk
- Surgical treatment of the wound
- Scheduled vaccinations for children according to the calendar
- Revaccination for adults approximately every ten years
Treatment of developed tetanus
The patient is hospitalized in the intensive care unit and placed in a darkened, quiet room, since any irritant provokes convulsions. Tetanus immunoglobulin is administered, the wound is surgically treated, and antibiotics are prescribed against the pathogen. The main direction is to control seizures and support breathing: they use drugs that relax the muscles, and, if necessary, transfer to artificial ventilation. The treatment is long-term, requires feeding through a tube, prevention of thrombosis and bedsores. Recovery takes weeks and months. After recovery, a full course of vaccination is required.
- Intensive care unit, silence and darkness
- Tetanus immunoglobulin
- Surgical debridement and antibiotics
- Anticonvulsant therapy and muscle relaxants
- Artificial ventilation if necessary
- Feeding through a tube, prevention of complications
- Vaccination after recovery