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Tetanus

Tetanus is a serious and often fatal disease caused by the neurotoxin tetanospasmin which is produced by the Gram-positive, obligate anaerobic bacterium Clostridium tetani. Tetanus also refers to a state of muscle tension. more...

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It was first documented by Hippocrates, and records dating back to the 5th century BCE provide countless clinical observations of the disease. However, the etiology of the disease was not discovered until 1884 by Carle and Rattone. Passive tetanus immunization was first implemented during World War I.

Bacilli of C. tetani can be found in soil (especially agricultural soil), and the intestines and feces of horses, sheep, cattle, rats, dogs, cats, guinea pigs, and chickens. Spores are found in manure-treated soil, skin surfaces (of both animals and humans), under nail-beds, and in contaminated heroin.

Types

There are four different clinical forms of tetanus: local (uncommon), cephalic (rare), generalized (most common), and neonatal (a common cause of infant mortality in underdeveloped countries). Generalized tetanus accounts for 80% of tetanus cases.

Symptoms

The incubation period for tetanus is 3 days to as long as 15 weeks (with the average being about 8 days) . For neonates, the incubation period is 4 to 14 days, with 7 days being the average. Most of the time, the further the wound is from the central nervous system, the longer the incubation period. Incubation period length and likelihood of death are inversely proportional; a deep, contaminated wound that allows the bacteria to flourish and causes a quick, aggressive infection is much more life-threatening than a shallower, less-contaminated wound that causes milder symptoms to appear days or weeks later.

The first sign of tetanus is a mild jaw muscle spasm called lockjaw (trismus), followed by stiffness of the neck and back, risus sardonicus, difficulty swallowing, and muscle rigidity in the abdomen. The stiffness and spasming of muscles expands throughout the body inferiorly, and can be so powerful that they cause muscle tears and even fractures. Typical signs of tetanus include an increase in body temperature by 2 to 4°C, diaphoresis (excessive sweating), an elevated blood pressure, and an episodic rapid heart rate. Spasms and muscle contraction last for 3 to 4 weeks, and complete recovery may take months. About 30% of tetanus victims die, most of whom are elderly patients. In developing countries, the mortality rate may be as high as sixty percent.

Complications of the disease include spasms of the larynx (vocal cords), accessory muscles (chest muscles used to aid in breathing), and the diaphragm (the primary breathing muscle); fractures of long bones secondary to violent muscle spasms; and hyperactivity of the autonomic nervous system.

Treatment

The wound must be cleaned. Penicillin and metronidazole will help decrease the amount of bacteria but they have no effect on the toxin produced by the bacteria. Human anti-tetanospasmin immunoglobulin should be given. Diazepam and DTaP vaccine booster are also given.

Read more at Wikipedia.org


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A few words on diphtheria and tetanus
From Pediatrics for Parents, 6/1/04

Diphtheria is a contagious disease caused by Coryne-bacterium diphtheriae, a bacteria found in the mouth, nose, and throat of an infected person. An infection begins with a mild sore throat, a low-grade fever, neck swelling. The symptoms progress to nausea, vomiting, chills, and headache.

A gray, tough, fibrinous membrane is found stuck on the throat and tonsils. Sometimes it's so tightly stuck that removing it causes bleeding.

Complications typical of a diphtheria infection include pneumonia, swelling of the breathing tubes so severe that breathing is compromised, and respiratory failure. The child may have irregularities in the heart beat and even heart failure. Sometimes the heart itself can become infected--a condition called myocarditis.

Prevention is the best treatment. Proper immunizations eliminate the chances of coming down with diphtheria.

A person infected with diphtheria is contagious for two to four weeks. Once the diagnosis is made, the treatment begins with shots of an antitoxin. Antibiotics are an important part of the treatment. Even with adequate treatment, five to ten percent of those who become infected die.

Tetanus, also known as lockjaw, is caused by the bacteria Clostridium tetani. It enters the body through an open wound such as a cut, puncture wound, or a burn. An infection may occur after what seems like a trivial or even unapparent injury.

The bacteria, which is usually found in soil and manure. produces a toxin that can spread throughout the body. It enters the nerves and may cause painful tightening of the muscles, usually all over the body. The symptoms of tetanus include lockjaw, stiffness in the neck and abdomen, difficulty swallowing, fever, elevated blood pressure, and severe muscle spams.

Every year over 50,000 people worldwide die from tetanus. In the United States, there are about 100 cases of tetanus reported to the CDC each year. The vast majority of cases occur in unimmunized individuals or those whose last immunization was over 10 years ago.

As with any disease, the best treatment is prevention. The DTaP shot is very effective. The treatment for a person with tetanus is making sure their airway remains open so their breathing is normal. Human immune serum globulin is given to prevent the formation of new toxin. IV fluids are often needed as is sedation to lessen the muscle spasms. With proper treatment that's begun early, the chances of survival are good.

COPYRIGHT 2004 Pediatrics for Parents, Inc.
COPYRIGHT 2005 Gale Group

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