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19. Tetanus. Clinic. Diagnostics
Clinical manifestations. The incubation period for tetanus is 3-14 days after injury, less often - from 1 day to several months.
There are three clinical forms of tetanus:
1) local tetanus, manifested by pain, prolonged rigidity and muscle spasm proximal to the injury site, which can persist for several weeks and disappear without a trace.
2) general tetanus, usually beginning imperceptibly, but trismus can be detected in 50% of patients. Spasm of the chewing muscles is often combined with neck stiffness and difficulty swallowing. Early symptoms include anxiety, irritability, and headaches. Spasm of facial muscles causes a sardonic smile. Short tonic contractions of different muscle groups appear. The lumbar and abdominal muscle groups become rigid, spasms of the back muscles begin, leading to opisthotonus. Tetanus cramps are characterized by the sudden appearance of tonic contractions of different muscle groups, causing flexion and adduction of the arms, squeezing of the hands, and extension of the legs. Seizures are provoked by almost any visual, auditory or tactile stimulus. During the entire period of illness, the victim retains consciousness, he experiences severe pain. At the same time, there is a pronounced feeling of fear. Spasms of the muscles of the pharynx and respiratory tract can lead to closure of the airways, cause cyanosis, asphyxia.
Body temperature in patients usually increases slightly; its increase to 40 °C is explained by increased energy expenditure during convulsions. Patients experience profuse sweating, tachycardia, hypertension, and arrhythmia. During the first 3-7 days, the symptoms of the disease increase; over the next 2 weeks, the patient’s condition stabilizes. Full recovery occurs after 2-6 weeks;
3) cephalic tetanus. This is an unusual manifestation of the disease. The incubation period is 1-2 days. The most characteristic symptoms of the disease include dysfunction of the III, IV, VII, IX, X and XI pairs of cranial nerves. Most often, the VII pair (facial nerve) is involved in the process. Neonatal tetanus usually begins in a child aged 3-10 days and occurs in a generalized form. Initially, the child's act of sucking is disrupted, anxiety and severe crying appear. Swallowing problems soon develop, muscle rigidity appears, and convulsions begin.
Diagnosis. Diagnosis of tetanus is based on clinical findings. Determination of tetanus bacilli in swabs from wound discharge or their growth on nutrient media confirms the diagnosis of tetanus only with anamnestic and clinical data characteristic of tetanus.
Author: Pavlova N.V.
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