Fatal Injury

Contents

What is tetanus and why is it so dangerous?
When should you be concerned about tetanus?
Could every wound or injury be dangerous?
When to suspect tetanus?
What is tetanus treatment?
How to Avoid Getting Tetanus

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Proven content

Has it ever crossed our mind that an inconspicuous wound could be the cause of death? We get hurt many times in our lives, be it at home, on vacation or at work, and we don’t pay attention to it. Fortunately, in most of these situations, the wound heals and leaves no trace or serious consequences. However, it should be remembered that with age the risk of developing tetanus increases, which is associated with high mortality. This is due to the gradual decline in the level of protective antibodies produced by immunization.

Most people are last vaccinated against tetanus when they are 19 years old, and the protective level of antibodies lasts around 10 years. Most often, tetanus cases are observed in people over 60 years of age. In Poland, on average, about 20 cases of this disease are registered each year, of which, unfortunately, about half of them end in death. The second group with higher tetanus incidence is newborns. This problem currently concerns the so-called Third World countries and the development of the disease occurs as a result of infection of the umbilical cord stump.

What is tetanus and why is it so dangerous?

Tetanus is an infectious disease and is associated with contamination of the wound with spores of the Clostridium tetani bacteria. It is characteristic that the sick person does not infect people from the environment. When anaerobic conditions are created in the wound, the spores transform into vegetative forms of bacteria (active forms of bacteria capable of reproducing), which produce toxins.

Tetanus belongs to the so-called wound infections, and at the same time to the group of diseases known as toxicoses, because the main cause of clinical symptoms is tetanospasmine, a toxin produced by the Clostridium tetani bacteria. Tetanospazmin is a neurotoxin, i.e. it attacks our nervous system, causing disturbances in nerve conduction. Exactly the toxin penetrates from the wound to the nerve endings, where it blocks the action of the so-called inhibitory neurotransmitters: GABA and glycine. The effect of the blockade is uncontrolled, uninhibited flow of stimuli, which is manifested by increased muscle tension and increased overactivity of the nervous system.

When should you be concerned about tetanus?

As mentioned above, tetanus is a wound infection and this is the only way to develop the disease. Under natural conditions, Clostridium tetani bacteria live in the digestive tract of animals, especially horses and cattle, therefore soil enriched with natural fertilizers is the primary source of tetanus spores. Taking this into account, the most dangerous are wounds contaminated with soil and mainly injuries caused during field work, on a plot or in a garden.

Could every wound or injury be dangerous?

Of course, due to the properties of bacteria – development in strictly anaerobic conditions, the risk of developing tetanus is greatest in the case of deep, puncture, foreign body wounds, not surgically prepared or additionally infected with aerobic bacteria. On the other hand, patients’ cases show that tetanus can develop after inconspicuous injury with a rose thorn or after driving a splinter.

When to suspect tetanus?

The clinical symptoms of the disease appear on average 7 days after the injury, although they may appear after 2 days. The longer the time from the injury to the onset of clinical symptoms, the less severe the course of the disease and the better the prognosis.

A classic symptom that should arouse anxiety in association with an injury is trismus (resulting from increased tension in the masseter muscles). Another characteristic symptom is the so-called sardonic smile (mocking) – the effect of increased tension in the circular muscles of the mouth.

As the disease develops, further symptoms appear, resulting from the increased tension in the neck, chest, abdomen or lower limbs muscles. In the course of the disease, attacks of tension are characteristic, which are the result of external stimuli. Stress attacks are very dangerous and can be life-threatening. In the course of such attacks, respiratory failure, laryngospasm may occur, and the tension of the paraspinal muscles may result in a curvature of the spine with a possible fracture of the spine.

In addition, in patients with tetanus, sudden jumps in blood pressure, arrhythmias, up to stoppage, are observed. All symptoms occur while the patient is aware.

Before the appearance of the characteristic symptoms of muscle tension, the so-called the precursor period, which consists of symptoms such as: anxiety, worse well-being, increased muscle tension around the wound, increased sweating, headaches, insomnia. Depending on the brooding period of the disease and clinical symptoms, the following form of tetanus can be distinguished: light, medium-severe and severe. Diagnosis of tetanus is based on the picture of the disease and the association of symptoms with a previous injury.

In the course of tetanus, especially in the moderately severe and severe forms, bone fractures, pneumonia, renal failure due to muscle breakdown, respiratory failure, cardiac arrest, secondary bacterial infections and mental disorders may occur. These complications are the leading cause of death in tetanus patients.

What is tetanus treatment?

A patient with suspected tetanus should go to the Intensive Care Unit, where he should be placed in a dark and quiet room, so that the amount of external stimuli is as low as possible.

The basic treatment in the case of tetanus includes:

– surgical preparation of the wound, removal of dead tissue and its proper blood supply

– administration of human tetanus antitoxin

– the use of an antibiotic acting on Clostridium bacteria to eliminate them from the wound

– the use of drugs that reduce nervous tension

How to Avoid Getting Tetanus

Vaccination is the primary method of preventing tetanus. Compulsory vaccination includes three doses administered between 3 and 6 months of age. and subsequent doses of the vaccine: between 16 and 18 months of age, 6 years of age, 14 years of age and in 19 years of age

After this period, further booster doses are recommended every 10 years.

It is very important – in the case of injuries in adults – to analyze the history of tetanus vaccination. People with injuries who have been vaccinated before 5 years of age do not require a booster dose of the vaccine. A booster dose of the vaccine should be used in the case of injured persons with a time between vaccination against tetanus and tetanus within the range of 5-10 years. However, 10 years after vaccination, the injured person should have the so-called passive prophylaxis, i.e. the first dose of the vaccine and specific human anti-tetanus immunoglobulin should be administered, and then subsequent doses of tetanus vaccine should be administered in 4-6 weeks and after 6-12 months.

Additionally, in preventing tetanus, it is very important to cleanse the wound quickly.

Text: Mirosław Jawień, MD, PhD