PSYchology
Tetanus in adults is quite rare, but can lead to serious consequences and even death if you do not seek medical help in time. We will tell you how to avoid infection and how to recognize the first symptoms of the disease.

Tetanus is a very dangerous, although not very common disease. It is not difficult to prevent, but it can be difficult to cure even with the capabilities of modern medicine. According to WHO, the mortality rate from tetanus among unvaccinated people can reach 80-100% if medical care is not provided on time.

Our experts, bacteriologist Valeria Gazina and science adviser of the Nacimbio holding of Rostec State Corporation Igor Nikitin, told how you can get tetanus, how dangerous this disease is for adults, and also advised preventive measures and explained what to do in case of infection.

What is tetanus

Tetanus is an acute infectious disease that affects the central and autonomic nervous system. Tetanus is accompanied by severe convulsions in different parts of the body, disrupts the functioning of internal organs and can provoke cardiac and respiratory arrest. In this case, the disease is non-contagious, that is, it is not transmitted from person to person.

causative agents of tetanus in adults

The causative agent of tetanus in adults and children is the same – the anaerobic bacterium Clostridium tetani or tetanus bacillus. Clostridium tetani spores can live in soil and shallow stagnant water, on vegetables and plants, on wire, nails and other metal objects.1. Tetanus bacillus is found everywhere, but feels most comfortable in regions with a hot and humid climate.1.

Tetanus bacillus spores are not afraid of sunlight, antiseptics and high temperatures, so they can persist in the external environment for years1. Once in suitable conditions, spores turn into vegetative cells and begin to produce the strongest toxins. It is the toxins that affect the central and peripheral nervous system of a person and cause severe consequences.

Causes of tetanus in adults

Domestic and industrial injuries are the most common causes of tetanus in adults. Tetanus bacillus spores can enter the body through the wound surface, which appeared as a result of a cut, burn, splinter, frostbite2.

Stab wounds of the feet are very dangerous, especially if a person walks barefoot. Soil contaminated with tetanus bacillus easily enters such wounds. No wonder tetanus is called “barefoot disease”2, and the risk group includes people who are engaged in agriculture. The tetanus bacillus multiplies rapidly in wounds under the nails, where there is no oxygen access. These injuries are usually caused by a needle stick.

The cause of tetanus in adults can also be a surgical wound, abscess, gangrene, trophic ulcers, injuries and inflammatory diseases of the middle ear.2. Tetanus is often contracted by women during criminal abortions, as well as people who were injected in non-sterile conditions.3.

From the moment of infection to the first symptoms of tetanus in adults, on average, it takes from 1 to 21 days. The shorter the incubation period, the more severe the disease3. In fulminant tetanus, the incubation period is less than two days, and death can occur 6 to 7 hours after the onset of symptoms.2.

Symptoms of tetanus in adults

The first symptoms of tetanus in adults are non-specific, that is, inherent in many diseases. An infected person may suffer from headaches, general malaise, mild muscle tension and twitching, and dull, pulling pains in the area of ​​the wound. In this case, the wound can heal and be outwardly invisible.

According to the prevalence in the body, local and general (generalized) tetanus are distinguished. With local tetanus, muscle spasms are observed at the site of injury; in general, convulsions occur in different parts of the body. Local disease is usually mild and does not cause life-threatening complications.

With generalized tetanus, after the first symptoms, other, more specific ones appear. In 80% of cases, this is “trismus” – the tension of the chewing muscles, which prevents you from opening your mouth. Then the convulsive period begins, during which patients suffer from painful contraction and prolonged muscle tension or rigidity.3.

In the midst of the disease, the diagnosis is easy to make by the appearance of the patient:

  • the occipital muscles tense up and prevent you from tilting your head, so it remains in a tilted position3;
  • a “sardonic smile” appears on the face – eyebrows are raised, and the mouth is stretched, as if a person is crying and laughing at the same time3;
  • dysphagia appears – difficulty swallowing, which causes profuse salivation.

Trismus, dysphagia, and a sardonic smile are the three classic symptoms of tetanus.3. However, these symptoms are not the only ones. If the disease develops, rigidity (hardness) extends to the muscles of the neck, abdomen, arms, and legs. Because of this, the human body arches, so that only the back of the head and heels touch the surfaces.3. This condition is called opisthotonus.3. Sometimes there are other types of this severe symptom:

  • emprostotonus, when the patient’s body “rolls up into a ball”, like an embryo;
  • elongated position in the form of a “column”;
  • pleirostonus – bending to the side.

Muscle contraction is replaced by convulsions – at first rare, and then almost continuous. The cramps are so severe that they can cause a fracture of the thoracic vertebrae. Muscle spasms disrupt the functioning of internal organs, do not allow normal breathing and swallowing. Death can occur from a violation of the heart rhythm and suffocation, which provoked a spasm of the muscles of the larynx and diaphragm.

Treatment of tetanus in adults

Treatment of tetanus in adults begins with diagnosis. In typical cases, tests and examinations are not needed, because the diagnosis can be made according to the clinical picture. In difficult cases, examine the blood, the contents of the wound and the soil to identify the pathogen.

If tetanus is suspected, the patient is urgently hospitalized in a special tetanus center or intensive care unit of any hospital. The patient is placed in a separate room, where it should be dark and quiet. If a person cannot eat on his own, he is fed through a tube.

The treatment of tetanus in adults has several goals.3:

  • Neutralize toxins and prevent their spread in the body. The wound is treated with tetanus toxoid and surgically treated.
  • Eliminate convulsions.
  • Support the vital functions of the patient in order to prevent him from dying. With a strong violation of breathing, begin artificial ventilation of the lungs.

For the specific treatment of tetanus in adults, antitetanus antitoxic serum is used. In addition to serum, the patient is injected with tetanus toxoid and donor immunoglobulin. For symptomatic treatment, apply:

  • muscle relaxants;
  • anticonvulsants;
  • analgesics;
  • antihistamines;
  • antibiotics.

With dehydration, hyperthermia (overheating) and acidosis (violation of the acid-base balance in the body), the patient is administered polyionic and colloidal solutions, albumin and plasma, and non-steroidal anti-inflammatory drugs are prescribed.

After the illness, immunity is not formed, so a person can get sick again. The only reliable protection against infection is vaccination. As a vaccine, drugs that contain tetanus toxoid are used. Usually these are complex drugs, for example, DPT-vaccine against whooping cough, diphtheria and tetanus, ADS-anatoxin and Imovax DT against diphtheria and tetanus3. Adults should receive booster doses of the vaccine every 10 years, and military personnel, construction workers and machine operators every 5 years3.

Prevention of tetanus in adults at home

For non-specific prophylaxis of tetanus in adults, you need to follow simple rules. Doctors advise to avoid damage to the skin and try to prevent dirt and dust from getting into the wounds. It is necessary to wash with soap and treat with an antiseptic any, even minor scratches and cuts, and for more serious damage, contact a traumatologist or surgeon.

Popular questions and answers

Popular questions about tetanus risk and prevention are answered by our experts: MD, science adviser of the Nacimbio holding of the Rostec State Corporation, Igor Nikitin и bacteriologist Valeria Gazina.

Where can you get tetanus?

– You can become infected as a result of a work injury or at home, for example, while working on a personal plot. Some people become infected through dental and surgical instruments in medical facilities, piercing and tattoo parlors, where sterility is not observed. There are cases when tetanus developed during purulent-inflammatory processes in the middle ear and periodontium, after root canal treatment and tooth extraction.

In a word, tetanus bacillus is everywhere. And absolutely any damage to the skin, including burns, frostbite, blisters and animal bites, is capable of opening its way into the human body.

What is the chance of contracting tetanus?

– Vaccinated people are reliably protected by a vaccine that needs to be done every 10 years. Unvaccinated people are much more at risk, especially if they have frequent contact with the ground and are easily injured. The risk group includes villagers, foresters, hunters. The chances of contracting tetanus increase if a person has diabetes and suffers from trophic ulcers on the skin. The risk of infection increases with frostbite and burns and in the elderly, even if they were vaccinated against tetanus in their youth. The fact is that over the years, immune protection inevitably decreases.

What is the prognosis for tetanus infection?

— Vaccines and modern treatments significantly reduce mortality from tetanus. But this disease is still taking human lives. To judge possible outcomes, doctors usually rate the severity of the disease on a special scale.

There are four levels of severity:

• mild form, which usually ends in recovery;

• moderate form, which takes the lives of 10-20% of patients;

• severe form – the mortality rate is from 20 to 40%;

• very severe form – in this case, the mortality rate is 50% or more, even with timely treatment.

The average mortality rates among those vaccinated, who nevertheless became infected, do not exceed 6% (taking into account the fact that they also become infected much less often), and among the unvaccinated – 15%.

When to do tetanus prophylaxis for trauma?

– Emergency immunization for tetanus is carried out within 20 days after the alleged infection3. This procedure is indicated for deep and extensive injuries, burns and frostbite of 2, 3 and 4 degrees, out-of-hospital births and abortions.4.

For immunoprophylaxis, not one vaccination is used, but several drugs at once:

• Vaccines. Usually ADS-M is used – tetanus-diphtheria toxoid, in which the dose of the diphtheria component is reduced, or simply a separate tetanus toxoid (AS).

• PSS is a tetanus toxoid purified concentrated liquid serum that contains antibodies against the toxin.

• PSHI – human tetanus immunoglobulin.

Emergency prophylaxis is not carried out in people who have been vaccinated less than 5 years ago or have a high titer of tetanus antitoxin in the blood serum.

Sources of

  1. Diagnosis and treatment of tetanus. Guidelines for students of medical universities. M. A. Proidakov, Yu. M. Abmalov. Rostov-on-Don, 2014. https://vk.com/doc115750039_437450407?hash=9152e473efed0df813&dl=1de1bd7cc6983f4633.
  2. Tetanus. Textbook for students, residents, doctors. FSBEI HE Maikop State Technological University. Medical Institute. Namitokov Kh. A. Maikop 2016. https://clck.ru/bcwyV
  3. The causative agent of tetanus. Tutorial. GBOU VPO Ural State Medical Academy. Litusov N.V. Yekaterinburg 2013. https://clck.ru/bcx4h
  4. Epidemiological surveillance of tetanus. Federal Service for Supervision of Consumer Rights Protection and Human Welfare. Methodical instructions. year 2009. https://www.rospotrebnadzor.ru/upload/iblock/ccc/mu-3.1.2436_09.pdf

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