 and fulminant development of a disease. Tonic spasms arise several times within 3-5 min. They are accompanied by a hyper pyrexia, the expressed tachycardia and a tachypnea, cyanosis, the menacing asphyxia.
One of the hardest forms of the generalized descending tetanus - head ("bulbar") tetanus of Brunner. It proceeds with preferential damage of face muscles, necks and drinks, with spasms of deglutitory and intercostal muscles, muscles of a glottis and a diaphragm. Usually there is a defeat of the respiratory, vasomotor centers and kernels of a vagus nerve. Also gynecologic tetanus and tetanus of newborns which is one of the important reasons of child mortality in developing countries differ in weight of a current and the adverse forecast. It is connected with unsatisfactory conditions of rendering obstetric care and lack of programs of immunization of women.
The ascending tetanus observed in rare instances at first is shown by pain, tension and fibrillar twitchings in one group of muscles, further in process of defeat of new overlying departments of a spinal cord the disease gains typical lines of generalized process.
Local tetanus is met seldom. Front paralytic tetanus to Roza happens one of its typical manifestations developing after wounds of the person and head. There are a lockjaw, a stiff neck, "cynic spasm" which paresis of cranial nerves joins. Defeat is usually bilateral, it is more expressed on the party of wound.
When determining the forecast of tetanus much attention is paid to the period between emergence of the first symptoms of a disease (a lockjaw, etc.) and developing of spasms. If this period makes less than 48 h, the forecast of a disease extremely adverse.
The activator - obligatno an anaerobic gram-positive spore-forming mobile stick of Clostridium tetani of the Bacillaceae family. Disputes are located terminalno, giving to bacteria a type of "drum sticks" or "tennis rackets". Pages of tetani form strong exotoxin (tetanospasmin), cytotoxin (tetanolysin) and so-called low-molecular fraction. In the soil, excrements and on various objects disputes can remain for years. Maintain temperature of 90 °C during 2 h. In anaerobic conditions, at a temperature of 37 °C, sufficient humidity and in the presence of aerobic bacteria (for example, stafilokokk) disputes burgeon in vegetative forms. Vegetative forms of a tetanic stick perish within several minutes at boiling, in 30 min. - at 80 °C. Antiseptic agents and disinfectants kill the causative agent of tetanus during 3-6 h. In the countries with warm climate vegetation a dispute directly in the soil is possible. At S. tetani reveal two types of antigens: somatic (O-antigen) and flagellates (N-antigen). On structures of flagellar antigens allocate 10 serovars. All serovars form tetanospasmin and tetanolysin, identical on antigenic properties.
* Tetanospasmin - one of the strongest biological poisons. Represents polypeptide with the "distanced" action mechanism as bacteria seldom leave limits of primary center of infection. Toxin is fixed on a surface of shoots of nervous cells, gets into them (due to the endocytosis mediated by ligands) and by retrograde aksonny transport gets to TsNS. The mechanism of action is connected with suppression of release of brake neurotransmitters (in particular, glycine and at - aminobutyric acid) in synapses (toxin contacts synoptic proteins sinaptobreviny and tsellyubreviny). Originally toxin affects peripheral nerves, causing local tetanic reductions of muscles. In cultures toxin appears for the 2nd days, reaching education peak by 5-7th day.
* Tetanolysin shows hemolitic, cardiotoxic and lethal actions, causes development of focal necrotic lesions. In a disease pathogeny this toxin plays a less important role. The maximum accumulation of toxin in culture is observed already in 20-30 h. Processes of its education are not connected with tetanospasmin synthesis. The low-molecular fraction strengthens secretion of mediators in neuromuscular synapses.
Treatment of Tetanus:
It will be out in intensive care unit and resuscitation wi