zinsky, etc.).
At the height of a disease painful tonic spasms extend to muscles of a trunk and extremities (without taking a brush and foot). The tonic muscle tension is constant, relaxation of muscles, as a rule, does not happen even in a dream. Accurately appear, especially at men, contours of large skeletal muscles. From the 3-4th day of a disease of a muscle of an abdominal wall become firm as a board, legs are more often extended, the movements in them are limited. At the same time intercostal muscles and a diaphragm are involved in process, breath becomes superficial and speeded up. The tonic muscle tension of a crotch leads to difficulty of defecation and an urination. As a result of the expressed tension and morbidity of muscles of a back at heavy tetanus the opisthotonos develops: at position of the patient on spin his head is thrown back back, a lumbar part of a body is raised over a bed in such a way that between a back and a bed it is possible to push a hand.
Against the background of the constant tonic tension of skeletal muscles periodically with various frequency there are tetanic spasms. Their duration at first fluctuates from several seconds to one minute. Most often they are provoked by acoustical, visual and tactile irritants. In mild cases of a disease observe 1-2 attacks of spasms a day, at the heavy course of tetanus they can repeat to tens of times within an hour, become longer and widespread. Attacks of spasms arise suddenly. At the same time the face of the patient accepts suffering expression and becomes cyanochroic, contours of muscles appear more accurately, the opisthotonos amplifies. Patients groan and shout because of pains, try to grasp with hands a bed back to facilitate breath. Body temperature, skin increases (especially persons) becomes covered by large drops of sweat, note hypersalivation, tachycardia, short wind, cardiac sounds loud, arterial pressure is inclined to increase. The convulsive syndrome develops and amplifies at preservation of clear consciousness of the patient, the confused consciousness and nonsense appear only shortly before death.
The period since the end of the first week and to the 10-14th day of a disease is most life-threatening the patient. The metabolic acidosis and sharp strengthening of a metabolism cause a hyper pyrexia, the increased sweating. Expectoration as cough provokes tetanic spasms is complicated. Deterioration in ventilation of the lungs often promotes development of secondary bacterial pneumonia. Heart is expanded at the expense of both ventricles, tones loud. The liver and a spleen are not increased. Deep intoxication of a brainstem becomes the reason of oppression and arrhythmia of breath, weakening of cordial activity; the cardioplegia is possible. Because of frequent and long tonic spasms painful sleeplessness, irritability develop, the threat of asphyxia accrues.
In cases of a favorable outcome reconvalescence period long; gradually weakening clinical displays of a disease remain 2-4 weeks, recovery drags on up to 1,5-2 months.
Weight of a course of tetanus is defined by set of several indicators.
* At the easy course of a disease the incubation interval exceeds 20 days more often. Lockjaw, "cynic spasm" and opisthotonos moderate, hyper tone of other groups of muscles weak. Tonic spasms are absent or are insignificant, body temperature normal or subfebrile. Symptoms of a disease develop within 5-6 days.
* In cases of a medium-weight current the incubation interval makes 15-20 days. The main clinical signs of a disease accrue in 3-4 days. Spasms arise several times in days, tachycardia and perspiration moderate, body temperature subfebrile or (more rare) high.
* The severe form of tetanus differs in the incubation interval shortened up to 7-14 days, bystry (in 1-2 days) in increase of symptoms, a typical clinical picture with the frequent and intensive tetanic spasms (several times within an hour) expressed by perspiration and tachycardia, high fever.
Very heavy current is distinguished by the incubation interval shortened (less than a week)