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 with participation of the anesthesiologist. It is necessary to provide the guarding mode excluding acoustical, visual and tactile irritants. Feeding of patients is carried out via the probe or parenterally (at GIT paresis). Carry out prevention of decubituses: frequent turning of the patient in beds, smoothing crumpled bed and underwear, its cleaning and periodic change. The contaminated wound which even healed is cut away antitetanic serum (in a dose 1000-3000 ME), then carry out careful audit and surgical treatment of a wound with wide lampasny cuts (for creation of aerobic conditions), removal of the foreign bodys polluted and nekrotizirovanny fabrics. For the prevention of spasms it is better to carry out all these manipulations under anesthetic. In the subsequent it is reasonable to apply proteolytic enzymes to treatment of wounds (trypsin, chymotrypsin, etc.).
For neutralization of a spasmotoxin in a blood-groove once enter intramusculary 50 000 ME of antitetanic serum or 1500-10 000 PIECES (an average dose of 3000 PIECES) of specific immunoglobulin with preliminary check of individual sensitivity to them. These drugs should be administered in the earliest terms as the tetanin freely circulates in blood no more than 2-3 days, and the connected toxin is not inactivated that reduces therapeutic effect. After administration of heterogeneous antitetanic serum it is necessary to watch the patient during 1 h because of danger of development of an acute anaphylaxis.
Fight against a convulsive syndrome is carried out by use of sedative and narcotic, neuroplegic means and muscle relaxants. Recently widely each 2-4 h use diazepam on 5-10 mg inside; in hard cases it is entered intravenously on 10-20 mg by each 3 h. To children drug is appointed intravenously or intramusculary on 0,1-0,3 mg/kg by each 6 h (as much as possible to 10-15 mg/kg/days). It is possible to apply injections of mix of 2,5% of solution of aminazine, 1% of solution of Promedolum and 1% of solution of Dimedrol (on 2 ml of each drug) with addition of 