, 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) 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. 