(Lockjaw)

Tetanus is an acute intoxication is through an educated of Clostridium tetani neurotoxin. It comes to complaints such as intermittent tonic spasms of the auxiliary muscles. Spasms of the masseter muscle lead to the name lockjaw ( “lockjaw”). The diagnosis is made clinically. The therapy consists of human tetanus immunoglobulin and intensive care supportive care.

Tetanus bacteria form lasting spores found in soil and animal feces and can remain viable for many years. It is estimated that tetanus causes more than half a million deaths per year worldwide, mostly in neonates and young children; the disease is so rare, however, reported that all the figures are only rough estimates. In the US, 29 cases / year were registered from 2001 to 2008 on average.

Tetanus is an acute intoxication is through an educated of Clostridium tetani neurotoxin. It comes to complaints such as intermittent tonic spasms of the auxiliary muscles. Spasms of the masseter muscle lead to the name lockjaw ( “lockjaw”). The diagnosis is made clinically. The therapy consists of human tetanus immunoglobulin and intensive care supportive care. Tetanus bacteria form lasting spores found in soil and animal feces and can remain viable for many years. It is estimated that tetanus causes more than half a million deaths per year worldwide, mostly in neonates and young children; the disease is so rare, however, reported that all the figures are only rough estimates. In the US, 29 cases / year were registered from 2001 to 2008 on average. The incidence of the disease is directly related to the immunization coverage of the population, which is a clear indication of the effectiveness of the preventive efforts. In the US, more than half of all elderly patients have inadequate levels of antibodies and provide a third to half of the cases. Most of the remaining cases occurs in not adequately immunized patients between 20 and 59 years. Patients <20 years account for only <10% of cases. Patients with burn wounds, surgical wounds or anamnestic indications of i.v. Drug abuse are particularly prone to tetanus infection. Nevertheless Tetanus can occur as a result of minor injuries or even inapparent wounds. Infection can develop in utero (maternal tetanus) and in the navel of the newborn (neonatal tetanus) Also postpartum. Pathophysiology C. tetani spores usually appear one by contaminated wounds. The manifestations of tetanus are caused by an exotoxin (Tetanospasmin), which is produced when bacteria are lysed. The toxin enters the peripheral nerve endings one, where it binds irreversibly, then travels to decline along the axons and synapses, and finally enters the CNS. As a result of the release of inhibitory transmitter substances is blocked by the nerve endings, thereby resulting in unobstructed muscle stimulation by acetylcholine and generalized tonic-spastic cramps, usually with superimposed intermittent tonic seizures. The disinhibition of autonomic neurons and loss of control over the catecholamine adrenal cause autonomic instability and a hypersympathetischen state. Once bound, the toxin can not be neutralized. Mostly tetanus runs generalized and affects the skeletal muscles all over. However, tetanus is sometimes localized to muscles that are located near one wound entrance. Tips and risks The tetanus toxin binds irreversibly to nerve endings and once it is bound, it can not be countered. Symptoms and signs The incubation period ranges from 2-50 days (mean 5-10Tage). Symptoms include jaw stiffness (most common) swallowing restlessness irritability Stiff neck, arms or legs headache sore throat tonic spasms Later, patients have difficulty opening her jaw (trismus). Convulsions through a spasm of the facial muscles produces a characteristic facial expression with a fixed grin and elevierten eyebrows (risus sardonicus). Stiffness or spasm of abdominal, neck and back muscles and sometimes opisthotonus generalized stiffness of the body with curvature of the back and neck can occur. Spastic paralysis of the sphincter muscles can lead to urinary retention or constipation. Dysphagia can affect the diet. Already by minor stimuli such as drafts, noise or movement characteristic painful, generalized tonic spasms with pronounced sweating can be triggered. The mental status is usually not affected, repeated spastic convulsions but can lead to coma. While the generalized seizures, patients are unable to speak or because of rigidity of the chest wall or spastic Glottisl√§hmung able to scream. Rarely fractures caused by persistent cramps. The spasms affect respiratory functions and lead to cyanosis or fatal Asphyxie.Autonome instability Body temperature is only moderately increased, as long as no complicating infection is added, for example. B. pneumonia. The respiratory rate and pulse rate are increased. The reflex level is often increased. A protracted course of tetanus can manifestiern in the form of a very labile and overactive sympathetic nervous system, where there be periods of increased blood pressure, tachycardia and myocardial hyperexcitability kann.Todesursachen The most common cause of death is respiratory insufficiency. Spasms of the laryngeal muscles as well as rigidity and spasms of the abdominal wall, diaphragmatic and chest wall muscle can lead to asphyxia. Hypoxemia can lead to cardiac arrest, and larynx spasms cause aspiration of oral secretions, thereby possibly aspiration pneumonia, which contributes to a hypoxic cause of death. A pulmonary embolism is also possible. However, the immediate cause of death is not obvious must sein.Lokalisiert occurring tetanus In localized tetanus occurring there is a spasticity of the muscles, which is located near the entry wound, but no trismus; spasticity can last for weeks. Kephaler Tetanus Tetanus is a local form that affects the cranial nerves. This form is more common in children, in which they occur in the setting of chronic otitis media or can follow a head wound. The incidence is highest in Africa and India. All cranial nerves may be involved, in particular the VII. Cranial nerve. Kephaler tetanus can generalisieren.Tetanus neonatal tetanus in a newborn runs usually generalized and often fatal. The disease begins in inadequately cleaned umbilical stumps of newborn children whose mothers were inadequately immunized. The complaints during the first two weeks of life are characterized by rigidity, spasms, and poor feeding. In surviving neonates may lead to a two-sided deafness. Neonatal tetanus Image courtesy of the Public Health Image Library of the Centers for Disease Control and Prevention. var model = {thumbnailUrl: '/-/media/manual/professional/images/neonatal_tetanus_orig_de.jpg?la=de&thn=0&mw=350' imageUrl: '/-/media/manual/professional/images/neonatal_tetanus_orig_de.jpg?la = en & thn = 0 ', title:' Neonatal tetanus 'description:' u003Ca id = "v38396256 " class = ""anchor "" u003e u003c / a u003e u003cdiv class = ""para "" u003e u003cp u003eNeugeborenentetanus usually affects children not immunized mothers. The u003egebildete of u003ci u003eClostridium tetani u003c / i exotoxin enters the bloodstream when the umbilical cord is cut or the umbilical stump is cleaned in non-sterile manner. Generalized rigidity and spasms affecting the child in the first 2 weeks of life and can be fatal u003c / p u003e u003c / div u003e 'credits'. Image courtesy of the Public Health Image Library of the Centers for Disease Control and Prevention . '

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