Tetanus

 

* Toxic infection due to Bacillus Nicolaier (Clostridium tetani) which secretes a neurotoxin (tetanospasmin).

Gram + anaerobic bacillus; copro-telluric germ.

* Non immunizing Disease -> vaccination is mandatory despite infection with this germ.

Incubation of 3 to 30d (M: 8d).

Non-contagious disease.

* Three conditions must coexist for a tetanus develops: lack of proper vaccination, cutaneous or mucosal break, low redox potential at the wound (necrotic tissue ischemia, foreign body).

* Neurospasmine -> blocking the release of inhibitory neurotransmitters of the alpha motor neurons -> spasticity.

* Average length of invasion (period between the first symptom of widespread contracture) -> 48 h.

Tetanus

Tetanus

* Trismus: inaugural symptom (contracture of masseter indomitable, invincible, permanent, sometimes painful).

No fever; should be withdrawn immediately from the diet.

All trismus should be considered original tetanus until proven otherwise

* Other causes lockjaw neuroleptics; bulboprotubérancielles affected;temporomandibular arthritis; hysteria; phlegmon of the amygdala.

* Generalized tetanus is responsible for a anoxia spastic blocking the respiratory muscles and laryngospasm.

* Neonatal Tetanus -> sucking difficulty.

* Cephalic tetanus -> with motor paralysis on the side of the door: peripheral facial paralysis, ophthalmoplegia.

* No laboratory test; strictly clinical diagnosis.

* Poor prognostic factors: incubation time <7 days; duration of invasion <2 days; extreme ages; generalized contracture.

* Hospitalization in ICU a few of the severity of tetanus. Resuscitation with intubation or tracheostomy; muscle relaxant.

* Any generalized tetanus requires when a tracheostomy with or without assisted ventilation.

* Specific treatment: Penicillin G; Specific Ig; first toxoid injection (vaccine).

PREVENTION OF TETANUS WOUND AFTER:

Immunization status Moderate Risk * Significant risk **
Last call <5 years Nothing Nothing
Last call 5 to 10 years Nothing Reminder
Last call> 10 years Reminder Reminder + Ig (250 IU)
Incomplete vaccination Reminder Reminder + Ig (500 IU)
Absent vaccination Vaccine + Ig 250 IU Vaccine + Ig (500 IU)

* Minor wound, ulcer surgery

** Extent Wound, contaminated with foreign bodies or for late blight, gangrene, septic abortion.

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