* 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).
* 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.
* 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No fever; should be withdrawn immediately from the diet.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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