Tetanus is a spasm that starts in the jaw and neck. This condition is caused by harmful toxins of Clostridium Tetany bacteria, which enter the body's nerve attack through the dirty wound. Clostridium Tetany can survive outside the body in the form of spores for a very long time. For example, in the dust, soil, and animal and human feces. Spores Clostridium Tetany generally enter the body through dirty wounds, for example injuries due to injury, bitten animals, rusty nails, or burns .
Symptoms of Tetanus
When successfully entering the body, Clostridium tetani spores will become active tetanus bacteria. The spores will then multiply to release neurotoxins or toxins that attack the nervous system.
Neurotoxins that disrupt the performance of nerves that have the potential to cause people with seizures that resemble muscle stiffness. This is the main symptom of tetanus that can cause the jaw sufferers tightly closed and can not be opened or commonly referred to as lockjaw jaw. In addition, the problem of swallowing can also be experienced by people with tetanus.
Types of Tetanus
There are several types of tetanus, common tetanus, localized, cephalic , and neonatorum. Localized and cephalic types are a rare species.
Tetanus is said to be localized when it comes to certain body parts that will experience local seizures. This occurs when the body has only partial immunity to tetanus toxins and can be a common tetanus that spreads to other parts of the body.
Cephalic tetanus results from middle ear infections. Just as tetanus is localized, tetanus is also potentially a common tetanus.
While tetanus neonatorum is tetanus experienced by newborns due to the process of handling the delivery of contaminated spores of tetanus bacteria. This type of tetanus can occur because the baby's immunity to tetanus is still weak.
The type of tetanus to be discussed in this article is general tetanus.
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Diagnosis and Treatment of Tetanus
To diagnose tetanus, doctors will usually perform a physical exam. Includes examination of wounds while inquiring about the history of the disease, vaccinations ever received, and clinical symptoms and signs experienced by patients.
While the tetanus treatment step aims to provide supportive therapy; wipe out spores, and stop bacterial progression. The trick can be by cleaning the dirty wound, stop the production of neurotoxins, neutralize neurotoxins that have not attacked the nerves of the body, prevent complications, and handle complications when it happens.
The doctor will also recommend a tetanus vaccination if the patient:
- Never vaccinated.
- Have not received a complete vaccination yet.
- Not sure whether vaccinated or not.
Tetanus is not a contagious disease, but potentially deadly. Especially when the wound is on the head or face, experienced by newborns, as well as in patients who do not get a quick and proper treatment.
Prevention and Complication of Tetanus
The main step to prevent tetanus is by vaccination. In Indonesia, tetanus vaccine is included in the mandatory immunization list for children.
This immunization is given as part of the DTP vaccine (diphtheria, tetanus, pertussis). This vaccination process should be lived in 5 stages, ie at age 2, 4, 6, 18 months, and 5 years. This vaccine will then be repeated when a child aged 12 years in the form of Td immunization. However, DTP includes unlicensed immunizations for children aged 7 years and over, adolescents, and adults.
For women, TT immunization (tetanus toxoid) should be given 1 time before marriage and 1 time during pregnancy. The purpose of this immunization is to prevent tetanus in newborns.
In addition to vaccinations, tetanus prevention can also be done by always maintaining cleanliness. Especially when treating wounds so as not to get infected.
Untreated tetanus infection can cause complications and be fatal. Some of the tetanus complications that can occur include a sudden stopping heart, pulmonary embolism , and pneumonia .
The Cause Of Tetanus
Tetanus is an infection that is classified as serious and caused by Clostridium tetani bacteria. This bacterium can live more than 40 years outside the human body in the form of spores. Spores are commonly found in dust, soil, animal and human feces, rusted iron, razor wire, and unsterile needle tip.
If the spore is in an anaerobic (non-oxygenated) dirty wound, it will become an active bacterium, multiply, and release a neurotoxin called tetanospasmin .
Tetanus Risk Factors
There are a number of factors and conditions behind tetanus. The following conditions are believed to increase a person's risk of becoming infected with tetanus:
- Have not received the vaccinations or the process is incomplete.
- The presence of foreign objects in wounds, such as wood chips, rust, or nails.
- Wounds exposed to dust, animal waste, or soil.
- A deep penetrating wound, for example from a rusty or dirty impingement.
- People who pierced or tattooed the body with less sterile equipment.
- Drug users who use non-sterile injecting equipment.
- The umbilical cord of a newborn infant is infected because the mother is not adequately vaccinated with tetanus.
Duration since a person exposed to tetanus bacteria spores until symptoms appear (incubation period) generally takes between 4 to 14 days. The symptoms of tetanus may be:
- Seizures that resemble muscle stiffness, especially on the jaw and neck so that people have difficulty opening their mouth. The face of the patient also looks grinning, called the term risus sardonicus .
- Difficulty swallowing if muscle spasms spread to the neck.
- Muscles around the stomach are stiff.
- The spasms are painful throughout the body and lasts for several minutes. These symptoms are usually triggered by small things, such as a loud voice, touch, and light.
- Great seizures that occur throughout the body. These symptoms will cause the lower back of the body to curve upward.
- Fever and sweating.
- Increased blood pressure.
- Rapid heartbeat.
The diagnosis of tetanus is not determined by laboratory tests, but based on clinical manifestations.
In the early stages, the doctor will usually perform a physical examination while inquiring about the patient's disease history and vaccination. The types of vaccinations that have been received as well as the symptoms experienced will also be asked in detail.
Patients who go to the doctor in a seizure state will be given first aid and immediately referred to the hospital for intensive care. Such intensive handling methods generally include:
- Relieves seizures and calms the patient by giving muscle relaxant and sedative drugs.
- Cleaning the wound , for example getting rid of dirt or dead tissue and lifting the sharps remaining on the wound. This process is done to destroy spores and tetanus bacteria.
- Neutralize neurotoxins that are still free . This is done through the administration of tetanus immunoglobulin.
- Provide drugs to stop the production of neurotoxins by giving antimicrobials and antibiotics to kill the bacteria Clostridium tetani .
- Use of respiratory aids or ventilators if tetanus affects the respiratory muscles.
- Provide nutrition through the tube or infusion so that people are not dehydrated and have nutritional deficiencies.
- Do bed rest in a dark and quiet room. Even the slightest physical stimulus has the potential to cause a recurrence of the seizure cycle.
- Provide Tetanus Vaccination. Keep in mind that having tetanus does not mean you will be immune afterwards. Therefore, patients who have not received the vaccine, have a history of incomplete vaccinations, or are unsure of being vaccinated, should have tetanus vaccinations.
The main step to prevent tetanus is through vaccination. In Indonesia alone, tetanus vaccination is one of the 5 mandatory immunizations for children.
Tetanus immunization is given as part of the DTP vaccine ( Diphtheria , Tetanus, Pertussis). This vaccination process should be given in 5 stages, ie at age 2, 4, 6, 18 months, and 4-6 years.
For children aged over 7 years, Td vaccine is available which also serves to provide protection against tetanus and diphtheria. Td vaccination process needs to be repeated every 10 years to maintain immunity against tetanus and diphtheria.
In addition to vaccines, tetanus prevention can also be done by always keeping the wound clean so as not to have infection and quickly recover. Giving tetanus toxoid is also usually recommended by doctors to prevent the occurrence of tetanus infection in the wound.
Risk of Tetanus Complications
Tetanus infection that is not treated immediately can cause complications and fatal, especially for people who have not been vaccinated. A number of serious complications that can be experienced are:
- Aspiration pneumonia due to people inhaling foreign objects into the lungs, such as saliva, vomiting, food, or drink.
- Pulmonary embolus , especially in elderly and drug users. This complication occurs when there is a blockage in the blood vessels in the lungs.
- The sudden breathing stopped . This condition is caused by muscle stiffness around the vocal cords so that the patient can not breathe and suffocate. This complication generally occurs in people with high severity of tetanus and can lead to death because of cardiac performance is suddenly stopped due to lack of oxygen.
- Bone fractures due to convulsions and prolonged contractions.