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quote:Tetanus is a serious and often fatal disease caused by the neurotoxin tetanospasmin which is produced by the Gram-positive, obligate anaerobic bacterium Clostridium tetani. Infection usually originates from a contaminated wound, often a cut or deep puncture wound. Common symptoms are muscle spasms in the jaw (hence the common name lockjaw), followed by difficulty swallowing and general muscle stiffness in other parts of the body. Infection can be prevented by proper immunization, as well as by post-exposure prophylaxis. SymptomsThe incubation period for tetanus is 3 days to as long as 15 weeks (with the average being about 8 days) . For neonates, the incubation period is 4 to 14 days, with 7 days being the average. Most of the time, the further the wound is from the central nervous system, the longer the incubation period. Incubation period length and likelihood of death are inversely proportional; a deep, contaminated wound that allows the bacteria to flourish and causes a quick, aggressive infection is much more life-threatening than a shallower, less-contaminated wound that causes milder symptoms to appear days or weeks later.The first sign of tetanus is a mild jaw muscle spasm called lockjaw (trismus), followed by stiffness of the neck and back, risus sardonicus, difficulty swallowing, and muscle rigidity in the abdomen. The stiffness and spasming of muscles expands throughout the body inferiorly, and can be so powerful that they cause muscle tears and even fractures. These muscle contractions are due to tetanospasmin—a chemical released by C. tetani—which inhibits the release of both GABA and glycine, the neurotransmitters that serve to inhibit muscle contraction.Typical signs of tetanus include an increase in body temperature by 2 to 4°C, diaphoresis (excessive sweating), an elevated blood pressure, and an episodic rapid heart rate. Spasms and muscle contraction last for 3 to 4 weeks, and complete recovery may take months. About 30% of tetanus victims die, most of whom are elderly patients. In developing countries, the mortality rate may be as high as 60%.Complications of the disease include spasms of the larynx (vocal cords), accessory muscles (chest muscles used to aid in breathing), and the diaphragm (the primary breathing muscle); fractures of long bones secondary to violent muscle spasms; and hyperactivity of the autonomic nervous system.TreatmentThe wound must be cleaned; dead and infected tissue should be removed by surgical debridement. Metronidazole will help decrease the amount of bacteria but has no effect on the bacterial toxin. Penicillin has been used in the past to treat tetanus, but is no longer the treatment of choice because there is a theoretical risk that it can increase spasms; however, if metronidazole is not available penicillin should still be used. Human anti-tetanospasmin immunoglobulin (or tetanus immune globulin) is a crucial part of treatment; if specific anti-tetanospasmin immunoglobulin is not available then human normal immunoglobulin may be given instead. All tetanus victims should be vaccinated against tetanus or offered a booster vaccine if they have been previously vaccinated.Mild tetanusMild cases of tetanus can be treated on the ward. In addition to the measures given above:5000 units tetanus immune globulin IV or IM metronidazole 500mg IV for 10 days diazepam 5 to 20mg tds PO tetanus vaccination Severe tetanusThese patients will require admission to intensive care. In additional to the measures listed above for mild tetanus:human tetanus immunoglobulin 1000 units intrathecally (increases clinical improvement from 4% to 35%) tracheostomy and mechanical ventilation for 3 to 4 weeks diazepam 20 to 100mg per day continuous IV infusion autonomic features can be difficult to manage (alternating hyper- and hypotension, hyperpyrexia/hypothermia) and may require IV labetalol, magnesium, clonidine, nifedipine, etc. PreventionTetanus can be prevented by vaccination. A booster vaccine is recommended every ten years, and standard care in many places is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated. One Tetanus booster used presently is called TDap or DTaP (a protection from Diphtheria and Pertussis as well). The risk from Tetanus, Diphtheria and Pertussis (whooping cough) is higher than the risk of vaccine side-effects. There was a shortage of tetanus vaccine in the United States in 2001 and 2002, but this supply issue was corrected in 2003.Worldwide, there are approximately one million cases of tetanus each year. (There are about 100 cases and approximately five deaths each year in the USA.)
quote:Originally posted by toughguy1please help me. I was bit by my friends dog about 10 days ago. I am 28 male caucasian. I was bitten on the nose and put neosporin on it. About a week after being bitten I felt very weak and cold and started shaking a bit. I went to emergency at 4 am and they gave me a tetanus shot as it had been a while maybe 12 yrs. since last one. since then for the last 5 days I have been sweating, no energy, dizzy, little appetite, sore back difficult swallowing etc. went to the er again yesterday to get checked they did a bloodtest and it was fine, no infections, normal. Said I had a virus and to sleep and drink lots of liquids. I am very naustious and I feel like crying sometimes, should I go in to get a TIG shot? What should I do. please get back to me asap.
quote:I was bit by my friends dog about 10 days agotoughguy1
quote:...Once symptoms appear, death usually followsPlease don't panic...just get checked now!...Karen W
quote:Originally posted by toughguy1the nausea is all day and night. still have difficulty swallowing. had a bit of an eye infection and nose infection/ sinus? that comes and goes.any ideas?
quote:Bacteriologic analysis of infected dog and cat bites....To define better the bacteria responsible for infections of dog and cat bites, we conducted a prospective study at 18 emergency departments. To be eligible for enrollment, patients had to meet one of three major criteria for infection of a bite wound (fever, abscess, and lymphangitis) or four of five minor criteria (wound-associated erythema, tenderness at the wound site, swelling at the site, purulent drainage, and leukocytosis). Wound specimens were cultured for aerobic and anaerobic bacteria at a research microbiology laboratory and, in some cases, at local hospital laboratories.RESULTS: The infected wounds of 50 patients with dog bites and 57 patients with cat bites yielded a median of 5 bacterial isolates per culture (range, 0 to 16) at the reference laboratory. Significantly more isolates grew at the reference laboratory than at the local laboratories (median, 1; range, 0 to 5; P<0.001). Aerobes and anaerobes were isolated from 56 percent of the wounds, aerobes alone from 36 percent, and anaerobes alone from 1 percent; 7 percent of cultures had no growth. Pasteurella species were the most frequent isolates from both dog bites (50 percent) and cat bites (75 percent). Pasteurella canis was the most common isolate of dog bites, and Past. multocida subspecies multocida and septica were the most common isolates of cat bites. Other common aerobes included streptococci, staphylococci, moraxella, and neisseria. Common anaerobes included fusobacterium, bacteroides, porphyromonas, and prevotella. Isolates not previously identified as human pathogens included Reimerella anatipestifer from two cat bites and Bacteroides tectum, Prevotella heparinolytica, and several porphyromonas species from dog and cat bites. Erysipelothrix rhusiopathiae was isolated from two cat bites. Patients were most often treated with a combination of a beta-lactam antibiotic and a beta-lactamase inhibitor, which, on the basis of the microbiologic findings, was appropriate therapy.CONCLUSIONS: Infected dog and cat bites have a complex microbiologic mix that usually includes pasteurella species but may also include many other organisms not routinely identified by clinical microbiology laboratories and not previously recognized as bite-wound pathogens.from: Talan DA et al. N Engl J Med. 1999 Jan 14;340(2):85-92.
quote:Originally posted by CarolynThank you for clearing up another mystery for me George. No I guess I don't want to be one of the few, and that would be just my luck. I had always thought you were only in danger if something rusty penetrated the skin. Hubby insisted that it didn't matter whether it was rusty or not. I hate it when he's is right. He gets entirely too much satisfaction from it. I guess I'll go get the blasted shot tomorrow.Carolyn
quote:Originally posted by moonfireYes, Carolyn, it would be advisable that you do so for your protection. It last a long time just in case you have another day like yesterday. Today is a new day, you will not have the same thing 2 days in a row...They are doing a study on how long is long enough now. They think it needs to be more frequently than that long. (probably because most of us forget how long it has been...mine has been about 25 years...and lord knows I am klutzy.) I am with Hubby, which you tell your lil studdiemuffin he is correct from me..hehe  I guess that means he didn't get no lil dance then last night?[)] Okay, okay, I will really behave now..."Just Me, Lo" Loretta
quote:Originally posted by toughguy1week 5 still nausea, sometimes twitches in leg, shoulder etc.taking flax seems to help.
NKS Forum to Toughguy1...NKS Forum to Toughguy1...NKS Forum to Toughguy1...Toughguy1...How 're you doing? iko