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JUST THE FACTS IN EMERGENCY MEDICINE - PART 6

Các biểu hiện lâm sàng của bệnh uốn ván là tổng quát cứng cơ, co bóp cơ bạo lực, và sự bất ổn của hệ thống thần kinh tự chủ. • Những vết thương bị nhiễm độc tố sản xuất C. tetani thường wounds1 thủng nhưng khác nhau về mức độ nghiêm trọng | 288 SECTION 1 2 INFECTIOUS DISEASES AND IMMUNOLOGY CLINICAL FEATURES The clinical manifestations of tetanus are generalized muscular rigidity violent muscular contractions and instability of the autonomic nervous system. Wounds that become infected with toxin-producing C. tetani are most often puncture wounds1 but vary in severity from deep lacerations to minor abrasions.1 5 The incubation period of tetanus that is the period from initial inoculation to the onset of symp-toms can range from less than 24 h to longer than 1 month. The shorter the incubation period the more severe the disease and the worse the prognosis for recovery.6 Local tetanus is manifest by persistent rigidity of the muscles in close proximity to the site of injury and usually resolves after weeks to months without sequelae. Generalized tetanus is the most common form of the disease and frequently follows a puncture wound to the foot from a nail.1 The most frequent presenting complaints of patients with generalized tetanus are pain and stiffness in the masseter muscles lockjaw .7 Nerves with short axons are affected initially therefore symptoms appear first in the facial muscles with progression to the neck trunk and extrem-ities.7 Disturbances of the autonomic nervous system generally a hypersympathetic state occur during the second week of clinical tetanus and present as tachycardia labile hypertension profuse sweating hyperpyrexia and increased urinary excretion of catecholamines.8 Cephalic tetanus follows injuries to the head or occasionally otitis media and results in dysfunction of the cranial nerves most commonly the seventh. Neonatal tetanus occurs only if the mother is inadequately immunized. Most cases of neonatal tetanus arise from unsterile handling of the umbilical stump.7 DIAGNOSIS AND DIFFERENTIAL Tetanus is diagnosed solely on the basis of clinical evidence. Strychnine poisoning most closely mimics the clinical picture of generalized tetanus. Other diseases in the differential .