neonatal tetanus
Introduction
Introduction to neonatal tetanus Neonatal tetanus (tetanusofnewborn) is an acute infectious disease caused by the invasion of tetanus anaerobic spores from the umbilicus. It usually occurs about 7 days after birth. It is clinically characterized by the rigidity of the whole body skeletal muscle and the teeth. Closed as a feature, it is called "umbilical wind", "seven-day wind" and "locking the wind". basic knowledge Sickness ratio: 0.0001%-0.0005% Susceptible people: children Mode of infection: contact spread Complications: pneumonia, umbilical inflammation, sepsis, scleredema, heart failure
Cause
Neonatal tetanus cause
(1) Causes of the disease
Clostridium tetanus is a Gram-positive anaerobic bacterium, widely distributed in soil, dust and human and animal feces. Its spore resistance is extremely strong. It can not be killed for decades in the sun-free soil. It can withstand boiling for 60min, dry heat. 150 ° C 1h, 5% phenol 10 ~ 15h, need high pressure disinfection, with iodine and other iodine-containing disinfectant or dioxyethane, gas disinfectant epoxy acetylene can kill it, the infection is often used unsterilized Scissors, cords to break the umbilicus, ligation of the umbilical cord; when the birther's hand or the cotton gauze covering the umbilical cord stump is not strictly disinfected, the Clostridium typhimurium can be invaded, and the neonatal tetanus can occur in the vaccination. After that, the bacterium is not a tissue invasive bacterium, but only caused by tetanus toxin. Tetanus toxin is the second toxin in the known toxin, second only to botulinum toxin, and its lethal dose is about 10-6 mg/kg.
(two) pathogenesis
The necrotic umbilical stump and the covering thereon reduce the redox potential of the place, which is beneficial to the budding and breeding of the Clostridium typhimurium and the production of tetanus toxin. As the toxin is released, the toxin-producing bacteria die and dissolve. Tetanus toxin enters the bloodstream through the lymphocytes in the lymph, attached to the globulin to the central nervous system; it can also be absorbed by the muscle nerve junction, through the intima and adventitial space of the peripheral nerve or the motor axis to the spinal cord and brain stem, Once the toxin binds to the gangliosides in the central nervous tissue, the antitoxin is also not neutralized. The toxin binds to the gangliosides of the synaptosome membrane in the gray matter, making it unable to release the inhibitory neurotransmitter (glycine, amino Butyric acid), so that the motor nervous system strengthens the reflex of the afferent stimulus, causing the flexor and extensor to contract continuously at the same time. The more frequently the muscles are active, the more involved, so the masticatory tendon closes the jaw and the facial muscles. Its a bitter smile, and when the back muscles are strong, they form a horn arch. This toxin can also excite the sympathetic nerves, causing tachycardia, high blood pressure, and more. And other performance.
Prevention
Neonatal tetanus prevention
Neonatal tetanus is the main disease that threatens the life and health of newborns. Once infected, treatment is difficult, but neonatal tetanus can be effectively prevented. Newborns are generally susceptible to tetanus, so it should:
1. The new method will promote the new method to deliver the baby. The scissors should be burnt red with fire. After cooling, or after using 2% iodine, the scissors should be dried and the umbilical cord should be broken. The wire rope should also be sterilized by 2% iodine, and the umbilical cord should be ligated. Cm, try to re-treat the umbilical cord within 24 hours according to strict disinfection method, cut off the distal end of the residual umbilical cord and then re-ligature.
2. In case of emergency, in case of emergency, in addition to strict disinfection of the umbilical cord treatment, at the same time:
(1) Penicillin: intramuscular injection of penicillin for 3 to 4 days.
(2) tetanus antitoxin: intramuscular injection of tetanus antitoxin 1500 ~ 3000U.
(3) tetanus immunoglobulin: muscle injection tetanus immunoglobulin 75 ~ 250U.
3. Pregnant women with intramuscular injection of tetanus toxoid is positively correlated with maternal antibody and neonatal antibody. When the level of tetanus antitoxin in antibody serum is 0.01U/ml, it can effectively protect the body from tetanus infection, and can not guarantee aseptic delivery. Pregnant women can be injected with 0.5 ml of tetanus toxoid twice in the third trimester, one month apart, and the second time at least 2 weeks before the birth (preferably 1 month).
Domestic reports on the protection level of women of childbearing age in China are only 38.22%, the mainland is higher than the remote areas, and there are potential dangers of neonatal tetanus in remote areas, so it is necessary to carry out tetanus toxoid immunization for women of childbearing age or pregnant women as soon as possible. Protecting babies from infection by increasing maternal immunity.
Complication
Neonatal tetanus complications Complications pneumonitis, septicemia, scleredema, heart failure
Frequent convulsions, can not cough out respiratory secretions, easily lead to sputum occlusion, the most common complications are pneumonia, umbilical inflammation, umbilical hemorrhage, sepsis, scleredema and heart failure.
Symptom
Neonatal tetanus symptoms Common symptoms Difficulty breathing Closed twitching angle bow anti-explosive - strong straight bitter smile face smile face newborns eat less body skeletal muscle asphyxia
Most of the incubation period is 4 to 8 days (3 to 14 days). The incubation period and the time from the onset of symptoms to the first convulsion are shorter. The worse the prognosis is. The general illness is caused by crying and irritability. The child wants to eat, but the mouth is not big, and the sucking is difficult. Then the jaws are closed, the eyebrows are wrinkled, the mouth is pulled, and the face of "chat smile" appears, the fists are clenched, the upper limbs are excessively flexed, the lower limbs are straight, the horns are reversed, and the tonic convulsions occur intermittently. Muscle contraction still exists, mild stimulation (sound, light, light touch, drinking water, light stab, etc.) often induces seizures, respiratory muscles and laryngeal spasm cause breathing difficulties, bruising, suffocation; pharyngeal tendon fills saliva with mouth, bladder And rectal sphincter spasm can cause urinary retention and constipation.
The child is conscious and has no fever in the early stage. After the body temperature rises, it may be caused by repeated tonicity of the whole body muscles. It may also be caused by secondary infections such as pneumonia. After timely treatment, the seizures may be gradually reduced and relieved. It will heal after a few weeks, otherwise it will die due to more frequent frequency, lack of oxygen suffocation or secondary infection.
Examine
Neonatal tetanus examination
1. Peripheral blood: It can be infected with bloody nucleus due to secondary infection of umbilical cord or persistent stress, and neutrophils are increased.
2. Bacterial culture: Tetanus secretion culture can isolate tetanus, but only some children are positive.
3. Cerebrospinal fluid: Cerebrospinal fluid examination is normal.
4. X-ray chest X-ray: examination can confirm the presence or absence of secondary lung infection.
5. Brain CT: no obvious abnormalities, no intracranial hemorrhage, can be identified with convulsion caused by neonatal intracranial hemorrhagic disease.
6. EEG examination: no obvious abnormalities.
Diagnosis
Diagnosis of neonatal tetanus
diagnosis
The clinical symptoms of tetanus are the most characteristic, and the main points of diagnosis are as follows:
1. Medical history: improper handling of the umbilical cord during delivery, especially the scissors used to break the umbilical cord is not properly disinfected.
2. The teeth are closed, and the face of the bitter smile is 3 to 14 days after birth. It is common for 7 days to have a closed jaw, a smile and a smile.
3. Tonic sputum: the progress of the disease, limb twitching or tonic convulsions, once stimulated, it causes seizures, severe laryngeal muscles, respiratory muscle spasm, and even suffocation, and pneumonia.
The history of the episode and the typical episodes after birth are generally easy to diagnose. When there is no typical performance in the early stage, the pharyngeal part of the child can be examined with a tongue depressor. If the force is pressed down, the more the tongue depressor is bitten, the diagnosis can be confirmed.
Differential diagnosis
1. Suppurative meningitis: Although there are angular reflexes, strong back and other symptoms, but no paroxysmal muscle twitching, patients with increased intracranial pressure, accompanied by severe headache, jet vomiting, high fever, lethargy, etc., cerebrospinal fluid examination Make an identification.
2. Rabies: There are many cases of rabies and cat bites, which are mainly caused by swallowing muscle twitching, which produces what is called hydrophobia in the clinic. The diaphragm is contracted and produces loud voices such as the sound of canines.
3. Hand and foot convulsions: Strong sputum is mainly limited to the hands and feet, but no teeth close tight and smile face.
4. Neonatal seizures: not necessarily in 4 to 8 days of onset, generally no mouth and lips tight, face is a bitter smile and other manifestations, caused by a variety of causes, can detect the primary disease.
