Tetanus

Tetanus is an acute infectious disease characterized by painful spasms of the muscles and caused by the Bacillus tetani which gains entrance into the body through a wound or break in the skin. When they enter a deep wound, spores of the bacilli may produce a powerful toxin, tetanospasmin, which actively impairs motor neurons, nerves that control muscles. The effect of the toxin on motor neurons can cause muscle stiffness and spasms — the major signs of tetanus.

Doctors diagnose tetanus based on a physical examination, medical and immunization history, and the signs and symptoms of muscle spasms, stiffness and pain. Laboratory tests generally aren't helpful for diagnosing tetanus.

The incubation period varies on an average from 5 to 15 days. In general, the shorter the incubation period the more serious is the disease. The earliest symptoms are vague. The patient is restless, irritable; he suffers from nightmare, and may become delirious. Severe headache, difficulty in urination, and sweating may be noted. In the majority of cases following a short period when there is pain in the back of the neck and in the muscles of the jaw, a tonic spasm of the masticating muscles occurs so that the patient is unable to open his mouth, producing the characteristic picture known as lockjaw (trismus). Gradually all muscles of the body become affected except those of the forearm and of the hand. At the height of the disease there occurs the typical facial expression known as risus sardonicus, where the patient appears to be laughing, due to the drawing up of the angles of the mouth. The brows are contracted, the eyes are partly closed, the teeth are clenched tightly and the lips are slightly protruded. The body is arched in the position known as opisthotonus. Upon the slightest stimulus the entire body may go into a convulsive seizure of the utmost severity, accompanied by severe pain.

There is no characteristic temperature; the patient may be afebrile or ran a fever as high as 104°F during the attacks.

Complications include broken bones (the severity of spasms may cause the spine and other bones to break), disability (prolonged immobility due to the use of drugs can lead to permanent disability) and death. Death may ensue within the first 48 hours or at any time up to one week after onset. If the patient survives the first week, his chances of recovery are greatly improved, the spasms gradually lessening in frequency and severity.

Since there's no cure for tetanus, treatment consists of wound care, medications to ease symptoms and supportive care. Cleaning the wound is essential in preventing growth of tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound. Some drugs (e.g. antitoxins, antibiotics, vaccines and sedatives) are also prescribed.

Exercise 8. Answer the following questions:

1. What is tetanus caused by?

2. What examinations are necessary to diagnose tetanus?

3. What is the incubation period of tetanus?

4. What are the symptoms of tetanus?

5. When does a tonic spasm of masticating muscles occur?

6. How can you describe such typical facial expression known Risus Sardonicus?

7. When are the changes of recovery greatly improved?

8. How does Bacillus tetani gain entrance into the body?

Exercise 9. Translate the following word combinations:

Cупроводжуватися сильним болем; спазм жувальних м`язів; проникати крізь рану; характерна картина хвороби; поступово зменшуватися по частоті та важкості; інкубаційний період хвороби; міцно стиснуті зуби; пік хвороби; сардонічний сміх; сильнодіюча отрута; виробляти сильнодіючі токсини; видалити відмерлу тканину з рани; погіршувати роботу моторних нейронів.

Exercise 10. Match medical terms with the proper definitions:

1. tetanus 2. tetani 3. toxin 4. urination 5. spasm 6. trismus

a) Spasm of the jaw muscles, keeping the jaw tightly closed. b) An acute infectious disease, affecting the nervous system, caused by the bacterium Clostridium tetani. c) The periodic discharge of urine from the bladder through the urethra. d) Spasm and twitching of the muscles, particularly those of the face, hands, and feet. e) A poison produced by a living organism, especially by a bacterium. f) A sustained involuntary muscular contraction, which may occur either as part of a generalized disorder, such as a spastic paralysis, or as a local response to an otherwise unconnected painful condition.

Exercise 11. Complete the following sentences using the text:

1. Tetanus is an acute infectious disease characterized by … .

2. Severe headache, difficulty in urination, and sweating … .

3. The patient is unable to open his mouth, producing the … .

4. Gradually all muscles of the body become … of the forearm and of the hand.

5. … there occurs the typical facial expression known as risus sardonicus.

6. The body … known as opisthotonus.

7. The patient may be …during the attacks.

8. Death may ensue within … after onset.

Exercise 12. Read the sentences and say whether they are true to the text:

1. Tetanus is an acute inherited disease characterized by painful spasms of the muscles.

2. Tetanus is caused by the Bacillus tetani which gains entrance into the body through the blood.

3. The tetanus bacillus produces a toxin.

4. The incubation period varies on an average from 15 to 25 days.

5. Gradually all muscles of the body become affected inclusive those of the forearm and of the hand.

6. The typical facial expression known as risus sardonicus, where the patient appears to be crying, due to the drawing up of the angles of the mouth.

7. The body is arched in the position known as opisthotonus.

8. There is no characteristic temperature; the patient may be afebrile or ran a fever as high as 40,00°C during the attacks.

Exercise 13. Translate Russian sentences into English using Complex Subject Construction:

1. Відомо, що правець є гострим хронічним захворюванням, яке характеризується болісними спазмами м'язів.

2. Виявляється, що при захворюванні Bacillus tetani проникає в організм через рану чи розрив шкіри.

3. Відомо, що інкубаційний період хвороби триває від 5 до 15 днів.

4. Ймовірно, що першими симптомами правця будуть збудженй стан та страшні сни.

5. Кажуть, що в пік хвороби у пацієнта часто траплялись приступи і була висока температура.

6. Без сумніву, шанси пацієнта на одужання збільшуються, якщо він виживає в перший тиждень.

7. Кажуть, що смерть може настати на протязі 48 годин або в будь-який інший час після початку приступу.

8. Доведено, що деякі ліки можуть допомогти у лікуванні правця.

Exercise 14. Put questions to the underlined words:

1. Tetanus is an acute infectious disease characterized by painful spasms of the muscles.

2. The Bacillus tetani gains entrance into the body through a wound or break in the skin.

3. The tetanus bacillus produces a toxin.

4. The patient is restless, irritable and suffers from nightmare, and may become delirious.

5. Gradually all muscles of the body become affected except those of the forearm and of the hand.

6. At the height of the disease there occurs the typical facial expression known as risus sardonicus.

7. The patient appears to be laughing, due to the drawing up of the angles of the mouth.

8. The patient may be afebrile.

Exercise 15. Use the verbs in brackets in the appropriate tense. Translate them into Russian:

1. The incubation period is likely (to vary) on an average from 5 to 15 days in future.

2. The patient (to suffer) from nightmare, and (to become) delirious.

3. At the height of the disease there (to occur) the typical facial expression known as risus sardonicus.

4. The brows (to contract), the teeth (to clench) tightly and the lips (to protrude) slightly.

5. Now the patient’s body is reported (to arch) in the position known as opisthotonus.

6. Upon the slightest stimulus the entire body just (to go) into a convulsive seizure of the utmost severity, accompanied by severe pain.

7. It was said that the patient (to ran) a fever as high as 104°F during the attacks for a weak.

8. Death (to ensue) within the first 48 hours or at any time up to one week after onset.

Exercise 16. Describe the term “tetanus” according to the table:

1.	General characteristics
2.	Symptoms
3.	Analyses
4.	Treatment
5.	Complications