Tetanus

Tetanus je akutno oboljenje izazvano toksinima bakterije klostridujum tetani (lat. Clostridium tetani). Klostridija tetanusa proizvodi jak neurotoksin, tetanospazmin, koji se vezuje za receptore nervnih ćelija i sprečava prenošenje inhibitornih signala iz malog mozga na mišićne motorne neurone. Kao posledica se javlja pojačana mišićna aktivnost u vidu grčeva i povećan mišićni tonus.

Uzročnik

Tetanus je izazvan tetanospazminom, toksinom bakterije klostridijum tetani. To je relativno krupna, gram pozitivna, bakterija veličine 3-8 μm, štapićastog oblika. Klostridije su anaerobne bakterije i nalaze se svuda, posebno u zemlji i crevu čoveka. U nepovoljnim uslovima grade spore. Klostridija tetanusa poseduje treplje pomoću kojih se kreće.

Toksin tetanusa pripada grupi AB toksina. Sastoji se iz dve podjedinice A i B povezane disulfidnim mostom. Veća podjedinica B (engl. bindingvezujuća) se vezuje za receptore nervnih ćelija. Manja podjedinica A, je aktivna komponenta i to je enzim iz grupe cink-metaloproteinaza. Ova komponenta razlaže proteine koji učestvuju u procesu sekrecije inhibitornih neurotransmitera u prednjim rogovima kičmene moždine. Kao posledica javlja se povećan mišićni tonus i aktivnost u vidu grčeva mišića.

Patogeneza i simptomi

Nakon povrede dolazi do naseljavana rane raznim bakterijama, između kojih je i klostridija tetanusa, koja je široko rasprostranjena. Ukoliko u rani postoje anaerobni uslovi dolazi do razmnožavanja ove bakterije i proizvodnje toksina, tetanospazmina. Tetanospazmin dolazi putem nervnih vlakana ili krvi do prednjih rogova kičmene moždine gde ispoljava svoje dejstvo. Ovaj toksin blokira oslobađanje inhibitornih neurotransmitera: GABA i glicina, što za posledicu ima povećanje mišićnog tonusa i nekontrlisane mišićne kontrakcije u vidu grčeva izazvanih optičim i akustičkim dražima. Simptomi se najpre javljaju na mišiću maseteru koji učestvuje u žvakanju u vidu povišenog tonusa i grča ovog mišića-trizmus. Zatim sledi ukočenost vrata i mišića leđa. Usled grča mišića lica javlja se sardonični (iskeženi) osmeh (lat. risus sardonicus). Postoje i problemi sa gutanjem, ili sa disanjem ukoliko dođe do grča mišića grkljana ili dijafragme. Na kraju dolazi do toničnih kontrakcije celokupne muskulature trupa-opistotonus. Usled siline mišićnih kontrakcija može doći do istezanja i pucanja tetiva, preloma kostiju... Telesna temperatura obolelih je takođe povišena, krvni pritisak može biti povišen i mogu se javiti poremećaji rada srca. Svest je očuvana.

Bolest se dijagnostikfikuje na osnovu kliničke slike, pronalaženja toksina putem PCR-a (jez-en|PCR) ili njegovim testiranjem na životinjama (npr. mišu). U terapiji je važna primena antitoksina, higijena rane, mišićnih relaksanasa itd.

Zahvaljujući vakcinaciji (difterija-pertusis-tetanus DTP) bolest je postala ređa. Ukoliko dođe do težih povreda 5 i više godina nakon vakcinacije, potrebno je primiti osvežavajuću dozu vakcine.

Povezano

Literatura

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