破伤风

title: 成因与临床症状.
content: 破伤风的病原体是破伤风梭状芽胞杆菌。感染到此疾病的原因,通常是由沾有细菌的物品(如金属锐器)对皮肤造成损伤(如切伤或穿刺伤),并同时将病原菌送至体内(较深的伤口会提供该细菌繁衍的厌氧性环境从而激活该细菌)。此细菌通常存在于泥土、灰尘、以及粪便。  破伤风在临床上明显的症状为痉挛。最常见的痉挛型态从颚开始,接着进展到身体其余部位。痉挛通常每次持续数分钟,且在三到四周内频繁发生。有些严重痉挛甚至会使患者骨折。其他症状包括发烧、头痛、吞咽困难、高血压、以及心跳过速。症状通常在感染后3天至3周内发生,可能需要数个月康复,然而约10%的感染者会死亡。  破伤风梭状芽胞杆菌会刺激神经中枢,干扰肌肉正常收缩的能力,并引起上述症状。诊断通常依赖患者述说的症状及表现征候,然而此疾病通常不会通过人与人之间的互动而传染。
title: 预防、治疗与预后.
content: 患者在感染可经过适当的接种破伤风疫苗来预防。当伤者有显著伤口,一般而言可用不到三个剂量的疫苗内含有免疫抗体和破伤风免疫球蛋白的破伤风预防注射剂来减轻感染破伤风的可能性。而对伤者也染上破伤风,破伤风预防注射剂或静脉注射免疫球蛋白(intravenous immunoglobulin, IVIG)可择一使用。伤口应清洗并去除任何坏死组织。肌肉松弛剂也可以用来控制痉挛。若病况影响到患者的呼吸,可能要使用。  患者在伤口做好基本处理后,保持干净,保温,避光及不必要的刺激。必要时可注射止痉剂。破伤风免疫球蛋白(TIgG或TIG)500IU(生物活性)深部肌肉注射或用破伤风马血清抗破伤风毒素(TAT)1～2万IU静脉滴注,使用前需先使皮肤测试患者是否会过敏与否,经皮肤测试后的结果若呈现阳性者,需经脱敏治疗。  依照患者伤口干净程度、以及在5或10年内是否曾接受或疫苗注射两个因子,决定是否需追加注射破伤风疫苗。
title: 流行病学史.
content: 破伤风在全世界都可能发生,尤其以湿热气候的区域较常发生,因其泥土通常含有大量有机物质,较适宜破伤风梭状芽孢杆菌存活。在2013年,破伤风造成约59,000人死亡,比起1990年的356,000来的低。根据希波克拉底描述,破伤风至少从公元前5世纪就存在,但直到1884年致病的病原菌才被发现,而1924年才发展出疫苗。

Summary: 破伤风(英语:Tetanus/Lockjaw),俗称四六风、脐带风、七日风,因为在婴儿出生后4至6天,少数早至2天或迟至14天以上发病。当破损的皮肤或粘膜被感染,或新生儿由于切断脐带时被感染,破伤风芽孢杆菌侵入致病。破伤风梭状芽孢杆菌也会对其他有开放性损伤的人或动物侵入而致病。目前死亡率约20-40%。目前破伤风在发达国家已获得控制,主要疫区几乎都集中在发展中国家。

Tetanus: Tetanus, also known as lockjaw, is a bacterial infection characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually lasts a few minutes. Spasms occur frequently for three to four weeks. Some spasms may be severe enough to fracture bones. Other symptoms of tetanus may include fever, sweating, headache, trouble swallowing, high blood pressure, and a fast heart rate. Onset of symptoms is typically three to twenty-one days following infection. Recovery may take months. About ten percent of cases prove fatal. Tetanus is caused by an infection with the bacterium "Clostridium tetani", which is commonly found in soil, saliva, dust, and manure. The bacteria generally enter through a break in the skin such as a cut or puncture wound by a contaminated object. They produce toxins that interfere with normal muscle contractions. Diagnosis is based on the presenting signs and symptoms. The disease does not spread between people. Tetanus can be prevented by immunization with the tetanus vaccine. In those who have a significant wound and have had fewer than three doses of the vaccine, both vaccination and tetanus immune globulin are recommended. The wound should be cleaned and any dead tissue should be removed. In those who are infected, tetanus immune globulin or, if unavailable, intravenous immunoglobulin (IVIG) is used. Muscle relaxants may be used to control spasms. Mechanical ventilation may be required if a person's breathing is affected. Tetanus occurs in all parts of the world but is most frequent in hot and wet climates where the soil has a high organic content. In 2015 there were about 209,000 infections and about 59,000 deaths globally. This is down from 356,000 deaths in 1990. In the US there are about 30 cases per year, almost all of which have not been vaccinated. An early description of the disease was made by Hippocrates in the 5th century BC. The cause of the disease was determined in 1884 by Antonio Carle and Giorgio Rattone at the University of Turin, and a vaccine was developed in 1924.