II. Answer the following questions:

1. What is tetanus?

2. How can an individual contract this disease?

3. What are the clinical manifestations of tetanus?

4. What can you say about epidemiology of this disease?

5. What is the incubation period of tetanus?

6. What forms of tetanus have been described by the infectionists?

III. Read the text «Treatment of tetanus» and make up a dialogue between a professor and a medical student discussing treatment options of a tetanus case. Treatment

The wound must be cleaned. Dead and infected tissue should be removed by surgical debridement. Metronidazole treatment decreases the number of bacteria but has no effect on the bacterial toxin. Penicillin was once used to treat tetanus, but is no longer the treatment of choice, owing to a theoretical risk of increased spasms. However, its use is recommended if metronidazole is not available. Passive immunization with human anti-tetanospasmin immunoglobulin or tetanus immune globulin is crucial. If specific anti-tetanospasmin immunoglobulin is not available, then normal human immunoglobulin may be given instead. All tetanus victims should be vaccinated against the disease or offered a booster shot.

An infant suffering from neonatal tetanus.

Mild tetanus

Mild cases of tetanus can be treated with: tetanus immune globulin IV or IM, metronidazole IV for 10 days, diazepam, tetanus vaccination

Severe tetanus

Severe cases will require admission to intensive care.

Lock-jaw in a patient suffering from tetanus.

Drugs such as diazepam or other muscle relaxants can be given to control the muscle spasms. In extreme cases it may be necessary to paralyze the patient with curare-like drugs and use a mechanical ventilator.

In order to survive a tetanus infection, the maintenance of an airway and proper nutrition are required. An intake of 3500-4000 Calories, and at least 150g of protein per day, is often given in liquid form through a tube directly into the stomach, or through a drip into a vein. This high-caloric diet maintenance is required because of the increased metabolic strain brought on by the increased muscle activity

Make up a dialogue between the Professor and student:

P. This patient presents with generalized tetanus.

Infection has occurred through wound contamination.

What manipulations should be done at first?

S. –

P. What medicine decreases the number of bacteria?

What is the prescribed dose?

S. –

P. What is diazepam used for?

S. –

P. What is your opinion? Should this tetanus victim be vaccinated against the disease?

S. –

P. What steps would you undertake in severe cases?

S. –

IV. Listen the text “Tetanus” and retell it in Russian.

V. Make the sentences complete:

Tetanus is an acute infectious disease affecting … It is caused by … Infection occurs by the contamination of wounds by … Bacteria multiply … Produced toxin irritates nerves so that they … Symptoms appear … Symptoms consist of … In severe cases the spasm may affect … If respiratory muscles are affected … Mortality is high in … Prompt treatment is … Immunization against tetanus is effective but …	a) the bacterium Clostridium tetani.
	b) at 4 to 25 day after infection.
	c) the nervous system.
	d) at the site of infection.
	e) the whole body.
	f) temporary.
	g) bacterial spores.
	h) a tracheotomy or intubation and ventilation is essential.
	i) cause spasmodic contraction of muscles.
	j) untreated cases.
	k) muscle stiffness, spasm and subsequent rigidity.
	l) effective.