Antitoxin Health Dictionary

Diphtheria is an acute infectious disease of the respiratory tract. Rarely seen in the UK since the introduction of inoculation in 1940, it is still an important cause of disease in many parts of the world. The infection is caused by the Corynebacterium diphtheriae and is spread by water droplets. It usually presents with a sore throat, and there is a slightly raised membrane on the tonsils surrounded by an in?ammatory zone. There may be some swelling of the neck and lymph nodes, though the patient’s temperature is seldom much raised. Occasionally the disease occurs in the eye or genital tract, or it may complicate lesions of the skin. More serious consequences follow the absorption of TOXINS which damage the heart muscle and the nervous system.

Treatment Provided that the patient is not allergic to horse serum, an injection of the antitoxin is given immediately. A one-week course of penicillin is started (or erythromycin if the patient is allergic to penicillin). Diphtheria may cause temporary muscle weakness or paralysis, which should resolve without special treatment; if the respiratory muscles are involved, however, arti?cial respiration may be necessary.

All infants should be immunised against diphtheria; for details see table under IMMUNISATION.... diphtheria

Also called LOCKJAW, this is a bacterial infection of the nervous system. Increased excitability of the SPINAL CORD results in painful and prolonged spasms of the voluntary muscles throughout the body, rapidly leading to death unless treated.

Causes The disease is caused by the bacillus Clostridium tetani, found generally in earth and dust and especially in places where animal manure is collected. Infection usually follows a wound, especially a deeply punctured or gunshot wound, with the presence of some foreign body. It is a hazard in war and also among farmers, gardeners and those in the construction industry. The bacillus develops a toxin in the wound, which is absorbed through the motor nerves into the spinal cord where it renders the nerves excitable and acutely sensitive to mild stimuli.

Symptoms Most commonly appearing within four to ?ve days of the wound, the patient’s symptoms may be delayed for several weeks – by which time the wound may have healed. Initially there is muscle sti?ness around the wound followed by sti?ness around the jaw, leading to lockjaw, or trismus. This extends to the muscles of the neck, back, chest, abdomen, and limbs, leading to strange, often changing, contorted postures, accompanied by frequent seizures – often provoked by quite minor stimuli such as a sudden noise. The patient’s breathing may be seriously affected, in severe cases leading to ASPHYXIA; the temperature may rise sharply, often with sweating; and severe pain is common. Mental clarity is characteristic adding to the patient’s anxiety. In severe infections death may be from asphyxia, PNEUMONIA, or general exhaustion. More commonly, the disease takes a chronic course, leading to gradual recovery. Outcome depends on several factors, chie?y the patient’s immune status and age, and early administration of appropriate treatment.

Tetanus may occur in newborn babies, particularly when birth takes place in an unhygienic environment. It is particularly common in the tropics and developing countries, with a high mortality rate. Local tetanus is a rare manifestation, in which only muscles around the wound are affected, though sti?ness may last for several months. STRYCHNINE poisoning and RABIES, although similar in some respects to tetanus, may be easily distinguished by taking a good history.

Prevention and treatment The incidence of tetanus in the United Kingdom has been almost abolished by the introduction of tetanus vaccine (see IMMUNISATION). Children are routinely immunised at two, three and four months of age, and boosters are given later in life to at-risk workers, or those travelling to tropical parts.

Treatment should be started as soon as possible after sustaining a potentially dangerous wound. An intravenous injection of antitoxin should be given immediately, the wound thoroughly cleaned and PENICILLIN administered. Expert nursing is most important. Spasms may be minimised by reducing unexpected stimuli, and diazepam (see BENZODIAZEPINES; TRANQUILLISERS) is helpful. Intravenous feeding should be started immediately if the patient cannot swallow. Aspiration of bronchial secretions and antibiotic treatment of pneumonia may be necessary.... tetanus

A complex systemic reaction that may become evident any time up to 14 days after antivenom or antitoxin use. Symptoms are fever, generalised lymphadenopathy and an urticarial rash. Severe cases of serum sickness may have to be treated with oral steroids. The incidence of serum sickness is often related to the amount of antivenom used.... serum sickness

A toxin (see TOXINS) which has been rendered non-toxic by certain chemicals, or by heat, or by being partly neutralised by antitoxin. The best-known example is DIPHTHERIA toxoid. (See also IMMUNITY.)... toxoid

A poison released by certain types of bacteria that enters the bloodstream and causes widespread effects around the body. Exotoxins are among the most poisonous substances known. Infections by tetanus, diphtheria, and some other bacteria that release lifethreatening exotoxins can be prevented by immunization. Treatment of such infections usually includes administration of antibiotic drugs and an antitoxin. (See also endotoxin; enterotoxin.)... exotoxin

n. a poison produced by a living organism, especially by a bacterium (see endotoxin; exotoxin). In the body toxins act as *antigens, and special *antibodies (antitoxins) are formed to neutralize their effects.... toxin

Poisons produced by BACTERIA. (See also IMMUNITY; IMMUNOLOGY; MICROBIOLOGY.) Toxins are usually soluble, easily destroyed by heat, sometimes of the nature of crystalline substances, and sometimes ALBUMINS. When injected into animals in carefully graduated doses, they bring about the formation of substances called antitoxins which neutralise the action of the toxin. These antitoxins are generally produced in excessive amount, and the SERUM of the animal when withdrawn can be used for conferring antitoxic powers upon other animals or human beings to neutralise the disease in question. The best known of these antitoxins are those of DIPHTHERIA and TETANUS. Toxins are also found in many plants and in snake venom.

Some toxins are not set free by bacteria, but remain in the substance of the latter. They are known as endotoxins and are not capable of producing antitoxins.... toxins

Most snake bites are by nonvenomous species. Venomous snakes are found mainly in the tropics; the only species native to the is the adder.

The effects of a venomous bite depend on the species and size of the snake, the amount of venom injected, and the age and health of the victim. A bite from an adder or other viper typically causes immediate pain and swelling at the site, followed by dizziness and nausea, a drop in blood pressure, an increase in heart-rate, and internal bleeding.

Antibiotic drugs and tetanus antitoxin injections are given for all bites to prevent infection and tetanus.

An injection of antivenom is also given for a venomous bite.

With prompt treatment, most victims recover completely.... snake bites