Thursday, September 14, 2017

Dealer's Choice

Clostridium tetani spore (@about 12,000X magnification):
6350 of these to the inch
125 end to end would be the width of this period: .
98,000 of them would fit on it.

Clostridium tetani is an evil little sonofabitch. It exists as a dormant spore in dust, soil, feces, and manure, as well as flood waters, and in the mouths of dogs, cats, and other animals*. (Cats bury their poop with their paws, then lick their paws, and their butts; dogs lick their butts, eat poop, and drink from your toilet bowl. Neither of them brushes their teeth. You do the math on how that works if they bite you.) Because it lives in dirt and dust, it's also found on your own skin. (Which is one reason why mommy/your drill instructor always told you to wash your hands and bathe your nasty @$$.) It can also live in contaminated substances, e.g. heroin. Neither "cooking" in a junkie spoon, nor boiling in water for 15 minutes reliably kills all the spores. It is not contagious, and does not pass from person to person. The spores are robust, readily surviving extremes of heat, cold, wet, or dryness, and can hang around dormant for decades. The disease was described as far back as Hippocrates in the 5th Century B.C.

It is therefore endemic and ubiquitous throughout the world, and doesn't just live on rusty nails, it lives everywhere. The little bastard is opportunistic, remaining dormant until it's able to enter living tissue through a cut, scrape, or especially a puncture. Any break in the skin is sufficient to admit it. Once they find a nice, oxygen-starved location, the anaerobic spores mature and become bacterium, which multiply like bacteria does, and produces as a by-product of its cellular function tetanospasmin, a potent and frequently fatal neurotoxin, along with tetanolysin, which cause destruction of tissue.

We call this infection Tetanus.

The bacterium prefer nerve tissue, gaining entry, and transmitting along the cells of the nervous system until it reaches the central nervous system. It binds and inhabits the nerve tissue permanently and irreversibly, and by actions too long and arcane to describe here, stops the nerves from turning off once they turn on, which leads to severe muscle spasms, progressing to death about 10% of the time, even with treatment.
Incubation is typically about 7-10 days, sometimes several weeks, and death can occur within four days.
The shorter nerves are affected first, leading to the characteristic "sardonic smile", and lockjaw, which is exactly what it sounds like. Other symptoms include general irritability, muscle stiffness, difficulty swallowing (which leads to drooling), fever (from muscle contractions), sweating (from the fever), difficulty breathing (from muscular paralysis), and heart attack/cardiac failure (from not being able to breathe). The muscle spasms can be severe enough to break bones, including the spinal bones, and in terminal cases, the victim will be lying on a bed taut as a bowstring, with only head and heels on the bed, the body arched backwards, wracked in pain, until eventually suffocation and death occur. While you're wide-eyed, awake, and aware of it, and totally helpless in suffering a particularly gruesome (and wholly preventable) death.

There were 300,000+ deaths from it as recently as 1990, and it killed 56,000+ worldwide in 2015, nearly 20K of them newborns. (Until they got their act together, it killed 2400 newborns out of 3600 or so who contracted it, annually, in Uganda. It enters through the umbilical stump. Now you know why neonatal nurseries are such pricks about making you wash and gown and glove to visit.) Most of them clustered in Africa, Southwest Asia/India, and parts of South America. In other words, the exact poverty-wracked Third World shitholes with minimal medical care for vast swaths of the population where you'd expect it to be most prevalent.
In non-fatal cases, the symptoms can persist for months, as the disease only passes as the nerves are regrown, with recovery taking as long as several months.

All of this assumes first-world access to medications to treat the symptoms, and possibly intubation and mechanical ventilation.

All of this is problematic in a disaster, societal collapse, or any trip outside of modern society.

Disasters don't make reservations.

Keep your tetanus (usually Tdap - tetanus, diphtheria, and accelular pertussis, aka Whooping Cough, because the latter two are making a comeback, thanks to hordes of unvaccinated legal and illegal alien arrivals here from the rest of the world - Thanks!) shot up-to-date. Period.

They're good for ten years for minor cuts and punctures, and 5 years for major (deep/dirty) wounds, so get a booster at least every tenth year. The only likely harm getting boosters every 5 years is to your wallet.

Keep track of your last shot, and get the booster on time, every time.
(My standard ER benediction is for you to write the vaccination date on a Post-it, and stick it to the back of your driver's license, which, hereabouts anyways, is good for - ten years - meaning if you forget, you can remember to check your ID, and if the note is gone, because the ID is gone, it's time for a booster, isn't it? See how easy that is?)

Untreated tetanus infection is lethal in 10% of cases. The US averages about 30 cases/year, and no fatalities. After the window of initial injury (+/- 72 hours is the ER rule of thumb) when a booster will probably work, there's nothing anyone can do to turn it around if you get it, except manage the symptoms (to the limit of what you have to do that - think SHTF/no hospital/on safari in BFAfrica).

So you can roll the dice with an excruciating, debilitating, and frequently fatal disease.

Or you can get your frickin' tetanus booster in a timely manner.

Horrible death or Tiny needle? Horrible death or Tiny needle? Decisions, decisions.

Dealer's choice.

*(Also horses, cattle, sheep, chickens, rats, and guinea pigs.)

Wikipedia link
Mayo Clinic link
WebMD link


loren said...

Down in Oz one day I was sweeping a garage floor when the metal broom handle shaped on my hand and tore the end of my finger to shreds. The RN EX-wife put it back together with steri strips (her house) and I went off to the GP for a booster. Come back in a week was the reply, so went to the local ER. Asked how long the wait. Answer was whenever we get through all these drug OD's and other more important horrors which in that city was never.
Went to the lone after hours GP and waited 2 hours for him to open. I was second in line when a guy rocks up with a kid in tow Kid had a bandaged hand and dad was holding a jar with a finger in it. Said come right up the the front here with me. Asked the nurse or whatever the fuck he was how many docs were working. Finally got an answer - 1.
Never did get that shot.
Guess if you want to get treated, don't get a little hurt.

Anonymous said...

Living on the farm I get all manner of cuts and pokes on a regular basis. Ran a piece of wire into my calf sickeningly deep right above my boot a couple of weeks ago. When I go to the doc it's noted on my chart to keep up with tetanus shots. Got a booster last Christmas when I ripped the nail off my big toe (well, mostly. I had to finish tearing it off with vice grips). Good times.

MMinWA said...

Thank you for that reminder, I'm going to take care of that ASAP. I get all kinds of cuts and punctures working with glass.

Anonymous said...

Back when my mom was a girl (she was born in 1919) her cousin burned himself with a cap gun, and died of "lockjaw", this is why I wasn't allowed to have caps in my toy guns as a kid. I don't know when tetanus shots became a thing, but I assume it was later.

Mark D

Aesop said...

The vaccine was invented 1923, and saved a lot of lives in WWII.
I don't know when it went from "good idea" to "damned near mandatory", but the fall in worldwide death rates where the vaccine is normative speaks to how well it's worked.

Bill gates and his wife are spending their money to wipe out polio. Good for them.
Some other rich schlub should commit to wiping out tetanus. It would be a godsend in the trashcanistans (Afghanistan itself is one of the worst sufferers, BTW) I mentioned.

loren said...

Polio can be controlled when the last infected person is isolated, like Smallpox and the common cold perhaps. Tetanus lives in the environment like Influenza (as you wrote). We'll never be safe unless inoculated.
I've always thought Gates could do more good by designing and paying for clean water and reliable waste systems than medicine. Engineers and plumbers have saved more lives than doctors ever though about. Course it's his money so he can do as he wishes and good on him for doing it.
That assumes of course that a larger third world population is a good thing for the human race.

Aesop said...

Polio is a virus, and as long as there's a virus, no one is safe.
And although it's a bacteria, one never builds up an immunity to tetanus.
Either way, wiping out disease is never a bad thing. As for third world populations, when they stop dying off by the score, the populations tend to reach homeostasis, and everyone settles down to living their lives instead of trying to outbreed natural selection.

The way to solve the third world is to make it stop being the third world.

Nota bene that but for the happy intervention of British colonialism and some hardy prison stock a couple of centuries hence, Oz would be part of the same yellow-to-orange area on the epidemiological map. As likewise would my happy little republic.

Introduce some dominant culture to such lands, and a lot of problems get solved, politically incorrect as it may be to note such. One need only look at Rhodesia cum Zimbabwe, and South Africa, to observe the rise and decline of such nations when rampant Western culture is removed by ignorant tribalism. Chaos ensues, followed inevitably by the Four Horsemen.

loren said...

:As for third world populations, when they stop dying off by the score, the populations tend to reach homeostasis, and everyone settles down to living their lives instead of trying to outbreed natural selection."
A common thought and one without merit or example.
Name one non white country that has a stable population. Korea perhaps. China working at it. Japan's is declining.
Course I can't really think of any country that has gone from third to first in the in any event.
Your last paragraph is mostly true.
S. Africa was mostly un-populated when the Dutch moved in. Just a few nomadic Bushmen. The chaos came later with immigrating Zulus and a few other tribes and allowed to fester. Rhodesia is a classic of course.
Not sure about Oz. The Aboriginals are still dysfunctional. Mostly because they're just too damn stupid to live in a Western society, exasperated by progressive policies.

The Gray Man said...

No no no... I was told that vaccines are poison created by JOOS!

But really, as a RN, I approve this message.

The Gray Man said...

Also, your map of the world looks like all of the other color coded maps... Africa is ALWAYS shaded differently from the rest of the world due to their complete lack of ability to live as civilized human beings.