From the Guidelines
Tetanus symptoms typically begin with trismus (lockjaw), followed by generalized rigidity caused by painful contractions of the skeletal muscles, which can impair respiratory function and lead to death 1. The symptoms of tetanus are caused by the tetanus toxin (tetanospasmin) produced by Clostridium tetani bacteria, which enters the body through nonintact skin and germinates in oxygen-poor sites, such as necrotic tissue. Some key symptoms include:
- Trismus (lockjaw)
- Generalized rigidity
- Painful contractions of the skeletal muscles
- Impaired respiratory function
- Glottic spasm
- Respiratory failure
- Autonomic instability These symptoms can result in death, with a case-fatality ratio of 18% in the United States during 1998-2000 1. It is essential to seek immediate medical attention if tetanus is suspected, as prompt treatment with tetanus immune globulin, antibiotics, wound care, and potentially respiratory support can improve outcomes. The incubation period of tetanus typically ranges from 3-21 days after infection, with shorter incubation periods associated with more severe disease 1.
From the Research
Tetanus Symptoms
- Tetanus is characterized by muscle rigidity and reflex spasms, caused by the neurotoxin tetanospasmin produced by Clostridium tetani 2, 3
- Common symptoms include:
- Severe tetanus can lead to autonomic overactivity, causing labile hypertension, tachycardia, increased secretions, sweating, and urinary retention 3
- Frequent severe spasms can trigger apnea and rhabdomyolysis 3
Clinical Manifestations
- The incubation period of tetanus is usually 3 days to 3 weeks 2
- 75% of patients present with trismus, and reflex spasms are seen in 70% of patients 2
- The disease can progress to respiratory complications, which require aggressive airway management 2
- A serious, late complication is the syndrome of sympathetic nervous system overactivity, treated with alpha and beta blockade 2
Diagnosis and Treatment
- Diagnosis of tetanus can be delayed due to its rarity, and timely diagnosis and proper treatment are crucial to prevent fatal outcomes 4
- Treatment involves reducing muscle spasms, rigidity, and autonomic instability, neutralizing tetanus toxin, wound debridement, and administration of antibiotics 4, 2
- Diazepam may be used alone in mild cases, while severe cases require the addition of nondepolarizing neuromuscular blocking agents and mechanical ventilation 2, 5, 3