Tetanus Clinical Presentation

  • Author: Patrick B Hinfey, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Sep 28, 2011
 

History

Most cases in the United States occur in patients with a history of only partial immunization. Persons who inject drugs also constitute a high-risk group.

  • Symptoms usually begin 8 days after the infection, but onset may range from 3 days to 3 weeks.
  • Patients may report a sore throat with dysphagia (early sign).
  • Localized tetanus causes muscle rigidity at the site of spore inoculation.
  • The initial manifestation may be local tetanus, in which the rigidity affects only 1 limb or area of the body where the clostridium-containing wound is located.
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Physical

Common first signs of tetanus are headache and muscular stiffness in the jaw (ie, lockjaw), followed by neck stiffness, difficulty swallowing, rigidity of abdominal muscles, spasms, and sweating.

  • Patients often are afebrile.
  • Severe tetanus results in opisthotonos, flexion of the arms, extension of the legs, periods of apnea resulting from spasm of the intercostal muscles and diaphragm, and rigidity of the abdominal wall.
  • Late in the disease, autonomic dysfunction develops, with hypertension and tachycardia alternating with hypotension and bradycardia.
  • Patients may have reflex spasms of the masseters muscles when the posterior pharyngeal wall is stimulated that cause them to bite down as opposed to gag (spatula test).[7]
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Causes

The source of infection usually is a wound (~65%), which often is minor (eg, wood or metal splinters, thorns). Chronic skin ulcers are the source in approximately 5% of cases, and in the remainder of cases, no obvious source is identified.

The US Centers for Disease Control and Prevention (CDC) statistics from 1982-84 are as follows:

  • Infected lacerations or puncture wounds (69%)
  • Infected chronic wounds and abscesses (20%)
  • Exposure via intravenous drug abuse (3%)
  • Neonates (1%)
  • Other or no identifiable cause (7%)

Possible causes not usually associated with tetanus

  • Otitis media
  • Burns
  • Intranasal foreign bodies
  • Corneal abrasions
  • Foreign bodies
  • Dental or surgical procedures
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Contributor Information and Disclosures
Author

Patrick B Hinfey, MD  Research Director and Associate Residency Director, Department of Emergency Medicine, Newark Beth Israel Medical Center; Clinical Assistant Professor of Emergency Medicine, New York College of Osteopathic Medicine

Patrick B Hinfey, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Stroke Association, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jill Ripper, MD, MS  Residency Director, Newark Beth Israel Medical Center

Jill Ripper, MD, MS is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Christian August Engell, MD  Attending Physician, Department of Infectious Diseases, Newark Beth Israel Medical Center

Christian August Engell, MD is a member of the following medical societies: Infectious Diseases Society of America and Infectious Diseases Society of New Jersey

Disclosure: Nothing to disclose.

Keith N Chappell, MD  Administrative Chief Resident, Junior Attending Resident, Department of Emergency Medicine, Newark Beth Israel Medical Center

Disclosure: Newark Beth Israel Medical Center Salary Employment

Specialty Editor Board

Gregory William Rutecki  MD, Professor of Medicine, University of South Alabama Medical School

Gregory William Rutecki is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Nephrology, National Kidney Foundation, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard B Brown, MD, FACP  Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Eleftherios Mylonakis, MD, to the development and writing of this article.

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