Clinical Features of Tetanus

Key points

  • There are three forms of tetanus with varying clinical presentations.
  • Tetanus is diagnosed based on clinical signs and medical history.
  • Tetanus is a medical emergency that requires hospitalization and often causes complications.
A woman with a stiff neck or sore jaw.

Clinical presentations

There are three forms of tetanus:

  • Generalized
  • Localized
  • Cephalic

Generalized

Generalized tetanus is the most common form of the disease. It accounts for more than 4 in 5 cases.

Neonatal tetanus is a form of generalized tetanus. It occurs in newborns who lack the passive protection derived from maternal antibodies.

Localized

Localized tetanus is an unusual form of the disease. It's possible for it to progress to generalized tetanus.

It typically occurs in people with partial tetanus immunity.

Cephalic

Cephalic tetanus is the rarest form. It's associated with lesions of the head or face. It may be associated with otitis media. It's possible for it to progress to generalized tetanus.

Common signs and symptoms

newborn infant with a stiff (spasm) arched back and nasal tube suffering from tetanus disease
This baby has bodily rigidity due to neonatal tetanus.

Generalized tetanus

Painful muscular contractions are characteristic of tetanus:

  • Difficulty in swallowing or breathing
  • Generalized spasms (frequently induced by sensory stimuli)
  • Rigidity
  • Seizures
  • Trismus, or lockjaw painful muscle contractions

Localized tetanus

Like generalized tetanus, localized tetanus is characterized by painful muscle spasms. However, they're in a confined area close to the injury site.

Cephalic tetanus

Unlike the other two forms, cephalic tetanus results in flaccid cranial nerve palsies rather than spasm.

Common first signs in older children and adults‎‎

Abdominal rigidity is a common first sign suggestive of tetanus in older children and adults. However, it's sometimes confined to the region of injury. Generalized spasms occur, frequently induced by sensory stimuli.

Clinical assessment

Tetanus is a clinical syndrome without confirmatory laboratory tests.

Note: History of an injury or apparent portal of entry may be lacking. In addition, healthcare providers rarely recover tetanus bacteria from the site of infection.

Keep Reading: Clinical Care of Tetanus

Complications

Nervous system abnormalities, as well as a variety of complications related to severe spasms and prolonged hospitalization, can accompany generalized tetanus.

Complications of tetanus can also include:

  • Aspiration pneumonia
  • Fractures
  • Hypertension
  • Laryngospasms
  • Nosocomial infections
  • Pulmonary embolism
  • Death
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Content Source:
National Center for Immunization and Respiratory Diseases; Division of Bacterial Diseases