Tetanus

Caused by Clostridium tetani. May occur from one day to several months after injury. Neonatal tetanus can occur from contamination of the umbilical stump.

Clinical features

• Prodrome: fever, malaise, headache
• Trismus — inability to open the mouth (“lockjaw”)
• Risus sardonicus — a grin-like effect from hypertonic facial muscles
• Opisthotonos — rigid arching of the back
• Spasms, precipitated by minimal stimuli

Differential diagnosis: phenothiazine (dystonic) reaction, strychnine poisoning, rabies, dental abscess.

Management

• Refer to hospital.
• Human tetanus immunoglobulin (neutralises unbound toxin) + tetanus antitoxin.
• Wound debridement, antibiotics (metronidazole), and supportive care (spasm control, airway/ventilation).

Prevention is by immunisation — see the wound-management tetanus-prophylaxis schedule (booster ± immunoglobulin based on wound type and vaccination history).