Tetanus signs and symptoms

Overview

It is an infectious but not contagious disease, brought about by direct inoculation of material containing the causative agent Clostridium tetani. Clostridium tetani is commonly inhabiting in the soil especially if fertilized with manure. They are long, slender, gram positive bacilllus (can only be seen on a microscope) that form spores which are extremely resistant to heat and ordinary antiseptics. These are anaerobic (does not grow in the presence of oxygen) and multiplies only at the site of the wound. They produce a harmful effect by releasing a true soluble toxin (tetanospasmin) which reaches the brain and spinal cord which causes muscle spasm. People sometimes refer this as "Lockjaw".

Incubation period & Mode of Transmission

Commonly 5 - 10 days but may vary from 2 days to several weeks or longer, depending on the extent, location, and character of the wound. A short duration period gives a bad prognosis: the longer the incubation period the greater the chance of recovery.

Normally, the mode of transmission is through punctured wound that is contaminated by dust, soil, or animal feces containing C. tetani.

  • Rugged traumatic wounds and burns
  • Umbilical stump in newborn especially for babies delivered at home with faulty cord dressing; babies delivered to mothers without tetanus toxoid immunization.
  • Unrecognized wounds (cleaning if the ears with sharp objects).
  • Dental extraction, circumcision, and ear piercings.

Signs and Symptoms

  • Stiffness in the neck, the jaw muscles, abdomen or limbs which either rapidly or gradually increase until the jaws are locked (trismus) and cannot be opened. Masseter muscle is dominant.
  • The lips protrude and the corners of the mouth are drawn out of shape, giving rise to the sardonic grin (risus sardonicus). Heightened by stimulation elevation of eyebrows and wrinkling of the forehead, the eyes remain partially closed.
  • The head retract, other muscles of the body become spastic, the back become bowed and stiffened, patients rests on his head and heels (opisthotonos).
  • Slightest stimulation of the patient causes frightful convulsions and causes unbearable pain. Voluntary movements are not possible. Convulsion last from a few seconds to several minutes and from a few to an almost continuous seizure during a 24-hour period.

Types of stimuli:

exteroceptives - outside the patient; bright lights and loud noises.

interoceptives - from the patient himself; flatus.

proprioceptives - touching the patient, jarring the bed and turning the patient.

  • Low-grade fever with profuse sweating, difficulty breathing and swallowing.
  • Cyanosis because of laryngeal spasms and secretions, may have urinary retention and constipation as well.

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