Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The hallmark feature of tetanus is muscle rigidity and spasms.
In generalized tetanus, the initial complaints may include any of the following:
Irritability, muscle cramps, sore muscles, weakness, or difficulty swallowing are commonly seen.
Facial muscles are often affected first. Trismus or lockjaw is most common. This condition results from spasms of the jaw muscles that are responsible for chewing. A sardonic smile
-- medically termed risus sardonicus -- is a characteristic feature that results from facial muscle spasms.
Muscle spasms are progressive and may include a characteristic arching of the back known as opisthotonus
(Figure 2). Muscle spasms may be intense enough to cause bones to break and joints to dislocate.
Severe cases can involve spasms of the vocal cords or muscles involved in breathing. If this happens, death is likely, unless medical help
(mechanical ventilation with a respirator) is readily available.
Figure 2: Picture of opisthotonus or arched back due to muscle spasms in a person with generalized tetanus; SOURCE: CDC
In cephalic tetanus, in addition to lockjaw, weakness of at least one other facial muscle occurs. In two-thirds of these cases, generalized tetanus will develop.
In localized tetanus, muscle spasms occur at or near the site of the injury. This condition
can progress to generalized tetanus.
Neonatal tetanus is identical to generalized tetanus except that it affects the newborn infant.
Neonates may be irritable and have poor sucking ability or difficulty swallowing.