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Tetanus (cont.)

What Are the Symptoms and Signs of Tetanus?

The hallmark feature of tetanus is muscle rigidity and spasms. The median incubation period is seven days with a range from about four to 14 days. The shorter the incubation period, usually the more severe are the symptoms.

Picture of opisthotonus or arched back due to muscle spasms in a person with generalized tetanus
Figure 2: Picture of opisthotonus or arched back due to muscle spasms in a person with generalized tetanus. Source: CDC
  • 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.

  • 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.

When to Call a Doctor for Tetanus

When to call the doctor

  • Individuals should know if their tetanus immunization is current; often primary-care physicians have immunization records and may be able to supply people with that information.
  • If people have a wound, they should seek medical attention. If they are not immunized against tetanus or have not kept up tetanus booster shots every 10 years, any open wound is at risk of developing tetanus. Many emergency physicians advise a tetanus booster be given if the patient's last booster is between 5 to 10 years old because patients may not accurately recall the date of their last booster and also because not all patients' immune systems will give 10-year protection following the vaccine.

When to go to the hospital

  • Most doctors can care for minor wounds with mild degrees of contamination. In addition, most doctors maintain tetanus vaccines in their offices and can, if they have the records, vaccinate anyone who is inadequately immunized. Call the patient's doctor and follow his or her advice regarding whether or not they should seek treatment in a hospital's emergency department after an injury or wound.
  • If the wound is large, contains crushed tissues, or is heavily contaminated, individuals should go to the nearest hospital's emergency department for evaluation. Occasionally, both a tetanus booster and tetanus antibodies are required if patients have any wound that is tetanus-prone. Tetanus antibodies are reserved for people with incomplete immunizations with a tetanus-prone wound.
  • If individuals have a recent injury and are starting to experience muscle cramps or spasms at or near the injury, they should go to a hospital's emergency department immediately.
  • If individuals have trouble swallowing or have muscle spasms in the facial muscles, go to the emergency department for treatment immediately.
Last Reviewed 12/29/2017

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The word tetanus comes from the Greek tetanos, which is derived from the term teinein, meaning to stretch.

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