Symptoms and Signs of Tetanus (Lockjaw)

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 8/30/2021

Doctor's Notes on Tetanus (Lockjaw)

Tetanus is an infectious disease caused by the contamination of wounds with the Clostridium tetani bacterial spores that live in the soil, dust, and animal waste. The bacteria can enter the body through puncture wounds, such as those caused by rusty nails, splinters, and insect bites. Any break in the skin, burns, and IV drug access sites are also potential entryways for the bacteria. 

Symptoms of tetanus include

Facial muscles are often affected and lockjaw is common. Muscle spasms are progressive and may include a characteristic arching of the back (opisthotonus), and maybe intense enough to cause broken bones and dislocated joints. In severe cases, muscle spasms may involve the vocal cords or breathing muscles and can result in death if there is no medical intervention. In neonates, symptoms of tetanus may also include irritability and poor sucking ability, or difficulty swallowing.

What is the Treatment for Tetanus?

Infections with tetanus are usually severe and life-threatening. Tetanus is a medical emergency requiring:

  • Care in the hospital
  • Immediate treatment with medical antitoxin called human tetanus immune globulin (TIG)
  • Aggressive wound care 
  • Drugs to control muscle spasms
  • Antibiotics
  • Sedatives such as benzodiazepines and other muscle relaxers to treat extreme muscle spasm and injury
  • Intravenous (IV) hydration and electrolyte replacement
  • Tetanus vaccination
  • Depending on how serious the infection is, a machine to help you breathe may be required

The prognosis of infection with tetanus depends on the availability and quality of treatment. In 25-50% of cases, generalized tetanus infections are fatal. Death is usually caused by respiratory failure or heart arrhythmia caused by electrolyte abnormalities. Patients older than 65 are more likely to die of a tetanus infection. In many countries that have poor access to intensive or modern healthcare, the mortality rate is 60-80%.

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.