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==Overview==
 
The history of a patient presenting with tetanus typically reveals soil, rust containing metal or manure related contamination of an injury or a wound. A history of puncture wounds, burns, scratches by animals, [[fractures]], and surgical wounds in a patient presenting with symptoms of tetanus may be indicative of a tetanus infection. [[Trismus]], or [[lockjaw]], [[spasms]] of the facial muscles ([[risus sardonicus]]), neck [[stiffness]] and swallowing difficulty are common symptoms of tetanus.<ref name="urlTetanus | Symptoms and Complications | Lockjaw | CDC">{{cite web |url=https://www.cdc.gov/tetanus/about/symptoms-complications.html |title=Tetanus &#124; Symptoms and Complications &#124; Lockjaw &#124; CDC |format= |work= |accessdate=}}</ref><ref>{{Cite journal
| author = [[Anisha Doshi]], [[Clare Warrell]], [[Dima Dahdaleh]] & [[Dimitri Kullmann]]
| title = Just a graze? Cephalic tetanus presenting as a stroke mimic
| journal = [[Practical neurology]]
| volume = 14
| issue = 1
| pages = 39–41
| year = 2014
| month = February
| doi = 10.1136/practneurol-2013-000541
| pmid = 24052566
}}</ref>Common iatrogenic sources of infection that may be revealed in a patient's history include recent surgeries on the [[gastrointestinal tract]] or [[Abortion|abortions]]. History of recent accident or an injury leading to a break in the continuity of the skin in a contaminated environment is helpful in making a diagnosis.


==History and Symptoms==
==History and Symptoms==
The incubation period of tetanus ranges from 3 to 21 days, with an average onset of clinical presentation of symptoms in 8 days. In general, the farther the injury site is from the [[central nervous system]], the longer the incubation period. The shorter the incubation period, the higher the chance of death. In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days. On the basis of clinical findings, four different forms of tetanus have been described.
Tetanus infection is a clinical diagnosis that must be suspected in patients with:
*An injury involving contact of broken skin with contaminated environment, soil or dust.
*An absent or inconsistent history of [[Immunization|immunizations]].
The history of a patient presenting with tetanus typically reveals soil, rust containing metal or manure related contamination of an injury or a wound. Punctured wounds, burns, scratches by animals, fractures, otitis media and surgical wounds that are contaminated, these can be related to surgeries on the gastrointestinal tract or abortions. Contamination of the umbilical cord may also be an important history finding.<ref name="WHO_2000">{{cite web | title=Maternal and Neonatal Tetanus Elimination by 2005 | author=World Health Organization | date=2000-11-01 | url=http://www.unicef.org/immunization/files/MNTE_strategy_paper.pdf#search=%22neonatal%20tetanus%20rates%22 | accessdate=2007-01-26}}</ref><ref>{{Cite journal
| author = [[Lisa Mitchell]], [[William Adams]] & [[Francois Aspesberro]]
| title = Case 6: Episodic Stiffness in a 30-month-old Girl
| journal = [[Pediatrics in review]]
| volume = 38
| issue = 1
| pages = 52–53
| year = 2017
| month = January
| doi = 10.1542/pir.2014-0142
| pmid = 28044038
}}</ref><ref>{{Cite journal
| author = [[Martha H. Roper]], [[Jos H. Vandelaer]] & [[Francois L. Gasse]]
| title = Maternal and neonatal tetanus
| journal = [[Lancet (London, England)]]
| volume = 370
| issue = 9603
| pages = 1947–1959
| year = 2007
| month = December
| doi = 10.1016/S0140-6736(07)61261-6
| pmid = 17854885
}}</ref>
 
*Punctured wounds
*[[Burns]]
*Scratches by animals
*[[Fractures]]
*[[Otitis media]]
*Surgical wounds that are contaminated
**Gastrointestinal tract surgeries
**Abortion
*Contamination of the [[umbilical cord]]
**Unhygienic clamping
**Covering with juice or cow dung
 
'''Local Tetanus'''
 
*Localized injury
*Contaminated wound
*Spasmodic contraction limited to area of injury
*May continue for weeks
*Can lead to features of generalized tetanus
 
'''Cephalic Tetanus'''
 
*Rare
*Associated with [[otitis media]] (ear infections with C. tetani present in the middle ear), or after head injuries
*[[Cranial nerve]] involved specially facial area


'''Local tetanus''' is an uncommon form of the disease, in which patients have persistent contraction of muscles in the same anatomic area as the injury. The contractions may persist for many weeks before gradually subsiding. Local tetanus is generally milder; only about 1% of cases are fatal, but it may precede the onset of generalized tetanus.
'''Generalized Tetanus'''  


'''Cephalic tetanus''' is a rare form of the disease, occasionally occurring with [[otitis media]] (ear infections) in which C. tetani is present in the flora of the middle ear, or following injuries to the head. There is involvement of the [[cranial nerve]]s, especially in the facial area.
*Descending muscle spasm
*The first sign is [[trismus]] or lockjaw. It can be followed by
**Neck stiffness
**Swallowing difficulty
**Stiffening of the calf and pectoral muscle groups


'''Generalized tetanus''' is the most common type of tetanus, representing about 80% of cases. The generalized form usually presents with a descending pattern. The first sign is [[trismus]] or lockjaw, followed by stiffness of the neck, difficulty in swallowing, and rigidity of pectoral and calf muscles. Other symptoms include elevated temperature, sweating, elevated [[blood pressure]], and episodic rapid heart rate. [[Spasm]]s may occur frequently and last for several minutes. Spasms continue for 3–4 weeks and complete recovery may take months.
*Some other symptoms of tetanus may include:
**Temperature elevation
**Sweating
**[[Blood pressure]] elevation
**Episodes of tachycardia
*Episodic [[spasm]]s (for minutes), may remain occur for weeks to  months
*History of cephalic or localized tetanus
*History of injury


'''Neonatal tetanus''' is a form of generalized tetanus that occurs in newborn infants. It occurs in infants who have not acquired passive [[immunity (medical)|immunity]] because the mother has never been immunized. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. Neonatal tetanus is common in many developing countries and is responsible for 14% (215,000) of all neonatal deaths, but is very rare in developed countries.<ref name=WHO_2000>{{cite web | title=Maternal and Neonatal Tetanus Elimination by 2005 | author=World Health Organization | date=2000-11-01 | url=http://www.unicef.org/immunization/files/MNTE_strategy_paper.pdf#search=%22neonatal%20tetanus%20rates%22 | accessdate=2007-01-26}}</ref>
'''Neonatal Tetanus'''  


The infection causes painful tightening of the [[muscles]], usually all over the [[body]]. It can lead to "locking" of the [[jaw]], which makes it impossible to open your [[mouth]] or [[swallow]]. If this happens, you could [[die]] of [[suffocation]].
Neonatal tetanus may present with a history and symptoms of:<ref>{{Cite journal
*[[Trismus]], or [[lockjaw]]
| author = [[Martha H. Roper]], [[Jos H. Vandelaer]] & [[Francois L. Gasse]]
*Facial [[spasms]] called [[risus sardonicus]]
| title = Maternal and neonatal tetanus
*[[Stiffness]] of the [[neck]]
| journal = [[Lancet (London, England)]]
*Difficulty in swallowing
| volume = 370
*Rigidity of [[pectoral]] and [[calf]] muscles.  
| issue = 9603
*Elevated [[temperature]]
| pages = 1947–1959
*[[Sweating]]
| year = 2007
*Elevated [[blood pressure]]
| month = December
*Episodic rapid [[heart rate]].
| doi = 10.1016/S0140-6736(07)61261-6
*Spasms may occur frequently and last for several minutes with the body shaped into a characteristic form called [[opisthotonos]]. Spasms continue for up to 4 weeks, and complete recovery may take months.
| pmid = 17854885
*[[Neonatal]] tetanus is a form of generalized tetanus that occurs in newborns.
}}</ref>
*Generalized [[muscle spasms]] in a newborn
*History of unhygienic umbilical stump clamping


==References==
== References ==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 00:24, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

The history of a patient presenting with tetanus typically reveals soil, rust containing metal or manure related contamination of an injury or a wound. A history of puncture wounds, burns, scratches by animals, fractures, and surgical wounds in a patient presenting with symptoms of tetanus may be indicative of a tetanus infection. Trismus, or lockjaw, spasms of the facial muscles (risus sardonicus), neck stiffness and swallowing difficulty are common symptoms of tetanus.[1][2]Common iatrogenic sources of infection that may be revealed in a patient's history include recent surgeries on the gastrointestinal tract or abortions. History of recent accident or an injury leading to a break in the continuity of the skin in a contaminated environment is helpful in making a diagnosis.

History and Symptoms

Tetanus infection is a clinical diagnosis that must be suspected in patients with:

  • An injury involving contact of broken skin with contaminated environment, soil or dust.
  • An absent or inconsistent history of immunizations.

The history of a patient presenting with tetanus typically reveals soil, rust containing metal or manure related contamination of an injury or a wound. Punctured wounds, burns, scratches by animals, fractures, otitis media and surgical wounds that are contaminated, these can be related to surgeries on the gastrointestinal tract or abortions. Contamination of the umbilical cord may also be an important history finding.[3][4][5]

  • Punctured wounds
  • Burns
  • Scratches by animals
  • Fractures
  • Otitis media
  • Surgical wounds that are contaminated
    • Gastrointestinal tract surgeries
    • Abortion
  • Contamination of the umbilical cord
    • Unhygienic clamping
    • Covering with juice or cow dung

Local Tetanus

  • Localized injury
  • Contaminated wound
  • Spasmodic contraction limited to area of injury
  • May continue for weeks
  • Can lead to features of generalized tetanus

Cephalic Tetanus

  • Rare
  • Associated with otitis media (ear infections with C. tetani present in the middle ear), or after head injuries
  • Cranial nerve involved specially facial area

Generalized Tetanus

  • Descending muscle spasm
  • The first sign is trismus or lockjaw. It can be followed by
    • Neck stiffness
    • Swallowing difficulty
    • Stiffening of the calf and pectoral muscle groups
  • Some other symptoms of tetanus may include:
    • Temperature elevation
    • Sweating
    • Blood pressure elevation
    • Episodes of tachycardia
  • Episodic spasms (for minutes), may remain occur for weeks to months
  • History of cephalic or localized tetanus
  • History of injury

Neonatal Tetanus

Neonatal tetanus may present with a history and symptoms of:[6]

  • Generalized muscle spasms in a newborn
  • History of unhygienic umbilical stump clamping

References

  1. ↑ "Tetanus | Symptoms and Complications | Lockjaw | CDC".
  2. ↑ Anisha Doshi, Clare Warrell, Dima Dahdaleh & Dimitri Kullmann (2014). "Just a graze? Cephalic tetanus presenting as a stroke mimic". Practical neurology. 14 (1): 39–41. doi:10.1136/practneurol-2013-000541. PMID 24052566. Unknown parameter |month= ignored (help)
  3. ↑ World Health Organization (2000-11-01). "Maternal and Neonatal Tetanus Elimination by 2005" (PDF). Retrieved 2007-01-26.
  4. ↑ Lisa Mitchell, William Adams & Francois Aspesberro (2017). "Case 6: Episodic Stiffness in a 30-month-old Girl". Pediatrics in review. 38 (1): 52–53. doi:10.1542/pir.2014-0142. PMID 28044038. Unknown parameter |month= ignored (help)
  5. ↑ Martha H. Roper, Jos H. Vandelaer & Francois L. Gasse (2007). "Maternal and neonatal tetanus". Lancet (London, England). 370 (9603): 1947–1959. doi:10.1016/S0140-6736(07)61261-6. PMID 17854885. Unknown parameter |month= ignored (help)
  6. ↑ Martha H. Roper, Jos H. Vandelaer & Francois L. Gasse (2007). "Maternal and neonatal tetanus". Lancet (London, England). 370 (9603): 1947–1959. doi:10.1016/S0140-6736(07)61261-6. PMID 17854885. Unknown parameter |month= ignored (help)

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