Tetanus

Caused by Clostridium tetani; up to 20% of patients have no observable entry wound.

Clinical features

• Prodrome: fever, malaise, headache

• Trismus (patient cannot close mouth)

• Risus sardonicus (a grin-like effect from hypertonic facial muscles)

• Opisthotonus (arched trunk with hyperextended neck)

• Spasms, precipitated by minimal stimuli

Differential diagnosis: phenothiazine toxicity, strychnine poisoning, rabies.

Refer immediately to expert centre. Give tetanus antitoxoid + human tetanus immunoglobulin.

Intubate and ventilate if nec.

Prophylaxis

Immunisation of adults:

• two doses 6 wks apart

• third dose 6 mths later

Boosters every 10 yrs or 5 yrs if major wound.

In-wound management (see Table T2).