Presenting Features

Tetanus is a clinical diagnosis.

The most common presentation of tetanus is generalised tetanus, where the key clinical features include at least two of the following:

• Trismus
• Painful muscular contractions of trunk muscles
• Generalised spasms, frequently position of opisthotonos [9]

Another classical feature is risus sardonicus or rictus grin, which is an abnormal sustained facial muscle spasm that appears to produce grinning.

Patients remain conscious during these episodes, which are extremely painful.

There are three other forms

• Localised tetanus – rigidity and spasms confined to the area around the site of infection
• Cephalic tetanus – localised tetanus after a head or neck injury involving primarily muscles supplied by the cranial nerves
• Maternal and neonatal tetanus (MNT) – this has been eliminated in the UK for decades, however cases are linked to inequality in access to healthcare services. MNT still remains a threat in 12 countries across Africa and Asia. 25,000 neonates died of tetanus in 2019. [10]

Learning bite

With an average of less than ten cases per year reported in England and Wales over the last three decades, the number of emergency department clinicians that have seen or diagnosed a case will be few and far between, so it’s important to have this disease in the back of your mind.