Clinical features of Tetanus :

A. Prodromal stage:

1) . Early stage :

• Dysphagia.
• Jaw stiffness (lock jaw)
• Severe pains in neck, back & abdomen
• Wound pain.

2) Active stage : 

• Muscle cramps.
• Trismus.
• Risus sardonicus.

B) Phase of clonic spasm:

1. Laryngeal and pharyngeal spasm.
2. Respiratory fixation- Respiratory failure.

Investigations of tetanus :

The diagnosis is made on clinical backgrounds. It is rarely possible to isolated the affecting organism from the original locus of entry.

Treatment of tetanus :

1). Isolation of patient in quiet dark room.

2) Oxygen inhalation, tracheostomy if necessary.

3) Maintenance of food and nutrition by IV fluid.

4) Control of muscle spasms : 

• Inj Diazepam 0.1-0.2 mg/kg I/M or I/V 6-hourly. If failed Injection tubocuraine.

5)  Neutralization of toxin : 

• Inj. Tetanus Immunoglobulin (TIG) 3000-6000 units I/M single dose For neonate 500 units I/M.

Or

• Inj. Tetanus Antitoxin (ATS) 10000-20000 units I/M after skin sensitivity test

6)  Antibiotics to prevent further toxin production : 

• Benzyl penicillin 600 mg 6 hourly I/V for 7 days.

7) Local care of wound : 

• Closed wound should be opened up.
• Wash with fresh water H2O2 solution
• Debridement of all dead tissues should be removed.

The prevention measures of tetanus : 

Prevention of tetanus : 

1. Active Immunization must be given.
2. Contaminated injuries are treated by debridement.
3. Immediate danger of tetanus can be greatly reduced by Inj. of 1200 mg of penicillin followed by a 7 days course of oral penicillin.
4. When the risk of tetanus in judged to be present, Inj. of 250 units of human tetanus antitoxin should be given.
5. Intramuscular Inj. of tetanus toxoid (TT) which should be repeated 1 month and 6 month later. For those already protected only a booster dose of TT is required.