Tetanus Symptoms: Recognizing Lockjaw, Muscle Spasms, and Autonomic Crisis

Tetanus (Clostridium tetani toxin) causes progressive, severe muscle rigidity and spasms. It is not characterized by vomiting or confusion as primary features.

Classic Symptoms

• Trismus (lockjaw): Jaw stiffness—often the first sign.
• Risus sardonicus: Facial muscle spasm producing a fixed, grimacing "smile."
• Dysphagia: Difficulty swallowing due to throat muscle rigidity.
• Opisthotonos: Severe back arching from paraspinal muscle spasms.
• Generalized spasms: Triggered by minor stimuli (noise, light, touch, drafts).
• Autonomic instability: Blood pressure/heart rate fluctuations, profuse sweating, fever.

Timeline

Incubation: 3–21 days (average 10). Shorter incubation → worse prognosis.

Emergency Response

Any suspected tetanus after a wound → immediate ER. Treatment:

• Human tetanus immune globulin (TIG) — neutralizes unbound toxin
• Antibiotics (metronidazole or penicillin)
• Thorough wound debridement
• Spasm control (benzodiazepines, neuromuscular blockers)
• ICU support (ventilation, autonomic management)

Prevention

Tdap/Td boosters every 10 years; post-exposure prophylaxis (TIG + booster) for contaminated wounds if vaccination not up to date.