Tetanus history and symptoms

Overview
Tetanus affects skeletal muscle, a type of striated muscle. The other type of striated muscle, cardiac or heart muscle cannot be tetanized because of their intrinsic electrical properties. In recent years, approximately 11% of reported tetanus cases have been fatal. The highest mortality rates are in unvaccinated persons and persons over 60 years of age. C. tetani, the bacteria that causes tetanus, is recovered from the initial wound in only about 30% of cases, and can be found in patients who do not have tetanus.

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.

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.

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 nerves, especially in the facial area.

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. Spasms may occur frequently and last for several minutes. Spasms continue for 3–4 weeks and complete recovery may take months.

Neonatal tetanus is a form of generalized tetanus that occurs in newborn infants. It occurs in infants who have not acquired passive 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.

Symptoms
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.
 * Trismus, or lockjaw
 * Facial spasms called risus sardonicus
 * Stiffness of the neck
 * Difficulty in swallowing
 * Rigidity of pectoral and calf muscles.
 * Elevated temperature
 * Sweating
 * Elevated blood pressure
 * Episodic rapid heart rate.
 * 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.
 * Neonatal tetanus is a form of generalized tetanus that occurs in newborns.