General Principles: Caused by Clostridium tetani toxin from wound contamination with spores. Tetanus is best prevented by immunization. For high-risk wounds, additional prophylaxis with human tetanus immunoglobulin is recommended.
Diagnosis: Classically presents with intensely painful muscle spasms and rigidity , followed by autonomic dysfunction. Symptoms often begin in the face (trismus, risus sardonicus) and neck muscles. Delirium and high fever are usually absent. Diagnosis is clinical.
- Passive immunization with human tetanus immunoglobulin (in divided doses with part infiltrated around the wound) to neutralize unbound toxin is warranted. Active immunization with tetanus toxoid should be given at a separate site.
- Surgical debridement of the wound is critical.
- Antibiotic therapy , usually consisting of metronidazole or penicillin G, for 7–10 days is recommended.
- Benzodiazepines or neuromuscular blocking agents may be used to control spasms.