Tetanus is caused by toxins from clostridium tetani, a gram positive anaerobic bacillus found in soil.

Classically tetanus occurs following inoculation into a deep wound, but in 30% of cases no entry point is identified. Incubation varies from 24 hours to several months; shorter incubation heralds more severe disease. 

Clinical features include: 
  • Trismus – inability to open mouth due to rigidity of masseters – often the first symptom 
  • Neck stiffness
  • Risus sardonicus 
  • Widespread rigidity and spasms - can be severe enough to cause laryngeal obstruction and death 

Diagnosis is clinical – culturing c.tetani is difficult. 

  • Tetanus immunoglobulin 
  • IV Metronidazole – preferably PR as causes fewer muscle spasms 
  • Supportive – muscle relaxants, possibly intubation 
  • It is a notifiable disease


Vaccinations at 2,3 and 4 months, then preschool, then a further booster 10 years after the preschool jab. Thereafter, if a patient has had all their childhood vaccinations (5 doses of tetatnus vaccine), they should never need a booster. The vaccine is not live. 

Immunoglobulin should be given to patients presenting with a wound heavily contaminated with material likely to contain tetanus spores which is defined as a ‘tetanus prone wound’. The definition of a tetanus-prone wounds is: 
  • Wounds/burns that require surgical intervention that is delayed for more than 6 hours 
  • Wounds/burns with significant devitalized tissue or puncture-type injury 
  • Wounds containing foreign bodies 
  • Compound fractures 
  • Wounds/burns in patients with systemic sepsis. 

Mortality from tetanus is around 50% in developing countries. In developed countries this is around 15%. 

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