Tetanus is an acute and often fatal disease caused by clostridium tetani and is characterized by

  • Muscle rigidity
  • Autonomic instability
  • Convulsions

Higher incidence in third world countries (less immunized)


Clostridium tetani

  • Obligate anaerobic spore-bearing gram positive bacillus
  • Produces toxins (tetanospasmin, tetanolysin)
  • Infection via wound, puncture etc.
  • Infection remains local but toxin is spread via bloodstream

Toxin affects

  • Peripheral nerve ends (decreased Ach release) 
  • Spinal chord (polysynaptic reflexes)
  • Brain (seizure, autonomic dysfunction, inhibition of cortical activity)
  • Mainly bound to inhibitory neurons (therefore inhibition of neuronal action is decreased)


Presentation within 14days from infection

Main symptoms: stiffness and pain, trismus and lockjaw

Stiffness descending (facial stiffness > teeth clenching, “risus sardonicus”)

Severe muscle spasm (life threatening when affecting diaphragm or larynx

Autonomic dysfunction and instability (tachy-/bradycardia, hypo-/hypertension, pyrexia, sweating


  • Clinically
  • Clostridium culture only in 30%


  • Passive immunization (human antitetanus toxin, 3000-6000 IU iv)
  • wound care/surgery
  • antibiotics (Metronidazole 500mg 8/24 OR penicillin G 1-3mio 6/24)
  • Controlling muscle spasm (intubate, sedate, paralyze)
  • Treat autonomic dysfunction
  • general support