Symptoms Of Tetanus: Early Signs And Progression Of The Disease

Introduction

Tetanus is a serious bacterial infection caused by Clostridium tetani, which is commonly found in soil, dust, and animal faeces. This infection can lead to severe muscle stiffness and spasms, affecting various parts of the body. Understanding the symptoms of tetanus is crucial for timely diagnosis and treatment, as the disease can rapidly progress to life-threatening stages if left untreated.

Recognising the early signs of tetanus can make a significant difference in the outcome for those affected. Early symptoms often include muscle stiffness and spasms, particularly around the jaw, leading to a condition known as trismus or lockjaw. This can make it difficult to open the mouth and swallow. Other initial signs include stiffness in the neck and abdominal muscles, which may be accompanied by generalised muscle pain and discomfort.

As tetanus progresses, the symptoms can become more severe and widespread. Muscle spasms can extend to other parts of the body, causing painful contractions that may affect breathing and other vital functions. In advanced stages, patients may experience severe muscle rigidity, intense spasms that can lead to fractures, and complications such as respiratory failure.

In this article, we will explore the symptoms of tetanus in detail, from the initial signs to the advanced stages of the disease. We will also discuss the importance of vaccination and preventive measures to protect against this potentially fatal infection. By raising awareness and providing clear, accessible information, we aim to help readers understand tetanus better and take the necessary steps to safeguard their health.

Early signs of tetanus

Incubation period

The incubation period for tetanus, which is the time between exposure to the bacteria and the appearance of the first symptoms, typically ranges from 3 to 21 days.¹ Most commonly, symptoms appear around 8 days after exposure. However, the onset can vary significantly depending on the location and nature of the wound and the amount of toxin produced by the bacteria. 

Initial symptoms

Muscle stiffness and spasms

One of the earliest signs of tetanus is muscle stiffness and spasms, often beginning near the site of the wound.² The spasms are typically painful and can be severe. They are caused by the toxin produced by the bacteria, which affects the nerves controlling muscle activity.

Jaw cramping (Trismus)

A characteristic early symptom of tetanus is trismus, commonly known as lockjaw.³ This condition involves cramping of the jaw muscles, making it difficult to open the mouth. Trismus is often one of the first noticeable signs of the disease and can be particularly alarming due to its impact on basic functions like eating and speaking.

Difficulty swallowing

As the toxin spreads, it can affect muscles involved in swallowing, leading to dysphagia, or difficulty swallowing.⁴ This symptom can be particularly dangerous as it may interfere with the individual's ability to eat and drink, potentially leading to dehydration and malnutrition if not addressed promptly.

Stiffness of the neck and abdominal muscles

In addition to jaw cramping, early symptoms often include stiffness in the neck and abdominal muscles.⁵ This stiffness can cause significant discomfort and may make movement difficult. Muscle rigidity often progresses from the jaw and neck downwards, affecting the trunk and limbs as the disease advances.

Progression of tetanus symptoms

Generalised tetanus

Spasms spreading to other muscles

As tetanus progresses, muscle spasms that initially start near the wound site can spread to other parts of the body.⁶ These spasms can become more frequent and severe, affecting the muscles of the back, abdomen, and limbs. The spread of spasms throughout the body is a hallmark of generalised tetanus.

Opisthotonos (Arched back due to muscle contractions)

One of the more severe manifestations of generalised tetanus is opisthotonos, where powerful muscle contractions cause the back to arch severely. This condition results from the spasms of the muscles along the spine and can be both painful and distressing. The rigidity and arching of the body are often a sign of advanced tetanus.

Risus sardonicus (Abnormal facial muscle contraction)

Another distinctive symptom of generalised tetanus is risus sardonicus, an abnormal and often eerie smile caused by muscle spasms in the face. This condition results from the contraction of facial muscles and is named for its grimace-like appearance.⁷ It is one of the classic signs that clinicians look for when diagnosing tetanus.

Sweating and fever

In addition to muscle spasms, individuals with tetanus often experience systemic symptoms such as sweating and fever. These symptoms are part of the body's response to infection and the widespread effects of the tetanus toxin. Sweating can be profuse and is usually accompanied by increased body temperature.

Increased heart rate and blood pressure

The autonomic nervous system, which controls involuntary bodily functions, can also be affected by tetanus. This can lead to an increased heart rate (tachycardia) and high blood pressure (hypertension).⁸ These changes can be dangerous and require careful monitoring and management in a medical setting.

Symptoms in newborns

Initial signs of irritability and poor feeding

The initial signs of neonatal tetanus include irritability, poor feeding, and excessive crying. These symptoms may appear within a few days of birth and can escalate quickly.

Progression to muscle rigidity and spasms

As the disease progresses, affected newborns may develop muscle rigidity and spasms, similar to the symptoms seen in older children and adults. Muscle stiffness can lead to an inability to open the mouth, often referred to as trismus or lockjaw, and may progress to generalised spasms affecting the entire body.

Severe and late-stage symptoms

Severe muscle spasms

Impact on respiration

As tetanus progresses to its severe stages, muscle spasms can become so intense that they impact respiration. The diaphragm, the primary muscle involved in breathing, can undergo severe spasms, making it difficult for the patient to breathe effectively.⁹ This can lead to respiratory distress and a potentially life-threatening situation if not managed promptly. Medical intervention, including mechanical ventilation, may be necessary to support the patient's breathing.¹⁰

Risk of fractures due to intense spasms

The force of the muscle spasms in severe tetanus can be extremely strong, sometimes leading to fractures or muscle tears. The intense contractions can place significant stress on bones and joints, especially if the spasms involve large muscle groups such as those in the back or legs. Patients may experience intense pain and require careful handling to avoid further injury.

Autonomic dysfunction

Unstable blood pressure

Tetanus can also affect the autonomic nervous system, which controls involuntary body functions like blood pressure and heart rate.¹¹ Patients may experience unstable blood pressure, with sudden episodes of high blood pressure (hypertension) or low blood pressure (hypotension). These fluctuations can complicate the management of the disease and require careful monitoring and treatment by healthcare professionals.

Cardiac arrhythmias

The impact of tetanus on the autonomic nervous system can lead to cardiac arrhythmias, which are irregular heartbeats. These can range from mild palpitations to severe arrhythmias that can be life-threatening. Continuous cardiac monitoring is often necessary to detect and manage these irregularities promptly.

Excessive sweating

Excessive sweating, or hyperhidrosis, is another symptom of autonomic dysfunction in severe tetanus. This can be uncomfortable and may contribute to dehydration if fluid intake is not carefully managed. Sweating is a sign that the body is under significant stress, and it often accompanies other symptoms of severe tetanus.

FAQ’s

How can you detect tetanus early?

Early detection of tetanus involves recognising initial symptoms such as muscle stiffness and spasms, especially around the jaw (lockjaw or trismus), difficulty swallowing, and stiffness in the neck and abdominal muscles. If these symptoms appear following a wound or puncture injury, seek medical attention immediately.

What is the first clinical manifestation of tetanus neonatorum?

The first clinical manifestation of tetanus neonatorum is usually difficulty in feeding, often accompanied by irritability and excessive crying.

What is the triad of tetanus symptoms?

The triad of tetanus symptoms includes trismus (lockjaw), muscle spasms, and opisthotonos (arched back due to muscle contractions).

What are the hallmark signs of tetanus?

The hallmark signs of tetanus are trismus (lockjaw), muscle stiffness, and spasms, especially in the neck and abdominal muscles, and risus sardonicus (an abnormal, rigid smile caused by facial muscle contractions).

How quickly does tetanus progress?

Tetanus can progress rapidly, with symptoms worsening over days to weeks. Initial muscle stiffness and spasms can quickly escalate to severe and widespread muscle contractions, potentially affecting respiration and other vital functions.

What is the progression of tetanus symptoms?

Tetanus symptoms typically progress from initial muscle stiffness and spasms around the wound site to generalised muscle spasms, severe muscle contractions (opisthotonos), facial muscle spasms (risus sardonicus), and autonomic dysfunctions such as unstable blood pressure and heart rate, potentially leading to severe complications like respiratory failure.

When is it too late to get a tetanus shot?

It is never too late to get a tetanus shot. If you have a potentially contaminated wound and it has been more than 10 years since your last tetanus shot, or you are unsure of your vaccination status, you should get a booster shot immediately. In cases of suspected tetanus exposure, receiving the shot promptly can still provide some level of protection and help mitigate the severity of the disease.

Summary

Tetanus, a serious bacterial infection caused by Clostridium tetani, manifests initially through muscle stiffness and spasms, particularly around the jaw (trismus) and neck, leading to difficulties in swallowing and general discomfort. The incubation period, typically 3 to 21 days, is influenced by factors such as the severity and location of the wound.

As tetanus progresses, symptoms can become more severe and widespread. In generalised tetanus, muscle spasms can affect the entire body, causing severe conditions such as opisthotonos (arched back), risus sardonicus (abnormal facial contractions), sweating, fever, increased heart rate, and high blood pressure. Local tetanus involves muscle spasms near the infection site, with the potential to spread, while cephalic tetanus, specific to head injuries, affects facial muscles and cranial nerves. Neonatal tetanus, occurring in newborns due to umbilical stump infections, presents with irritability, and poor feeding, and progresses to severe muscle rigidity and spasms.

In severe and late-stage tetanus, intense muscle spasms can impede respiration and even cause fractures. Autonomic dysfunctions such as unstable blood pressure, cardiac arrhythmias, and excessive sweating may occur. Serious complications include secondary infections, respiratory failure, and death. Recognising and addressing the symptoms early is crucial for effective treatment and improved outcomes, underscoring the importance of vaccination and proper wound care in preventing tetanus.