Generalized tetanus

Generalized tetanus is characterized by rigidity of the masseter muscles (trismus) and involvement of the facial muscles, causing a smiling appearance (risus sardonicus).

Laryngospasm reduces ventilation and may lead to apnea. This is followed by rigidity of the axial musculature, with predominant involvement of the neck, back muscles (opisthotonus-arched back), and abdominal muscles. Paroxysmal, violent contractions of the involved muscles (reflex spasms) appear repet itively only in severe cases. Generalized spasms as well as laryngospasm contribute to ventilatory insufficiency and asphyxia. Tetanospasms may occur, and are painful. They can be elicited by minor stimulation. Autonomic features are hypertension, tachycardia, arrhythmia, sweating, and vasoconstriction, possibly leading to cardiac arrest.

The alteration of consciousness and true convulsive seizures are the result of severe cerebral hypoxia. The severity continues to increase for 10 to 14 days after onset.

Recovery usually begins after 4 weeks. Neonatal tetanus:

Neonatal tetanus usually occurs as a generalized form and carries a high mortality. It usually develops during the first 2 weeks in children born to inadequately immunized mothers and frequently follows nonsterile umbilical stump treatment.

Failure to suck, twitching, and spasms are the most frequent symptoms of neonatal tetanus.

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