Title: Clinical manifestations of tetanus
Course: Communicable Diseases Part 1 - Ethiopia (Full)

Clinical manifestations of tetanus

The time between becoming infected with Clostridium tetani bacteria and the person showing symptoms of tetanus disease is usually between three and 10 days, but it may be as long as three weeks.

What is the name given to the gap in time between infectious agents entering the body, and the first appearance of the disease they cause? (You learned this in Study Session 1.)

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It is called the incubation period.

In cases of tetanus, the shorter the incubation period, the higher the risk of death. In children and adults, muscular stiffness in the jaw, which makes it difficult or impossible to open the mouth (called 'locked jaw') is a common first sign of tetanus. This symptom is followed by neck stiffness (so the neck cannot be bent), difficulty in swallowing, sweating, fever, stiffness in the stomach muscles, and muscular spasms (involuntary contraction of the muscles).

Babies infected with tetanus during delivery appear normal at birth, but they become unable to feed by suckling from the breast at between three and 28 days of age. Their bodies become stiff, while severe muscle contractions and spasms occur (Figure 3.3). Death follows in most cases.

Figure 3.3 A baby who has rigidity and arching of the whole body due to tetanus. (Photo: WHO, 2000, at www.who.int/vaccines-documents/)

A newborn baby (10 days old) who was born in a village with the assistance of traditional birth attendants, is brought to you with fever, stiffness in the stomach muscles and difficulty in opening his mouth, so he is unable to breastfeed. What is the possible cause of this baby's symptoms, and why do you make this diagnosis? What action will you take?

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The newborn may have tetanus since he was born at home without the care of a skilled birth attendant. The umbilical cord could be infected by tetanus. You should refer this child urgently to the nearest health centre or hospital.