Classification of tetanus

There are four different forms of tetanus:

• localised
  • rare and relatively milder form of disease
  • spasm and rigidity are restricted to the site of injury
  • in some, may precede generalised tetanus
• cephalic
  • occurs secondary to a middle ear infection or from a injury to the head and neck
  • cranial nerve palsies (especially the seventh nerve) is characteristic
  • may develop in to a generalised disease
  • prognosis is poor (1)
• generalized
  • most common type and is responsible for around 80% of patients
  • there is haematogenous spread of the toxin
  • head and neck muscles are affected first with progressive distal spread of spasm and rigidity throughout the body
• neonatal
  • is responsible for over 50% of deaths associated with tetanus
  • caused by poor umbilical hygiene and is entirely preventable by maternal vaccination
  • symptoms like failure to thrive, poor sucking, grimacing and irritability is seen at first quickly followed by intense rigidity and spasms and is usually seen from 4 to 14 days after birth (average around 7 days) (2)
  • is completely eliminated from the UK (1)

References:

• (1) Taylor MA. Tetanus.Contin Educ Anaesth Crit Care Pain 2006;6(3):101-104
• (2) Centers for Disease Control and Prevention (CDC). Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book 2011. Chapter 20: Tetanus