classification of tetanus

Last edited 05/2022 and last reviewed 09/2023

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