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Tetanus

due to contamination of wound in non-immunised individuals with Clostridium tetani
- wound may be unnoticed
due to actions of neurotoxin
- marked flexor spasm
- autonomic dysfunction

generalised tetanus
- feeling unwell
- trismus / lockjaw
- risus sardonicus
  - characteristic grinning due to spasm of facial muscles
- painful reflex spasms within 24-72 hours of initial symptoms
  - easily provoked by noise, handling or light
  - increasing frequency
  - respiration impaired due to laryngeal spasm
- autonomic dysfunction
  - tachycardia
  - labile blood pressure
  - sweating
  - cardiac dysrythmias
- mentally alert
localised tetanus
- pain and stiffness confined to site of wound
- tone of surrounding muscles increased
cephalic tetanus
- uncommon
- invariably fatal
- portal of entry is middle ear
- cranial nerve abnormalities
neonatal tetanus
- umbilical stump dressed with dung / dusting powder
- failure to thrive
- poor feeding
- grimacing
- irritability
- followed by intense rigidity and spasms

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