Tetanus Ophistotonus

(Following pearl is contributed by

Dr Yash Javeri
Director
Apex Healthcare Consortium, Delhi, India

Secretary SCCM Delhi, India
Organizing Secretary DCCS, APCC)

Tetanus is caused by tetanospasmin which is a neurotoxin.Its a rare entity in developed world. History of wound and possible contamination in unvaccinated individuals is classic. Tetanus is characterized by a clinical triad of rigidity, muscles spasms, and, in more severe cases, autonomic dysfunction.The characteristic presentation of  tetanus is muscle rigidity and spasms.Jaw stiffness followed by spasms of jaw muscle is called trismus is characteristic of tetanus.Muscle spasms are progressive and may include a characteristic arching of the back known as opisthotonus as seen in the video.The spasm are triggered by any sort of stimuli. The disease can involve spasms of the vocal cords leading to respiratory failure.

Patient should be placed in restful environment with quietest possible conditions. Sedation, paralysis with curare like agents and mechanical ventilation are mainstay of therapy. Penicillin,20 MU intravenously in daily divided dose help eradicate toxins.