Local Tetanus in Man

Abstract

Tetanus may be one of the easiest or of the most difficult diagnoses in medicine. The sequence of injury, followed within a few days by fleeting spasm and muscular contraction near the wound, and then trismus, diffuse hypertonicity, and violent spasmodic contractions of the neck, trunk, and limb muscles, terminating in generalized convulsions and in some cases death, is the familiar picture of generalized tetanus. In contrast, twitching, localized fluctuating or intermittent spasm (often painful) in muscles of some part of the body, without known injury or wound, are usually not recognized as localized tetanus; or such symptoms may be mistaken for some other condition such as hysterical spasm, tetany, extrapyramidal rigidity, dystonia, or spasticity. Only the accidental discovery of tetanus bacilli, the later appearance of a mild trismus, or the subsidence of spasm over a period of weeks or months may provide clues to the true nature of the affliction. These latter cases of localized tetanus are particularly common in individuals who possess some resistance to the tetanus infec¬ tion, usually as the result of immunization, or who have suffered minor wounds into which only a few organisms have been intro¬ duced. Our clinical experience would suggest that illnesses of this type are more frequent than generally appreciated and may pass undiagnosed for want of reliable clinical and laboratory tests.In the course of our studies of a few cases of localized tetanus in man, we have observed a number of phenomena which have been helpful in diagnosis. One of these, to which one of the authors (RDA) has called atten¬ tion, might be designated as "recruitment Received for publication Sept. 12, 1962. From the

Stiff man syndrome and related conditions

“…Spinal motoneuron excitability and Renshaw cell function are normal 13, 15–19. The silent period after supramaximal peripheral nerve stimulation or a stretch reflex is also normal, in contrast to tetanus where motoneurones are hyperexcitable due to defective segmental inhibition 20. These findings indicate that continuous motor unit activity (and spasms) are driven by inputs to spinal motoneurones.…”

Atypical presentations in children with post-neonatal tetanus in Ibadan, Nigeria

“…8 Localized tetanus is said to be more common when there is partial immunity resulting from incomplete immunization and in those who have suffered minor wounds into which only a few organisms have been introduced. 5 It is perhaps tenable to speculate that localized tetanus in some or all of the children following IM injection was due to contamination of the injection site by small numbers of Cl. tetani.…”

“…5 Also, it has sometimes been initially mistaken for some other entity. 9,10 Tetanus complicating suppurative otitis media is well known, 8,11 but the two cases presented here developed tetanus secondary to impaction of a foreign body in a previously healthy ear, which is a previously unreported cause of tetanus.…”

Inverse activity of masticatory muscles with and without trismus: a brainstem syndrome.

“…Only upon forced jaw opening can some activity of jaw closers be observed because of a protective function of these muscles against dislocation of the jaw. When a local irritative process in the jaw muscles, in the mouth, or in the temporomandibular joint, tetanus, or an intoxication with psychopharmaceuticals can be excluded, a centrally evoked trismus is postulated to be due to the lack of some inhibitory effect upon the motor cells in the nucleus, as with the stretch reflex mechanism in cases with upper motor neurone lesions or to lack of Renshaw inhibition of the lower motor neurone (Struppler et al, 1963). This similarity between spastic contracture in extremities and spastic contracture of jaw muscles or another hypothetical disinhibition In all cases with trigeminal anaesthesia the masseter reflex and faciotrigeminal reflex were absent and could not be registered by EMG, as would be expected with sensory denervation of the muscles.…”