In some regions of the world, tetanus neonatorum is known as "seventh day evil" [1], because this is when symptoms first set in. In underdeveloped countries, this is the cause of up to half of neonatal deaths, while infection of all types represents the reason for 15% of newborn deaths worldwide [2]. Newborns develop the generalized form of the disease because exposure is made via the umbilical stump, when asepsis is not achieved. Other infectious agents leading to sepsis can also be transmitted to the child in this manner [3]. In some areas, the umbilical stump is covered with dust or spider webs, that are thought to promote healing, but actually contain Clostridium tetani. Proper umbilical cord handling [4] and population vaccination may help reduce tetanus neonatorum .

The incubation period for tetanus neonatorum is 3 to 10 days, but most newborns develop it at the end of their first week of life, when they present with irritability, feeding difficulties due to trismus and an inability to swallow, excessive crying caused by hunger, rigidity and generalized muscle spasms induced by touch, including those of the face, and opisthotonus. Patients exhibit tachycardia and tachypnea, are febrile and may have convulsions. The sooner generalized spasms occur, the worse the prognosis, with mortality usually higher than 70% [5] [6] [7]. During spasms, the child may be cyanotic. Death is caused by hemodynamic instability as a consequence of dysautonomia or heart arrhythmias, hydro-electrolytic imbalance or asphyxia.

• Fever

  الصفحة 99 - An extremely infectious disease with a sudden onset, fever, malaise, headache, severe backache, prostration and occasionally abdominal pain. [books.google.com]

  Seite 99 - An extremely infectious disease with a sudden onset, fever, malaise, headache, severe backache, prostration and occasionally abdominal pain. [books.google.de]

  My thanks are due to the staff of the Baghdad Fever Hospital for permission to use their records. [kundoc.com]

  Short incubation period, short period of onset, low birth weight, presence of fever and tachycardia were associated with a poor prognosis. The cases were divided into 2 groups of 46 and 30. First group was given TIG while second group was given ATS. [ncbi.nlm.nih.gov]

  Other signs are fever, elevated blood pressure, sweating and rapid heart rate. Diagnosis and Treatment. Tetanus is a clinical diagnosis. [pchrd.dost.gov.ph]

• Crying

  The incubation period for tetanus neonatorum is 3 to 10 days, but most newborns develop it at the end of their first week of life, when they present with irritability, feeding difficulties due to trismus and an inability to swallow, excessive crying caused [symptoma.com]

  Brief resolved unexplained event -- BRUE (Medical Encyclopedia) Crying - excessive (0-6 months) (Medical Encyclopedia) Failure to thrive (Medical Encyclopedia) Hemorrhagic disease of the newborn (Medical Encyclopedia) Hyperglycemia - infants (Medical [icdlist.com]

  Initial symptoms include unexplained crying followed by refusal of feeds. [jemds.com]

  The jaws become rigidly fixed (trismus), the voice is altered, and the muscles of the face contract, producing a wild excited expression and a combination of bitter laughter and crying. The muscles of the back and extremities become tetanic. [wordinfo.info]

• Sepsis

  Other infectious agents leading to sepsis can also be transmitted to the child in this manner. In some areas, the umbilical stump is covered with dust or spider webs, that are thought to promote healing, but actually contain Clostridium tetani. [symptoma.com]

  6 months) (Medical Encyclopedia) Failure to thrive (Medical Encyclopedia) Hemorrhagic disease of the newborn (Medical Encyclopedia) Hyperglycemia - infants (Medical Encyclopedia) Neonatal respiratory distress syndrome (Medical Encyclopedia) Neonatal sepsis [icdlist.com]

  Spasms aretypical but the diagnosis can be mistakentypical but the diagnosis can be mistakenfor meningitis or sepsis .for meningitis or sepsis. 15. [slideshare.net]

  2018 2019 Billable/Specific Code neonatorum A33 newborn A33 ICD-10-CM Codes Adjacent To A33 A32.0 Cutaneous listeriosis A32.1 Listerial meningitis and meningoencephalitis A32.11 Listerial meningitis A32.12 Listerial meningoencephalitis A32.7 Listerial sepsis [icd10data.com]

• Swelling

  Mumps Description Mumps is an acute viral disease characterized by fever, swelling, and tenderness of one or more salivary glands, usually the parotid and sometimes the sublingual or submaxillary glands. [books.google.com]

  […] getting immunized or not receiving booster tetanus shots The existence of a penetrating injury that results in tetanus spores getting into the wound The presence of other infective bacteria Injured tissue A foreign object, such as a nail or splinter Swelling [everydayhealth.com]

  (severe or no tender). b) Abscess (A = 103 /327; B = 96/332; C = 2/340 at the 14th week after immunisation). c) Fever between 37.8‐38.3 °C. d) Swelling. [cochranelibrary.com]

• Weakness

  Large reductions in neonatal tetanus deaths have been reported following major increases in the coverage of tetanus toxoid immunization, yet the level of evidence for the mortality effect of tetanus toxoid immunization is surprisingly weak with only two [ncbi.nlm.nih.gov]

  Diazepam can cause side effects including: drowsiness muscle weakness reduced alertness If you are prescribed diazepam, do not drive or operate heavy machinery, and avoid drinking alcohol as it is likely to make side effects worse. [hse.ie]

  As a result the baby was going down hill, losing weight, getting weak, and was commencing to have spasms and convulsions. 462 PUBLIC HEALTH VOL. [kundoc.com]

  Localized tetanus In mild cases of localized tetanus, patients may have weakness of the involved extremity, presumably due to partial immunity; in more severe cases, they may have intense, painful spasms of the group of muscles in close proximity to the [emedicine.medscape.com]

• Tachypnea

  Patients exhibit tachycardia and tachypnea, are febrile and may have convulsions. The sooner generalized spasms occur, the worse the prognosis, with mortality usually higher than 70%. During spasms, the child may be cyanotic. [symptoma.com]

  Frequent muscular spasms lead to fever, tachycardia and tachypnea. Umbilical stump does not show any sign of infection. 6 So in this study we tried to find out incidence & mortality of this easily preventable diseases. [jemds.com]

• Muscle Rigidity

  Muscle rigidity spreads in a descending pattern from the jaw and facial muscles over the next 24-48 hours to the extensor muscles of the limbs. [emedicine.medscape.com]

  This results in the characteristic muscle spasms (severe enough to tear muscles, cause long-bone fractures or spinal compression fractures) and rigidity. Epidemiology Incidence and mortality Tetanus is rare in the UK. [patient.info]

  Laryngeal spasm and rigidity and spasms of the abdominal wall, diaphragm, and chest wall muscles cause asphyxiation. [msdmanuals.com]

• Gagging

  This consists of trying to elicit a gag reflex by touching the oropharynx with a spatula. In tetanus newborns, this reflex is replaced by masseter muscles spasm, leading them to byte the spatula. [symptoma.com]

  The spatula test is useful: touching the back of the pharynx with a spatula elicits a bite reflex in tetanus, instead of a gag reflex. Management Early diagnosis and intervention can be life-saving. [patient.info]

  Stimulation of the posterior pharyngeal wall may elicit reflex spasms of the masseter muscles that cause patients to bite down as opposed to gag (spatula test). [17] Severe tetanus results in opisthotonos, flexion of the arms, extension of the legs, periods [emedicine.medscape.com]

• Abdominal Rigidity

  A common first sign suggestive of tetanus in older children and adults is abdominal rigidity, although rigidity is sometimes confined to the region of injury. Generalized spasms occur, frequently induced by sensory stimuli. [cdc.gov]

  He developed tetanic generalized spasms with opisthotonos, risus sardonicus and abdominal rigidity. The patient was transferred to the PICU where he was placed on a continuous infusion of midazolam at 0.1 mg/kg/hr. [pedsccm.org]

• Vomiting

  […] due to spastic paralysis, bowing of back; ~ risus sardonicus, a sarcastic grin due to facial muscles locking ~ death from respiratory distress: aspiration of regurgitated stomach contents into the lung; this is the most common death, drowning in own vomit [quizlet.com]

  The symptoms produced were similar to those in the last experiment; but the animal did not vomit, and the convulsive motions were in a less degree : he died eleven minutes after the poison was inserted. [books.google.ro]

• Tachycardia

  Short incubation period, short period of onset, low birth weight, presence of fever and tachycardia were associated with a poor prognosis. The cases were divided into 2 groups of 46 and 30. First group was given TIG while second group was given ATS. [ncbi.nlm.nih.gov]

  Patients exhibit tachycardia and tachypnea, are febrile and may have convulsions. The sooner generalized spasms occur, the worse the prognosis, with mortality usually higher than 70%. During spasms, the child may be cyanotic. [symptoma.com]

  Tachycardia. High frequency and greater severity and duration of muscular spasms especially of larynx. Frequent and prolong duration of apneic episodes. [jemds.com]

  Beta-blockade is used to control episodes of hypertension and tachycardia, but use of long-acting drugs such as propranolol is not recommended. [msdmanuals.com]

• Trismus

  Trismus, tonic contraction of jaw muscles, is usually absent. tetanic 1. Relating to tetanus or to the sustained contraction of the muscles that is characteristic of tetanus. 2. [wordinfo.info]

  Published: 01 April 1998 Pediatric Research volume 43, page 246 (1998)Cite this article 688 Accesses 3 Altmetric Metrics details Tetanus Neonatorum or neonatal tetanus is also known in Western medicine by the terms trismus nascentium, 7-day sickness, [nature.com]

  The incubation period for tetanus neonatorum is 3 to 10 days, but most newborns develop it at the end of their first week of life, when they present with irritability, feeding difficulties due to trismus and an inability to swallow, excessive crying caused [symptoma.com]

  Trismus ("lockjaw") maya head injury or ear infection. Trismus ("lockjaw") mayoccur. The disease can easily progress to generalizedoccur. The disease can easily progress to generalizedtetanus.tetanus. [slideshare.net]

• Muscle Spasm

  Serum muscle enzyme levels are increased due to the muscle spasms. The calcium blood level should be measured in order to exclude hypocalcemia, which is an important differential diagnosis. [symptoma.com]

  Treating muscle spasms A number of different types of medication may be prescribed to treat muscle spasms and muscle stiffness, including: anticonvulsants (sedatives) muscle relaxants neuromuscular blocking agents Anticonvulsants Anticonvulsants, such [hse.ie]

  […] hypertonia, hyperreflexia and muscle spasms; however, the patient remains lucid. [scielo.br]

  Mild spasms and stiffness in the jaw muscles are usually the first signs of tetanus; with the below symptoms following shortly thereafter: Stiffness in neck muscles Difficulty swallowing Stiffness in abdominal muscles Spasms in the back, which often cause [everydayhealth.com]

  The ICD code A33 is used to code Tetanus Tetanus, also known as lockjaw, is an infection characterized by muscle spasms. In the most common type the spasms begin in the jaw and then progress to the rest of the body. [icd.codes]

• Muscle Twitch

  […] of relaxation caused by repetitive stimulation of the motor nerve trunk at frequencies so high that individual muscle twitches are fused and cannot be distinguished from one another, also called tonic spasm and tetany). tetanus 1. [wordinfo.info]

  twitches are fused and cannot be distinguished from one another; called also tetanic or tonic contraction and tetanic or tonic spasm. tet·a·nus ne·o·na·to·rum tetanus occurring in newborn infants, usually due to infection of umbilical area with Clostridium [medical-dictionary.thefreedictionary.com]

• Muscle Spasticity

  Dantrolene Dantrolene is sometimes prescribed in cases of chronic (long-term) muscle spasticity (where your muscles are overly tight or rigid). [hse.ie]

  In localized tetanus, there is spasticity of muscles near the entry wound but no trismus; spasticity may persist for weeks. Cephalic tetanus is a form of localized tetanus that affects the cranial nerves. [msdmanuals.com]

• Myalgia

  Occurrence of other local (erythema, induration) and systemic (fever, headache, malaise, myalgia) reactions within seven days after immunisation was not statistically different between vaccine and placebo recipients. [cochranelibrary.com]

• Suggestibility

  Descriptive Epidemiology 587 Mechanisms and Routes of Transmission 7 Pathogenesis and Immunity 590 Patterns of Host Response 591 Control and Prevention 592 References 593 Suggested Reading 595 Rocky Mountain Spotted Fever Theodore E Woodward and J Stephen [books.google.com]

  We suggest that the mechanism responsible for this lesion involves the retrograde axoplasmic flow of tetanus toxin reaching the spinal cord via nerve endings in the infected umbilical cord stump. [ncbi.nlm.nih.gov]

  Suggestions: • If you typed the page address/URL, make sure it is spelt correctly. • Open the Indiatimes.com homepage or sitemap and look for links to the information you want. • Use the "Back" button on your browser to return to the previous page. [timesofindia.indiatimes.com]

  If you still encounter problems, please report these using the comments and suggestions page. [who.int]

• Hunger

  […] incubation period for tetanus neonatorum is 3 to 10 days, but most newborns develop it at the end of their first week of life, when they present with irritability, feeding difficulties due to trismus and an inability to swallow, excessive crying caused by hunger [symptoma.com]

  The patient also suffers from hunger, thirst, and lack of sleep. The mind is usually clear. [wordinfo.info]

  […] systemic blood pressure instability, heart arrhythmias, diaphoresis and hyperthermia.(2,3) In newborn infants, this disease manifests between three and 12 days after birth as progressively impaired feeding (e.g., sucking and swallowing), thus resulting in hunger [scielo.br]

• Facial Spasm

  “Risussardonicus” or “rigid smile” is characteristic in the facial spasms caused by tetanus in which the eyebrows are raised and there is a fixed smile. [pchrd.dost.gov.ph]

• Convulsions

  As for any patient subject to convulsions, maintenance of a safe environment is essential. Prevention of injury to and assessment of a patient with convulsive seizures are discussed under convulsion. [medical-dictionary.thefreedictionary.com]

  Patients exhibit tachycardia and tachypnea, are febrile and may have convulsions. The sooner generalized spasms occur, the worse the prognosis, with mortality usually higher than 70%. During spasms, the child may be cyanotic. [symptoma.com]

  Babies born with tetanus may take three to 14 days to exhibit symptoms, after which irritability, failure to feed properly, convulsions and ultimately death by suffocation await for 70 percent of infected newborns. [web.archive.org]

• Irritability

  Sedatives and antibiotic drugs are administered as ordered to reduce irritability and to combat secondary bacterial infections. [medical-dictionary.thefreedictionary.com]

  […] muscle spasms, opposite of botulism; ~ "Rigid Body" Tetanus: mode of transmission indirect contact by parenteral route; puncture, could be a rusty nail; grows in the absence of oxygen 1. prodromal: commonly misdiagnosed as a migraine ~ restlessness, irritability [quizlet.com]

  The incubation period for tetanus neonatorum is 3 to 10 days, but most newborns develop it at the end of their first week of life, when they present with irritability, feeding difficulties due to trismus and an inability to swallow, excessive crying caused [symptoma.com]

  On irritating the heart with the point of the scalpel, the ventricles... ‎ [books.google.ro]

• Seizure

  Diagnosis had to be differentiated between MSUD and other metabolic disorders and neonatal infections (especially neonatal tetanus because of severe opisthotonos) and generalized seizures of the patient. [ncbi.nlm.nih.gov]

  Tetanus was frequently confused with neonatal seizures at time of presentation. All infants were delivered at home. Mean age of onset of symptoms of poor suck, hypertonicity, and generalized spasms was 5.4 days with hospital admission at 6.4 days. [pediatrics.aappublications.org]

  As long as the patient is acutely ill and likely to suffer from convulsive seizures, someone should be in constant attendance. [medical-dictionary.thefreedictionary.com]

• Opisthotonus

  […] their first week of life, when they present with irritability, feeding difficulties due to trismus and an inability to swallow, excessive crying caused by hunger, rigidity and generalized muscle spasms induced by touch, including those of the face, and opisthotonus [symptoma.com]

  Related Concepts SNOMET-CT Tetanus neonatorum (disorder) Tetanic opisthotonus (disorder) Age at onset of clinical finding (observable entity) < 29.0 days ICD-10-CM Alphabetical Index References for 'A33 - Tetanus neonatorum' The ICD-10-CM Alphabetical [icd.codes]

  Subsequently, hypertonia, opisthotonus and generalized spasms occur. Table 1 summarizes Bazin's(10) categorization of tetanus neonatorum. [scielo.br]

  Clinical feaClinical fea tures of neonataltures of neonataltetanustetanus Abdominal muscles become rigid andAbdominal muscles become rigid andspasms of the muscles of the back mayspasms of the muscles of the back mayresult in opisthotonus.result in opisthotonus [slideshare.net]

• Meningism

  […] tetanus neonatorum ( A33 ) neonatorum A33 Trismus R25.2 ICD-10-CM Diagnosis Code R25.2 Cramp and spasm 2016 2017 2018 2019 Billable/Specific Code neonatorum A33 newborn A33 ICD-10-CM Codes Adjacent To A33 A32.0 Cutaneous listeriosis A32.1 Listerial meningitis [icd10data.com]

  The clinician should search for meningeal signs and labor related cerebral injury. Once the suspicion is raised, the physician is required to perform a spatula test. [symptoma.com]

  Spasms aretypical but the diagnosis can be mistakentypical but the diagnosis can be mistakenfor meningitis or sepsis .for meningitis or sepsis. 15. [slideshare.net]

Tetanus neonatorum diagnosis is mainly clinical. Careful history inquiry should include metoclopramide administration. The clinician should search for meningeal signs [8] and labor related cerebral injury. Once the suspicion is raised, the physician is required to perform a spatula test. This consists of trying to elicit a gag reflex by touching the oropharynx with a spatula. In tetanus newborns, this reflex is replaced by masseter muscles spasm, leading them to byte the spatula. This maneuver is highly specific [9] and is sometimes involuntarily performed by mothers while attempting to feed the baby. The next step in the clinical evaluation is to assess the severity of the disease, based on the state of the limbs: flexed or extended and the presence of generalized rigidity.

Laboratory workup offers little information, because no specific diagnosis test is available. Serum muscle enzyme levels are increased due to the muscle spasms. The calcium blood level should be measured in order to exclude hypocalcemia, which is an important differential diagnosis. If an antitoxin level test is feasible, a titer of more than 0.01 IU/mL is considered to be protective. Umbilical stump secretion can be cultured and the bacteria may be found there, but this does not necessarily mean the patient has tetanus. On the other hand, in a patient with clear clinical signs of tetanus, the pathogen may be absent from the secretion. Blood cultures are not useful in this disease.

The electrocardiogram may show nonspecific changes or several types of arrhythmia, while the electromyogram describes continuous discharge of motor subunits, the substrate of spasms and rigidity.

In a retrospective appraisal of treatment, it would seem that antitoxin serum has not been specific in the treatment of tetanus or in a decrease of the mortality rate; whereas heretofore, neglected supportive treatment was the primary factor contributing [pediatrics.aappublications.org]

[…] where the umbilical cord was not treated ( n = 147) as compared to births with cord treatment ( n = 69). [webmedcentral.com]

& Scrag 1 Affiliations : 1 King Edward VIII Hospital, Durban Source : South African Medical Journal, Volume 29, Issue 37, Sep 1955, p. 853 - 854 Keyword(s) : Case report, Modified treatment, Tetanus neonatorum and Treatment Accreditation : Department [journals.co.za]

Early diagnosis of the MSUD patient is very important for effective therapy and better long-term prognosis as well as genetic counselling and prenatal diagnosis for future pregnancies. [ncbi.nlm.nih.gov]

Joag, Grading of Tetanus to Evaluate Prognosis, Indian J. Med. Sci. 13, 884 (1959). Google Scholar M. Rey and I. Diop Mar, Tetanus in Dakar. Therapeutic Considerations. Principles on Tetanus, p. 501–511. Google Scholar M. J. [link.springer.com]

The sooner generalized spasms occur, the worse the prognosis, with mortality usually higher than 70%. During spasms, the child may be cyanotic. [symptoma.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

The etiology and mechanism tetanus neonatorum was the subject of debate and uncertainty throughout more than 2,000 years of recorded Western medicine. [nature.com]

Etiology of TetanusEtiology of Tetanus Tetanus occurs after introduced sporesTetanus occurs after introduced sporesgerminate, multiply, and produce tetanusgerminate, multiply, and produce tetanustoxin at the infected injury site.toxin at the infected [slideshare.net]

Descriptive Epidemiology 587 Mechanisms and Routes of Transmission 7 Pathogenesis and Immunity 590 Patterns of Host Response 591 Control and Prevention 592 References 593 Suggested Reading 595 Rocky Mountain Spotted Fever Theodore E Woodward and J Stephen [books.google.com]

Denchev, Epidemiological Peculiarities of Tetanus in Bulgaria, works of the Research Institute of Epidemiology and Microbiology 8, 73–82 (1962). Google Scholar K. W. Newell, Tetanus Neonatorum. Epidemiology and Prevention. [link.springer.com]

International Journal of Epidemiology. 39 (Suppl 1): i102–9. doi:10.1093/ije/dyq027. PMC 2845866. PMID 20348112. [en.wikipedia.org]

Pathophysiology Clostridium tetani is an obligate, anaerobic, motile, gram-positive bacillus. It is nonencapsulated and forms spores that are resistant to heat, desiccation, and disinfectants. [emedicine.medscape.com]

Tetanus: pathophysiology, management and prophylaxis. Disease-a-Month 1991;37:549-602. 2. Centers for Disease Control Tetanus - United States, 1987 and 1988. JAMA 1990;263:1192. 3. Prevots R, Sutter RW, Strebel PM, et al. [pedsccm.org]

The concept of prevention of the disease by proper handling of the cord was not even suggested. [nature.com]

Descriptive Epidemiology 587 Mechanisms and Routes of Transmission 7 Pathogenesis and Immunity 590 Patterns of Host Response 591 Control and Prevention 592 References 593 Suggested Reading 595 Rocky Mountain Spotted Fever Theodore E Woodward and J Stephen [books.google.com]

Immediate and proper wound care can prevent tetanus infection. [icdlist.com]

1. Murahovschi J. Tétano dos recém-nascidos: revisitado. Rev Paul Pediatr. 2008;26(4):312-4.
2. Black RE. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730):1969–87.
3. Ganatra HA, Stoll BJ, Zaidi AK. International perspective on early-onset neonatal sepsis. Clin Perinatol. 2010;37(2):501–23.
4. Blencowe H et al. Tetanus toxoid immunization to reduce mortality from neonatal tetanus. Int J Epidemiol. 2010;39(1):i102–9.
5. Glezen WP. Prevention of neonatal tetanus. Am J Public Health. 1998;88(6):871-2.
6. Prevots DR. Neonatal tetanus. MMWR Morb Mortal Wkly Rep. 1999;(48):176-7.
7. Darmstadt GL Population-based incidence and etiology of community-acquired neonatal bacteremia in Mirzapur, Bangladesh: an observational study. J Infect Dis. 2009;200(6):906–15.
8. Nida H. Neonatal tetanus in Awassa: retrospective analysis of patients admitted over 5 years. Ethiop Med J. 2001;39(3):241-6.
9. Apte NM, Karnad DR. Short report: the spatula test: a simple bedside test to diagnose tetanus. Am J Trop Med Hyg. 1995;53(4):386-7.