Tetanus

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Última revisão: 5 Aug 2025

Última atualização: 25 Feb 2025

Tetanus is an acute infection caused by the bacterium Clostridium tetani. Tetanus spores are highly prevalent in soil and manure and may be introduced into the body via broken skin (e.g., a puncture wound, burn, or scratch).

Prevention of tetanus includes appropriate management of tetanus-prone wounds and complete active immunization, with passive immunization administered when required.

Diagnosis is based on clinical findings that include trismus, muscle rigidity, spasms, respiratory embarrassment, dysphagia, or autonomic dysfunction.

Management of clinical tetanus includes supportive care, wound debridement, antimicrobials, passive and active immunization, control of muscle spasms, and management of autonomic dysfunction.

Definição

Tetanus is a life-threatening neurologic syndrome characterized by tonic muscle spasms and hyperreflexia, caused by the exotoxin of Clostridium tetani, a gram-positive spore-forming obligate anaerobe.

História e exame físico

Principais fatores diagnósticos

antecedent tetanus-prone injury
tetanus immunization status
trismus (lock jaw)
back pain
muscle stiffness/increased tone
dysphagia
spasms

Detalhes completos

Outros fatores diagnósticos

people who inject drugs
respiratory distress
labile blood pressure, pulse rate, and temperature
sweating

Detalhes completos

Fatores de risco

incomplete tetanus immunization
injury
aseptic obstetric practices
people who inject drugs
asterile intramuscular injection
abdominal surgery
acupuncture, ear piercing, pedicures, toothpicks
necrotic tumors
middle ear infection

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

clinical diagnosis

Detalhes completos

Investigações a serem consideradas

serum toxin
Clostridium tetani detection from wound tissue or swab
serum antitoxin antibodies
spores on drug samples or paraphernalia
lumbar puncture
electroencephalogram
electromyogram

Detalhes completos

Algoritmo de tratamento

Inicial

clean and minor wound

tetanus-prone wound

AGUDA

with clinical tetanus

Colaboradores

Autores

Russell W. Steele, MD

Clinical Professor of Pediatrics

Tulane University School of Medicine

New Orleans

Declarações

RWS declares that he has no competing interests.

Agradecimentos

Dr Russell W. Steele would like to gratefully acknowledge Dr Christopher M. Parry, Dr Nicholas J. Beeching, Dr Lucy E. Cottle, and Professor Enitan D. Carrol, the previous contributors to this topic.

Revisores

Louise Thwaites, BSc, MBBS, MD

Senior Clinical Research Fellow

Oxford University Clinical Research Unit

Hospital for Tropical Diseases

Ho Chi Minh City

Vietnam

Centre for Tropical Medicine and Global Health

Oxford University

Oxford, UK

Declarações

LT is an author of a number of references cited in this topic.

Katrina Kretsinger, MD, MA

Commander

U.S. Public Health Service

Medical Epidemiologist

HIV Vaccine Team

Epidemiology Branch

Division of HIV/AIDS Prevention

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention

Atlanta, GA

Declarações

KK declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

UK Health Security Agency. Tetanus: the green book, chapter 30. Jun 2022 [internet publication].Texto completo

Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age: recommendations for ages 18 years or younger, United States, 2025. Nov 2024 [internet publication].Texto completo

Centers for Disease Control and Prevention. Adult immunization schedule by age: recommendations for ages 19 years or older, United States, 2025. Nov 2024 [internet publication].Texto completo

Havers FP, Moro PL, Hunter P, et al. Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: updated recommendations of the Advisory Committee on Immunization Practices - United States, 2019. MMWR Morb Mortal Wkly Rep. 2020 Jan 24;69(3):77-83.Texto completo Resumo

Tiwari TSP, Moro PL, Acosta AM. Tetanus. In: Hall E, Wodi AP, Hamborsky J, et al, eds. Centers for Disease Control and Prevention. Epidemiology and vaccine-preventable diseases. 14th ed. Washington, D.C.: Public Health Foundation; 2021.Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Drug-induced dystonias, for example, phenothiazines
- Strychnine poisoning
- Neuroleptic malignant syndrome
Mais Diagnósticos diferenciais
Diretrizes
- Child and adolescent immunization schedule by age: recommendations for ages 18 years or younger, United States, 2025
- Adult immunization schedule by age: recommendations for ages 19 years or older, United States, 2025
Mais Diretrizes
Folhetos informativos para os pacientes
DTaP vaccine (diphtheria, tetanus, polio, and pertussis)
Mais Folhetos informativos para os pacientes
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Tetanus

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

clean and minor wound

tetanus-prone wound

with clinical tetanus

Colaboradores

Autores

Russell W. Steele, MD

Declarações

Agradecimentos

Revisores

Louise Thwaites, BSc, MBBS, MD

Declarações

Katrina Kretsinger, MD, MA

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice