Clinical features

• prodrome: fever, malaise, headache

• trismus (patient cannot close mouth)

• risus sardonicus (a grin-like effect from hypertonic facial muscles)

• opisthotonos (arched trunk with hyperextended neck)

• spasms, precipitated by minimal stimuli

Differential diagnosis: phenothiazine toxicity, strychnine poisoning, rabies Management

• Refer immediately to expert centre.

• Intubate and ventilate if necessary.

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