Clinical Manifestations DISEASE CLINCAL MANIFESTATIONSA Generalized Involvement of bulbar and paraspinal muscles(trismus or lockjaw, risus sardonicus, difficulty swallowing, irritability, opisthotonos);involvement of autonomic nervous system(sweating, hyper thermia, cardiac arrhythmias, fluctuations in blood pressure) Cephalic Primary infection in head, particularly ear isolated or com bined involvement of cranial nerves, particularly seventh cranial nerve; very poor prognosIs Localized Involvement of muscles in area of primary injury; infection may precede generalized disease favorable prognosis Neonatal Generalized disease in neonates; infection typically originates from umbilica脐带 stump very poor prognosis in infants whose mothers are nonimmuneClinical Manifestations DISEASE CLINCAL MANIFESTATIONSA Generalized Involvement of bulbar and paraspinal muscles(trismus or lockjaw, risus sardonicus, difficulty swallowing, irritability, opisthotonos);involvement of autonomic nervous system(sweating, hyper thermia, cardiac arrhythmias, fluctuations in blood pressure) Cephalic Primary infection in head,particularly ear;isolated or combined involvement of cranial nerves, particularly seventh cranial nerve; very poor prognosis Localized Involvement of muscles in area of primary injury; infection may precede generalized disease; favorable prognosis Neonatal Generalized disease in neonates; infection typically originates from umbilical脐带 stump;very poor prognosis in infants whose mothers are nonimmune