Summary
Definition
History and exam
Key diagnostic factors
- antecedent tetanus-prone injury
- tetanus immunization status
- trismus (lock jaw)
- back pain
- muscle stiffness/increased tone
- dysphagia
- spasms
Other diagnostic factors
- injecting drug habits
- respiratory distress
- labile blood pressure, pulse rate, and temperature
- sweating
Risk factors
- incomplete tetanus immunization
- injury
- aseptic obstetric practices
- injecting drug habits
- asterile intramuscular injection
- abdominal surgery
- acupuncture, ear piercing, pedicures, toothpicks
- necrotic tumors
- middle ear infection
Diagnostic investigations
1st investigations to order
- clinical diagnosis
Investigations to consider
- serum toxin
- Clostridium tetani detection from wound tissue or swab
- serum antitoxin antibodies
- spores on drug samples or paraphernalia
- lumbar puncture
- electroencephalogram (EEG)
- electromyogram (EMG)
Treatment algorithm
clean and minor wound
tetanus-prone wound
with clinical tetanus
Contributors
Authors
Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, FISTM, DCH, DTM&H
Honorary Consultant and Emeritus Professor of Tropical and Infectious Diseases
Liverpool University Hospitals NHS Foundation Trust and Liverpool School of Tropical Medicine
Liverpool
UK
Disclosures
NJB lectures at noncommercial meetings and conferences and publishes articles in peer-reviewed publications on the topic of tetanus. He has received sponsorship from specialist societies only to attend and speak at conferences. Views expressed in this topic are those of the contributor and do not necessarily represent the official position of the National Health Service, the National Institute for Health Research, the Department of Health, or the UK Health Security Agency. NJB is an author of a number of references cited in this topic.
Christopher M. Parry, BA, MB, BCh, PhD, FRCP, FRCPath, DTMH
Consultant in Medical Microbiology
Alder Hey Children’s NHS Foundation Trust
Director of Studies for DTM&H programme & Honorary Clinical Research Fellow
Liverpool School of Tropical Medicine
Liverpool
UK
Visiting Professor
School of Tropical Medicine and Global Health
Nagasaki University
Japan
Visiting Professor
Centre for Tropical Medicine and Global Health
University of Oxford
Oxford
UK
Disclosures
CMP is an author of a number of references cited in this topic.
Acknowledgements
Dr Nicholas J. Beeching and Dr Christopher M. Parry would like to gratefully acknowledge Dr Lucy E. Cottle and Professor Enitan D. Carrol, previous contributors to this topic.
Peer reviewers
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
Disclosures
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
Disclosures
KK declares that she has no competing interests.
Differentials
- Drug-induced dystonias, for example, phenothiazines
- Strychnine poisoning
- Neuroleptic malignant syndrome
More DifferentialsGuidelines
- Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2022
- Recommended adult immunization schedule for ages 19 years or older, United States, 2022
More GuidelinesPatient leaflets
DTaP vaccine (diphtheria, tetanus, polio, and pertussis)
More Patient leaflets
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