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
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
Contributors
Authors
Lucy E. Cottle, MA, BM BCh, MRCP, DTMH
Consultant in Infectious Diseases
Leeds Teaching Hospitals NHS Trust
Leeds
UK
Disclosures
LEC declares that she has no competing interests.
Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H
Consultant and Emeritus Professor of Tropical and Infectious Diseases
Royal Liverpool University Hospital
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 Public Health England. NJB is an author of a number of references cited in this topic.
Enitan D. Carrol, MBChB, MRCP, MRCPCH, MD, DTMH, Dip Med Sci
Professor in Paediatric Infection (Honorary Consultant)
University of Liverpool and Alder Hey Children’s NHS Foundation Trust
Liverpool
UK
Disclosures
EDC declares that she has no competing interests.
Christopher M. Parry, BA, MB, BCh, PhD, FRCP, FRCPath, DTMH
Consultant in Medical Microbiology
Alder Hey Children’s NHS Foundation Trust
Senior Lecturer, University of Liverpool
Honorary Clinical Research Fellow, Liverpool School of Tropical Medicine
Liverpool
UK
Professor
School of Tropical Medicine and Global Health
Nagasaki University
Japan
Disclosures
CMP is an author of a number of references cited in 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.
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