Tetanus

Last reviewed: 28 Dec 2022
Last updated: 20 Dec 2022

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
More key diagnostic factors

Other diagnostic factors

  • injecting drug habits
  • respiratory distress
  • labile blood pressure, pulse rate, and temperature
  • sweating
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

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)
More investigations to consider

Treatment algorithm

INITIAL

clean and minor wound

tetanus-prone wound

ACUTE

with clinical tetanus

Contributors

Authors

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 Christopher M. Parry would like to gratefully acknowledge Dr Nicholas J. Beeching, Dr Lucy E. Cottle, and Professor Enitan D. Carrol, the 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.

  • Tetanus images
  • Differentials

    • Drug-induced dystonias, for example, phenothiazines
    • Strychnine poisoning
    • Neuroleptic malignant syndrome
    More Differentials
  • Guidelines

    • 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 Guidelines
  • Patient leaflets

    DTaP vaccine (diphtheria, tetanus, polio, and pertussis)

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer