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Last reviewed: 4 Sep 2023
Last updated: 04 Apr 2023



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


clean and minor wound

tetanus-prone wound


with clinical tetanus



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



Visiting Professor

School of Tropical Medicine and Global Health

Nagasaki University


Visiting Professor

Centre for Tropical Medicine and Global Health

University of Oxford




CMP is an author of a number of references cited in this topic.


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


Centre for Tropical Medicine and Global Health

Oxford University

Oxford, UK


LT is an author of a number of references cited in this topic.

Katrina Kretsinger, MD, MA


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


KK declares that she has no competing interests.

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