With respect to a patient presenting with clinical features suggestive of tetanus:
a) List six other potential differential diagnoses other than tetanus that you would consider.
b) How would you confirm the diagnosis of tetanus?
Excluding general supportive measures (e.g. airway management), describe the specific management of tetanus.
a) The differential includes:
• Strychnine poisoning
• Drug induced dystonia
• Dental/local infections
• Stiff person syndrome
• Malignant Hyperthermia
• Stimulant Use
• Serotonin syndrome
• Seizure disorder
• Psychiatric disorders
b) The diagnosis is a clinical one.
• Appropriate History
• Vaccinations status
• Tetanus prone wound
• Appropriate clinical features
• C tetani is cultured from the wound in only 1/3 of cases. There are no specific lab tests to confirm the diagnosis
c) Passive immunisation.
Human antitetanus immunoglobulin (HIG) has now largely replaced antitetanus serum (ATS) of horse origin as it is less antigenic.it is recommended that HIG be administered to unimmunised patients or those where their immunisation status is unknown if they present with contaminated wounds
Eradication of the organism.
• Wound care. The infected site should the cleaned and all necrotic tissue should be debrided.
• Antibiotics .As tetanus spores are destroyed by antibiotics they should be administered.
• Recommendations include Metronidazole, penicillin and erythromycin.
Management of spasms
• Intra thecal Baclofen
• Muscle relaxants with mechanical ventilation
Management of autonomic dysfunction
• Alpha and beta blockers
Note: Mention of Human Antitetanus Immunoglobulin was considered essential to score a passing mark
Differentials for whole-body rigidity, opisthotonos and trismus:
Confirmation of the diagnosis of tetanus:
Management of tetanus:
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Wesley, A. G., et al. "Labetalol in tetanus." Anaesthesia 38.3 (1983): 243-249.
Attygalle, D., and N. Rodrigo. "Magnesium as first line therapy in the management of tetanus: a prospective study of 40 patients*." Anaesthesia 57.8 (2002): 778-817.
Henderson, Sean O., et al. "The presentation of tetanus in an emergency department." The Journal of emergency medicine 16.5 (1998): 705-708.
Apte, Nitin M., and Dilip R. Karnad. "The spatula test: A simple bedside test to diagnose tetanus." The American journal of tropical medicine and hygiene 53.4 (1995): 386-387.