- Author: Patrick B Hinfey, MD; Chief Editor: John L Brusch, MD, FACP more...
No specific laboratory tests exist for determining the diagnosis of tetanus. The diagnosis is clinically based on the presence of trismus, dysphagia, generalized muscular rigidity, spasm, or combinations thereof. Although the laboratory findings are not diagnostically valuable, they may help exclude strychnine poisoning.
Blood counts and blood chemical findings are unremarkable. Laboratory studies may demonstrate a moderate peripheral leukocytosis.
A lumbar puncture is not necessary for diagnosis. Cerebrospinal fluid (CSF) findings are normal, except for an increased opening pressure, especially during spasms.
Serum muscle enzyme levels (eg, creatine kinase, aldolase) may be elevated.
An assay for antitoxin levels is not readily available. However, a serum antitoxin level of 0.01 IU/mL or higher is generally considered protective, making the diagnosis of tetanus less likely (though rare cases have been reported to occur despite the presence of protective antitoxin levels).
Wounds should be cultured in cases of suspected tetanus. It must be kept in mind, however, that C tetani sometimes can be cultured from the wounds of patients who do not have tetanus and frequently cannot be cultured from the wounds of patients who do.
The spatula test is a simple diagnostic bedside test that involves touching the oropharynx with a spatula or tongue blade. In normal circumstances, it elicits a gag reflex, and the patient tries to expel the spatula (ie, a negative test result). If tetanus is present, patients develop a reflex spasm of the masseters and bite the spatula (ie, a positive test result).
In 400 patients, this test had a sensitivity of 94% and a specificity of 100%. No adverse sequelae (eg, laryngeal spasm) were reported.
Electromyography (EMG) may show continuous discharge of motor subunits and shortening or absence of the silent interval normally observed after an action potential.
Nonspecific changes may be evident on electrocardiography (ECG).
Imaging studies of the head and spine reveal no abnormalities.
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