eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Tetanus: Differential Diagnoses & Workup

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Jan 23, 2009

Differential Diagnoses

Arthrogryposis
Meningitis, Aseptic
Meningitis, Bacterial
Rabies

Other Problems to Be Considered

Strychnine poisoning
Dystonic drug reactions (eg, phenothiazines, metoclopramide)
Hypocalcemic tetany
Encephalitis
Acute intra-abdominal process (due to rigid abdomen)

Workup

Laboratory Studies

  • The diagnosis of tetanus is based entirely on clinical findings. Tetanus is unlikely if a reliable history indicates the completion of a primary vaccination series and the receipt of required booster doses.
  • Wounds should be cultured in suspected cases. However, C tetani can be cultured from wounds of patients without tetanus and frequently cannot be cultured from wounds of patients with tetanus.
  • The leukocyte count may be high.
  • Cerebrospinal fluid examination yields normal results.
  • Serum antitoxin levels of 0.01 or higher are considered protective and make tetanus unlikely, although rarely cases have been reported despite the presence of protective antitoxin levels.
  • Serum muscle enzyme levels (eg, creatine kinase, aldolase) may be elevated.

Other Tests

  • Electromyography 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.

More on Tetanus

Overview: Tetanus
Differential Diagnoses & Workup: Tetanus
Treatment & Medication: Tetanus
Follow-up: Tetanus
References
Further Reading
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References

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Further Reading

An interesting online case is available at the Gorgas Course in Clinical Tropical Medicine.

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Keywords

tetanus, abscesses, airway obstruction, burns, cephalic tetanus, Clostridium tetani, C tetani, compound fractures, contaminated crush injury, decubitus ulcers, disease of the seventh day, frostbite, gangrene, generalized tetanus, hyperreflexia, hyperthermia, laryngeal spasm, localized tetanus, lockjaw, middle ear infections, neonatal tetanus, opisthotonus, rhabdomyolysis, septic abortion, synaptobrevin, tetanospasmin, tetanus neonatorum, trismus, urinary retention

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Medical Editor

Rosemary Johann-Liang, MD, Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration
Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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