Diagnosis And Differential Diagnosis

Tetanus is rare in developed nations, where immunization and appropriate hygienic practices have eliminated the disease. The classic presenting complaints in tetanus of muscle spasms, trismus, stiffness, and pain with dysphagia and cranial nerve weakness can be seen in other conditions.

Conditions that can mimic some manifestations of tetanus include parapharyngeal and peritonsillar abscesses, poliomyelitis and other forms of viral encephalomyelitis, meningoen-cephalitis (including rabies), Bell's palsy, hypocalcemic tetany, and dystonic reactions to phenothiazines. These conditions can be differentiated from tetanus by specific laboratory or radiographic evaluations or by the clinical findings. The lack of altered consciousness in tetanus is an important point of differentiation from CNS infections, and a parapharyngeal inflammation can be diagnosed by clinical examination and/or radiographs of the airway (16).

Specific diagnosis of tetanus by routine laboratory tests is difficult. Blood counts are normal or slightly elevated; cerebrospinal fluid indexes are normal; and electroencephalogram and electromyogram are normal and nonspecifically abnormal, respectively. Gram stains and anaerobic cultures of wounds reveal the characteristic gram-positive bacilli with terminal spores in as many as one-third of tetanus patients. Even though a positive wound culture can support the clinical diagnosis, a positive culture in the absence of symptoms does not indicate that tetanus intoxication will develop.

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