Diagnosis and Differential Diagnosis of Tetanus

Diagnosis is based on clinical findings and a history of immunization:
1. A history of the contaminated wound, but 20% can be no history of injury.
2. History is not immunized or incomplete immunization
3. Trismus, dysphagia, rhisus sardonicus, stiffness in the neck, back, and abdominal muscles (opisthotonos), pain and anxiety.
4. In the early neonatal tetanus complaint form can not suck
5. Episodic generalized seizures triggered by minimal stimuli and spontaneous where consciousness remains good.

Laboratory test results:
• mild leukocytosis
• Platelets slightly increased
• Glucose and normal blood calcium
• Cerebrospinal fluid pressure is normal but can be increased
• serum muscle enzymes may be elevated
• ECG and EEG is usually normal
• anaerobic culture and microscopic examination of pus taken from the wound
can help, but it is difficult to grow and Clostridium tetani gram positive rods
rod-shaped drummer often not found.
• Creatinine phosphokinase increased due to seizure activity (> 3U/ml)

1. Infection
a. Meningoencephalitis
Fever, no trismus, depressed sensorium, abnormal CSF.
b. Poliomyelitis
Obtained a flaccid paralysis with trismus not found any. Cerebrospinal fluid examination, showed leukocytosis. Poliodiisolasi virus from stool and serological testing, antibody titers increased.
c. Rabies
Previously there was a history of a dog bite or other animal. Trismus rare, only orofaringeal spasms, seizures are clonic.
d. Oropharyngeal lesions
Only local, found no rigidity or spasm of the entire body.
e. Severe tonsillitis
Patients with high fever, seizures were not there but there trismus.
f. Peritonitis
Trismus or spasm of the entire body does not exist.

2. Metabolic abnormalities
a. Tetani
Arise due to hypocalcemia and hipofasfatemia where kalsiumdan phosphate levels in low serum. Typical forms of muscle spasm and the spasm is usually followed carpopedal laringospasme, trismus rare.
b. Strychnine poisoning
Complete relaxation between spasms.
c. Reaction caused fenotiazine
A history of drug taking phenothiazines. Abnormalities such as extrapyramidal syndrome. Acute dystonic reaction, torticollis and muscular rigidity. Responds with difenhidramine.
3. CNS disease
a. Status epilepticus
There is a depressed sensorium.
b. A hemorrhagic tumor
Trismus no, there are depressed sensorium.
4. Psychiatric disorders
a. Hysteria: Inconstan trismus, spasm between the relaxation complete.
5. Musculoskeletal disorders
a. Trauma Local Only
6. Stiff neck 
can also occur in mastoiditis, upper lobar pneumonia, myositis neck and neck spondylitis.

Related Articles

1. What Tetanus is

2. Pathophysiology of Tetanus

3. Clinical Manifestations of Tetanus

4. Medical Treatment and Therapy of Tetanus
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