Materiały źródłowe

• #1 Clinical Features of Tetanus | Tetanus | CDC

  https://www.cdc.gov/tetanus/hcp/clinical-signs/index.html

  Tetanus is diagnosed based on clinical signs and medical history. […] There are no laboratory tests to support or rule out tetanus diagnosis. […] Tetanus is a clinical syndrome. Healthcare providers diagnose tetanus based on clinical presentation consistent with tetanus, in the absence of an alternative or more likely cause. There are no diagnostic tests that can support or rule out tetanus. Culture can lead to both false-positive and false-negative results. Serologic studies can’t reliably evaluate individual-level tetanus immunity.

• #1 Tetanus Workup: Approach Considerations, Laboratory Studies, Spatula Test

  https://emedicine.medscape.com/article/229594-workup

  Tetanus should be suspected in patients experiencing sudden, unexplained muscle stiffness or spasms, especially if they have a recent wound or risk factors for the disease. It can be mistaken for meningoencephalitis, but the presence of an intact sensorium, normal cerebrospinal fluid, and muscle spasms indicates tetanus. […] Although Clostridium tetani can be cultured from wounds, the sensitivity is low, with only 30% of tetanus patients showing positive cultures, and false positives can occur in those without the disease. […] 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. […] Wound cultures are only positive for C tetani in 30% of cases and therefore generally are not useful clinically. Moreover, cultures can be positive in patients without clinical tetanus symptoms.

• #1 Tetanus – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/220

  Diagnosis is based on clinical findings that include trismus, muscle rigidity, spasms, respiratory embarrassment, dysphagia, or autonomic dysfunction. […] Key diagnostic factors include antecedent tetanus-prone injury, tetanus immunization status, trismus (lock jaw), back pain, muscle stiffness/increased tone, dysphagia, and spasms. […] Other diagnostic factors include people who inject drugs, respiratory distress, labile blood pressure, pulse rate, and temperature, and sweating. […] 1st tests to order include clinical diagnosis. […] Tests to consider include serum toxin, Clostridium tetani detection from wound tissue or swab, serum antitoxin antibodies, spores on drug samples or paraphernalia, lumbar puncture, electroencephalogram, and electromyogram.

• #1 Tetanus – UpToDate

  https://www.uptodate.com/contents/tetanus

  Tetanus is a nervous system disorder characterized by muscle spasms that is caused by the toxin-producing anaerobe Clostridium tetani, which is found in the soil. […] The diagnosis of tetanus is usually obvious and can generally be made based upon typical clinical findings outlined above. Tetanus should especially be suspected when there is a history of an antecedent tetanus-prone injury and a history of inadequate immunization for tetanus. […] Tetanus is a clinical diagnosis and should be considered in patients with an inadequate vaccination history and consistent clinical findings. The most common and severe clinical form of tetanus is generalized tetanus. The presenting symptom in more than 80 percent of such patients is trismus (lockjaw), although patients with generalized tetanus sometimes present initially with cephalic (involving the cranial nerves) or localized tetanus.

• #1 Tetanus: Symptoms, causes, and treatments

  https://www.medicalnewstoday.com/articles/163063

  The earlier a patient is diagnosed with tetanus, the more effective the treatment will be. […] A patient with muscle spasms and stiffness who has recently had a wound or cut is usually diagnosed quickly. […] Diagnosis may take longer with patients who inject drugs because they often have other medical conditions. They made need a blood test for confirmation. […] Anybody who experiences muscle spasms and stiffness should seek medical attention immediately.

• #1 Tetanus Workup: Approach Considerations, Laboratory Studies, Spatula Test

  https://emedicine.medscape.com/article/229594-workup

  A lumbar puncture is not necessary for diagnosis. Cerebrospinal fluid (CSF) findings are normal, except for an increased opening pressure, especially during spasms. […] Assay for tetanus toxin antibodies do exist. However, their clinical utility in diagnosing acute tetanus is limited. They are more commonly used for confirmation of tetanus immunity. […] 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). […] Electromyography (EMG) may show continuous discharge of motor subunits and shortening or absence of the silent interval normally observed after an action potential. […] No systematic studies have found diagnostically-significant findings on imaging.

• #1 Tetanus – Wikipedia

  https://en.wikipedia.org/wiki/Tetanus

  Diagnosis is based on the presentation of tetanus symptoms and does not depend upon isolation of the bacterium, which is recovered from the wound in only 30% of cases and can be isolated from people without tetanus. […] The „spatula test” is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a soft-tipped instrument and observing the effect. A positive test result is the involuntary contraction of the jaw (biting down on the „spatula”), and a negative test result would normally be a gag reflex attempting to expel the foreign object. A short report in The American Journal of Tropical Medicine and Hygiene states that, in an affected subject research study, the spatula test had a high specificity (zero false-positive test results) and a high sensitivity (94% of infected people produced a positive test).

• #1

  https://www.gov.uk/government/publications/tetanus-advice-for-health-professionals/guidance-on-the-management-of-suspected-tetanus-cases-and-the-assessment-and-management-of-tetanus-prone-wounds

  Tetanus is primarily a clinical diagnosis. A probable case can be defined as: In the absence of a more likely diagnosis, an acute illness with muscle spasms or hypertonia, and diagnosis of tetanus by a health care provider. The key clinical features of generalised tetanus include at least 2 of the following: Trismus (painful muscular contractions primarily of the masseter and neck muscles leading to facial spasms), Painful muscular contractions of trunk muscles, Generalized spasms, frequently position of opisthotonus. Laboratory tests are available to support the clinical diagnosis. Although a serum sample should be taken before administering immunoglobulin, treatment of clinical case of tetanus should never be delayed to wait for the laboratory result and case management should proceed based on clinical review including clinical presentation, history of injury and vaccination status. Laboratory investigations available to support a diagnosis of tetanus are: Detection of C. tetani and tetanus neurotoxin gene in tissue or deep wound material or from a pure culture, by direct PCR and culture methods. A negative result does not exclude tetanus. This is the most sensitive test currently in use and wound debridement to obtain samples is clinically beneficial. Detection of IgG against tetanus toxoid in serum. An antibody level of less than 0.1 IU/mL in serum taken during the acute illness but before administration of any immunoglobulin can support the diagnosis of tetanus. An antibody level of 0.1 IU/mL or above does not, however, exclude the diagnosis of tetanus.

• #1 Tetanus Differential Diagnoses

  https://emedicine.medscape.com/article/229594-differential

  Strychnine poisoning is the only condition that truly mimics tetanus. However, a number of conditions (eg, dental or other local infections, hysteria, neoplasms, and encephalitis) may cause trismus, and these must be differentiated from tetanus. […] The following conditions listed do not cause manifestations of tetanus other than trismus: Dental infections, Local infections, Hysteria, Neoplasms, Malignant hyperthermia, Stimulant use, Intraoral disease, Odontogenic infections, Globus hystericus, Hepatic encephalopathy, Acute abdomen, Intracranial hemorrhage, Dystonic drug reactions (eg, phenothiazines, metoclopramide), Acute abdominal emergencies, Seizure disorder (partial or generalized), Serotonin syndrome, Stroke, ischemic (cephalic tetanus). […] The spatula test: a simple bedside test to diagnose tetanus.

• #1

  https://www.who.int/news-room/fact-sheets/detail/tetanus

  Tetanus is diagnosed on the basis of clinical features and does not require laboratory confirmation. The WHO definition of a confirmed neonatal tetanus case is an illness occurring in an infant who has the normal ability to suck and cry in the first 2 days of life, but who loses this ability between days 3 and 28 of life and becomes rigid or has spasms. […] The WHO definition of non-neonatal tetanus requires at least one of the following signs: a sustained spasm of the facial muscles in which the person appears to be grinning, or painful muscular contractions. Although this definition requires a history of injury or wound, tetanus may also occur in patients who are unable to recall a specific wound or injury.

• #1 Case Series of Tetanus Diagnosis and Management in Hargeisa City

  http://clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-7-312.php?jid=cmrcr

  In this case series, we will discuss the special course of tetanus with a challenging delayed diagnosis in 5 patients of diverse age, gender and background who were hospitalized in Hargeisa, Somaliland. […] We also highlight the multiple visits to healthcare providers before a diagnosis was made and link the deficiencies in universal tetanus vaccine coverage to the high tetanus morbidity and mortality in the region. […] Tetanus diagnosis can be a clinical challenge in psychiatric settings. The physician may suspect that the patient is suffering from a psychosomatic disorder with muscular pain complaints appearing early on as over elaborated. […] In our case series, muscle spasms and autonomic disturbance presentations were more prominent then the lockjaw syndrome. […] The treatment of tetanus is multidimensional and revolves around supportive care, hemodynamic management, control of the toxin production and symptomatic treatment of the muscular spasms.

• #1 Tetanus (Clostridium tetani Infection) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482484/

  Patients exhibiting signs and symptoms of tetanus should be closely monitored, preferably in an intensive care unit (ICU). […] Tetanospasmin binds irreversibly at the neuromuscular junction, so neutralization focuses on unbound toxins circulating in the bloodstream. […] The management of tetanus relies on experience gained and reported in many case studies. […] The prognosis following tetanus depends on the time to symptom onset or the incubation period. Generally, a shorter incubation period often signifies a more severe disease.

• #1 Tetanus – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/tetanus

  Tetanus is acute poisoning resulting from a neurotoxin produced by Clostridium tetani. Diagnosis is clinical. […] Tetanus should be considered when patients have sudden, unexplained muscle stiffness or spasms, particularly if they have a history of a recent wound or risk factors for tetanus. […] Tetanus can be confused with meningoencephalitis of bacterial or viral origin, but the following combination suggests tetanus: An intact sensorium, Normal cerebrospinal fluid, Muscle spasms. […] Tetanus infection does not confer immunity, so unless their vaccination history indicates completion of a full primary series, patients should receive a full primary tetanus vaccination series using an age-appropriate preparation.

• #1 Tetanus (Lockjaw) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23582-tetanus-lockjaw

  The best way to prevent tetanus is to get a vaccine. Tetanus toxoid is the name of the tetanus vaccine. Side effects of the tetanus vaccine are usually mild. They include redness, swelling, soreness, tenderness and fever. […] If tetanus symptoms have developed, the disease has to run its course. This can take several weeks. With proper treatment, most people recover. But it can take several months to fully recover. […] Worldwide, one in four people infected with tetanus will die without treatment. The death rate for newborns with untreated tetanus is even higher. With proper treatment, less than 15% of infected people die. In the U.S., tetanus is rarely fatal with proper treatment. […] Tetanus is a rare but serious bacterial infection. Getting vaccinated against tetanus is the best way to prevent getting the disease. If you injure yourself and have an open wound, it’s important to treat your wound right away. If you’re not sure if you’re up to date on your vaccines, seek medical treatment right away. Your healthcare provider can help you manage your symptoms and prevent further complications.

• #1 Tetanus – Causes, Symptoms, Treatment, Diagnosis – MedBroadcast.com

  https://medbroadcast.com/condition/getcondition/tetanus

  Tetanus is a condition caused by a nerve toxin that is produced by the bacterium Clostridium tetani, a cousin of the bacteria that cause gangrene and botulism. […] The bacteria can’t always be detected in the wound, but the particular combination of symptoms and a recent wound usually paints a clear picture of tetanus. […] People with tetanus need to be in an intensive care unit so they can receive treatment and continuous monitoring. […] Treatment of tetanus usually includes supportive care, medications to control muscle spasms, antibiotics and tetanus immune globulin to manage the infection, wound treatment, and vaccination. […] Tetanus is a preventable disease, thanks to the development of a vaccine. […] When you see a doctor for a cut that might be dirty or infected, the preventive treatment you get depends on your vaccination status. […] Children today are normally vaccinated at 2, 4, and 6 months, then again at 18 months and once more around age 4 to 6. […] Adults should continue to get booster shots every 10 years to minimize the risk of tetanus.

• #2 Tetanus Workup: Approach Considerations, Laboratory Studies, Spatula Test

  https://emedicine.medscape.com/article/229594-workup

  Tetanus should be suspected in patients experiencing sudden, unexplained muscle stiffness or spasms, especially if they have a recent wound or risk factors for the disease. It can be mistaken for meningoencephalitis, but the presence of an intact sensorium, normal cerebrospinal fluid, and muscle spasms indicates tetanus. […] Although Clostridium tetani can be cultured from wounds, the sensitivity is low, with only 30% of tetanus patients showing positive cultures, and false positives can occur in those without the disease. […] 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. […] Wound cultures are only positive for C tetani in 30% of cases and therefore generally are not useful clinically. Moreover, cultures can be positive in patients without clinical tetanus symptoms.

• #2 Tetanus – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/tetanus

  Tetanus is acute poisoning resulting from a neurotoxin produced by Clostridium tetani. Diagnosis is clinical. […] Tetanus should be considered when patients have sudden, unexplained muscle stiffness or spasms, particularly if they have a history of a recent wound or risk factors for tetanus. […] Tetanus can be confused with meningoencephalitis of bacterial or viral origin, but the following combination suggests tetanus: An intact sensorium, Normal cerebrospinal fluid, Muscle spasms. […] Tetanus infection does not confer immunity, so unless their vaccination history indicates completion of a full primary series, patients should receive a full primary tetanus vaccination series using an age-appropriate preparation.

• #2 Tetanus Clinical Information – MN Dept. of Health

  https://www.health.state.mn.us/diseases/tetanus/hcp/clinical.html

  The diagnosis is entirely clinical and does not depend upon bacteriologic confirmation. Symptoms usually confirm the diagnosis of tetanus. […] Tetanus is characterized by the following: stiffness of jaw (also called lockjaw), stiffness of abdominal and back muscles, contraction of facial muscles, fast pulse, fever, sweating, painful muscle spasms near the wound area (if these affect the larynx or chest wall, they may cause asphyxiation), difficulty swallowing.

• #2 Tetanus (Lockjaw): Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/tetanus

  Tetanus is a medical emergency that requires immediate treatment in a hospital. […] Your doctor will perform a physical exam to check for symptoms of tetanus, such as muscle stiffness and painful spasms. […] Unlike many other diseases, tetanus is not generally diagnosed through laboratory tests. However, your doctor may still perform lab tests to help rule out diseases with similar symptoms. […] Your doctor will also base a tetanus diagnosis on your immunization history. You’re at a higher risk of tetanus if you haven’t been immunized or if you’re overdue for a booster shot.

• #2 Generalized Tetanus in an Adult Patient

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10561902/

  Despite the fact that tetanus occurs extremely rarely, cases are still reported in under-resourced countries, particularly in patients who are not up to date with their vaccinations, as we observed in this patient. Therefore, physicians in countries where there are still reported cases should know about the presentation of symptoms, diagnostic process, progression of the disease, and management of clinical tetanus. It is important to remind healthcare professionals about tetanus prophylaxis in routine wound management, as delay in prophylaxis can result in clinical tetanus. This case highlights the importance of the early diagnosis of this disease owing to its high mortality.

• #2 Tetanus – Wikipedia

  https://en.wikipedia.org/wiki/Tetanus

  Diagnosis is based on the presentation of tetanus symptoms and does not depend upon isolation of the bacterium, which is recovered from the wound in only 30% of cases and can be isolated from people without tetanus. […] The „spatula test” is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a soft-tipped instrument and observing the effect. A positive test result is the involuntary contraction of the jaw (biting down on the „spatula”), and a negative test result would normally be a gag reflex attempting to expel the foreign object. A short report in The American Journal of Tropical Medicine and Hygiene states that, in an affected subject research study, the spatula test had a high specificity (zero false-positive test results) and a high sensitivity (94% of infected people produced a positive test).

• #2 Tetanus – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/220

  Diagnosis is based on clinical findings that include trismus, muscle rigidity, spasms, respiratory embarrassment, dysphagia, or autonomic dysfunction. […] Key diagnostic factors include antecedent tetanus-prone injury, tetanus immunization status, trismus (lock jaw), back pain, muscle stiffness/increased tone, dysphagia, and spasms. […] Other diagnostic factors include people who inject drugs, respiratory distress, labile blood pressure, pulse rate, and temperature, and sweating. […] 1st tests to order include clinical diagnosis. […] Tests to consider include serum toxin, Clostridium tetani detection from wound tissue or swab, serum antitoxin antibodies, spores on drug samples or paraphernalia, lumbar puncture, electroencephalogram, and electromyogram.

• #2 Tetanus differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Tetanus_differential_diagnosis

  Tetanus must be differentiated from other diseases that present with fever and rigidity such as strychnine poisoning, dental infections, drug reactions, hypocalcemia, meningitis, stroke, and stiff man syndrome. […] Tetanus must also be differentiated from the following diseases that cause abnormal one sided movements of the face: Tetanus associated trismus.

• #2 Case Series of Tetanus Diagnosis and Management in Hargeisa City

  https://www.clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-7-312.php

  Tetanus diagnosis can be a clinical challenge in psychiatric settings. […] In our case series, muscle spasms and autonomic disturbance presentations were more prominent than the lockjaw syndrome. […] The reasons why so many people in rural Somaliland contract the disease are due to poor access to the vaccine only at ~ 47% in its needed 3 injection/booster regimen and a low level of literacy and health education to request and follow-up on what is their right for preventative lifesaving measures. […] We continue to push for awareness that tetanus is a preventable disease and its mortality and morbidity could be eradicated with proper vaccination and sanitization.

• #2 Tetanus (Lockjaw) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23582-tetanus-lockjaw

  Your healthcare provider will diagnose tetanus based on your symptoms. They will perform a physical examination and ask you about your medical history. There are no laboratory tests to diagnose or confirm tetanus. […] Tetanus isn’t curable. Once you’ve developed symptoms, the disease needs to run its course. But proper treatment can help manage symptoms and prevent complications. […] Treatment for tetanus (lockjaw) depends on the severity of your condition. But if you have tetanus, you need immediate medical care. Your healthcare provider may treat tetanus with: […] Your healthcare provider may use various medicines to treat tetanus. These medications include: […] Once tetanus symptoms develop, it can take two to three weeks for the disease to run its course. With proper treatment, most people recover. But it can take several months to fully recover from tetanus.

• #2 Tetanus – UpToDate

  https://www.uptodate.com/contents/tetanus

  Tetanus can sometimes be confused with the following mimics. […] The use of passive immunization (ie, antitoxin) to neutralize unbound toxin is associated with improved survival and it is considered to be standard of care. […] All patients with tetanus should receive active immunization with a full series (eg, three doses in adults and children >7 years old) of tetanus and diphtheria toxoid-containing vaccines, commencing immediately upon diagnosis.

• #2 Tetanus (Lockjaw) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23582-tetanus-lockjaw

  The best way to prevent tetanus is to get a vaccine. Tetanus toxoid is the name of the tetanus vaccine. Side effects of the tetanus vaccine are usually mild. They include redness, swelling, soreness, tenderness and fever. […] If tetanus symptoms have developed, the disease has to run its course. This can take several weeks. With proper treatment, most people recover. But it can take several months to fully recover. […] Worldwide, one in four people infected with tetanus will die without treatment. The death rate for newborns with untreated tetanus is even higher. With proper treatment, less than 15% of infected people die. In the U.S., tetanus is rarely fatal with proper treatment. […] Tetanus is a rare but serious bacterial infection. Getting vaccinated against tetanus is the best way to prevent getting the disease. If you injure yourself and have an open wound, it’s important to treat your wound right away. If you’re not sure if you’re up to date on your vaccines, seek medical treatment right away. Your healthcare provider can help you manage your symptoms and prevent further complications.

• #3 Clinical Overview of Tetanus | Tetanus | CDC

  https://www.cdc.gov/tetanus/hcp/clinical-overview/index.html

  Diagnostic tests arent useful in supporting or ruling out tetanus. […] CDC doesn’t conduct tetanus serologies or other tetanus laboratory tests. There are no laboratory tests that can diagnose or rule out a tetanus diagnosis. Tetanus is a clinical syndrome. Healthcare providers diagnose tetanus based on clinical presentation, in the absence of a more likely cause. Clinical presentation of tetanus includes: […] Diagnostic tests arent useful in supporting or ruling out tetanus.

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