Tetanus differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]


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.[1]

Differentiating Tetanus from other Diseases

Tetanus must be differentiated from other diseases that present with fever and rigidity such as::[2][3][4]

Differential Diagnosis on the basis of Rigidity and Fever
Disease Diagnosis Treatment
Symptoms Signs Laboratory Findings
  • Not significant
Neuroleptic Malignant Syndrome [7][8]
Viral Meningitis[9][10][11]
Stiff man syndrome
  • Marked rigidity
  • Spasms
    • Intermittent
    • Painful
    • Absent during sleep
Drug induced (Tardive dyskinesia)[12][13][14]
  • History of intake of the offending drug for at least one month
  • Eye deviation
  • Head and neck jerky movements
  • No tonic contraction of the muscles between the spasms
Strychnine poisoning[15][16][17][18]
  • Hx of up to date tetanus immunizations
  • History of intentional or accidental intake
    • Strychnos nux vomica seeds
    • Rodenticide
  • Hypervigilance
  • Anxiety
  • Mydriasis
  • Hypereflexia
  • Clonus
  • Facial and neck stiffness
  • Blood assay
  • Tissue assay
  • Urine assay
  • Initial stabilization
  • High dose Benzodiazepines
  • Intubation and airway securing
Dental abscess[21][22]
  • Tooth pain
  • Painful eating and chewing
  • Fever
  • Poor oral hygiene
  • Presence of a dental infection
  • Swollen gums
  • No progression of spasm with time
  • Cheek swelling
  • Clinical diagnosis
  • Labs may include
    • Microscopic exam of stained smear
    • Culture of oral swab
    • Blood culture
  • Improved dental hygiene
    • Use of fluoridated water
    • Brushing regularly
  • Antibiotics
  • Dental extraction in case of severity
Parkinson's disease[23][24]
  • Clinical diagnosis
  • Improvement with dopaminergic therapy confirms diagnosis

Differential for Unilateral Involuntary Face Movements

Tetanus must also be differentiated from the following diseases that cause abnormal one sided movements of the face:[25][26][27][28][29][30][31][32][33][34][35]


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