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Diagnosis of tetanus
Last reviewed: 23.04.2024
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Diagnosis of tetanus in the early period is based on the identification of trism, sardonic smile and dysphagia. Later, stiff neck muscles appear; hypertonus extends to other muscles of the trunk, technical convulsions join, the characteristic feature of which is the preservation of hypertonicity; muscles after an attack. Distinctive symptoms of tetanus are clear consciousness, fever, sweating and hypersalivation.
[Indications for consultation of other specialists
With the development of complications, consultation of other specialists is necessary. So, with fractures, tendon ruptures, massive bleeding, a surgeon's consultation is shown, with convulsive syndrome, respiratory failure and multiple organ failure - resuscitation consultation.
Indications for hospitalization
If there is a suspicion of tetanus, patients are subject to emergency admission to the intensive care unit in connection with possible disruption of vital functions, the need for intensive care and care.
Laboratory diagnostics of tetanus
Laboratory diagnosis of tetanus is of secondary importance. When there are clinical symptoms of the disease, the toxin in the blood can not be detected even by the most sensitive methods. Detection of antitoxic antibodies has no diagnostic value, since it indicates only a history of vaccination. When tetanus titers increase, antibodies do not occur, since even lethal doses of exotoxin do not elicit an immune response. In some cases, bacteriological methods are used (microscopy of smears-prints, histological examination of tissues excised during surgical treatment of wounds, sowing of wound detachable on nutrient media under anaerobic conditions), allowing to detect the pathogen at the site of the entry gate of the infection. Isolate the culture of the pathogen from the wound can not be more than 30% of patients.
Instrumental diagnosis of tetanus
Typically, the absence of pathological changes in the cerebrospinal fluid.
Example of the formulation of the diagnosis
Tetanus, generalized form, heavy course. Complications: aspiration pneumonia, rupture of right rectus abdominis muscle.
Differential diagnosis of tetanus
A similar clinical picture can be observed in patients with rabies, the distinguishing features of which are confusion, psychomotor agitation, exophthalmus and mydriasis, short (several seconds) and frequent seizures, hydrophotoacuphobia, muscle relaxation during the interictal period. Trism and "sardonic smile" with rabies are absent. On the 5th-7th day of illness, the disease passes into a paralytic stage, which inevitably ends with a fatal outcome.
Strychnine poisoning can be distinguished from tetanus, taking into account mydriasis, the upward spread of seizures and the absence of tonic muscle tension. When poisoning with strychnine, as well as in tetanus, generalized seizures are observed, but between the attacks there is complete relaxation of the muscles.
The tetany that occurs with hypothyroidism of parathyroid glands differs from tetanus by the defeat not only of striated, but also smooth mice, a gradual onset. In tetany, seizures are accompanied by vomiting. Diarrhea, abdominal pain, bronchospasm. Cramps very rarely become generalized and always grasp the fine muscles of the limbs. Identify the symptoms of Erb, Trusso, Khvostek. "Horse foot" and "hand obstetrician." Always detect hypocalcemia.
Epileptic seizure, unlike the convulsive syndrome in tetanus, ends with sleep, complete relaxation of the muscles, involuntary defecation and urination, retrograde amnesia is characteristic.
Patients with hysteria can simulate a picture of a seizure similar to tetanus, but after the attack, the mouse completely relaxes. The attack is accompanied by emotional reactions (crying, laughter), targeted reactions (patients tear clothing, throw various objects, etc.). In difficult cases, a sleeping pill is prescribed, during which the muscles relax completely.
Less often tetanus should be differentiated from exacerbation of a common osteochondrosis, craniocerebral trauma, and neuroinfections.