Understanding the Trajectory to a Diagnosis of Tetanus: A Descriptive Study

Abstract

Background and objectiveTetanus is a rare but potentially fatal disease in developed countries, including Japan. It is very difficult to diagnose this condition early because of its broad symptomatology and the lack of familiarity with tetanus among both physicians and patients. In this study, we aimed to describe the clinical manifestations of tetanus and to examine as to which departments/branches of medicine patients consult in order to provide helpful information for diagnosing this challenging condition. Materials and methodsThis was a descriptive, retrospective study conducted at a single tertiary hospital from January 2011 to December 2021. Patients with generalized tetanus, cephalic tetanus, and local tetanus presenting to our emergency department were included in the study. We examined the clinical manifestations and departments that patients with tetanus visited first. Additionally, the initial diagnosis and diagnostic evaluation before the diagnosis were examined. ResultsOf the total 10 patients included in the study, nine had generalized tetanus and one had cephalic tetanus; the common initial manifestations were neck stiffness (30%), dysarthria (20%), and trismus (20%). Of note, 80% of patients also complained of dysphagia before the diagnosis. Patients first visited various departments, including a dental clinic (30%) and the department of otorhinolaryngology (20%). Only two patients were accurately diagnosed with tetanus at the first department they visited. Physicians performed head imaging for all the patients. ConclusionsBased on our findings, in Japan, patients with tetanus present with symptoms that physicians interpret or suspect to be associated with disorders of the central nervous system. Meanwhile, patients themselves tend to consider the symptoms as indicative of oral or dental issues. Further prospective studies involving a larger number of participants are needed to investigate the clinical course of tetanus until the establishment of a diagnosis.

The Myriad Presentations of Tetanus: Where Do You Look for Clinical Clues in an Intubated Highly Sedated Patient?

“…In recent times, the decreasing prevalence of tetanus has led to a reduced level of awareness and recognition of its clinical presentations among healthcare practitioners 1,7 . This decline in cases has also made early diagnosis more challenging because of the diverse range of clinical manifestations associated with the disease 7 .…”

“…2,6 In recent times, the decreasing prevalence of tetanus has led to a reduced level of awareness and recognition of its clinical presentations among healthcare practitioners. 1,7 This decline in cases has also made early diagnosis more challenging because of the diverse range of clinical manifestations associated with the disease. 7 Although classic symptoms, such as jaw trismus and generalized muscle spasms are evident in over 80% of cases, atypical forms, such as cephalic tetanus, occur in only 1% to 3% of cases (Table 1).…”

“…1,7 This decline in cases has also made early diagnosis more challenging because of the diverse range of clinical manifestations associated with the disease. 7 Although classic symptoms, such as jaw trismus and generalized muscle spasms are evident in over 80% of cases, atypical forms, such as cephalic tetanus, occur in only 1% to 3% of cases (Table 1). 4,[8][9][10][11] In our case, we encountered a rare presentation characterized by stimuli-sensitive jerky movements, strongly indicative of spinal myoclonus-an atypical manifestation of generalized tetanus.…”

Tetanus Overlooked Due to the Involvement of Multiple Departments: A Case Report

“…The reasons for the delay in tetanus diagnosis include the low awareness of the usefulness of the spatula test (sensitivity 94%, specificity 100% [ 4 ]) and lack of experience among doctors in the developed world in diagnosing tetanus, as pointed out in previous reports [ 5 ].…”