Tetanus Workup

Updated: Jan 18, 2019

Author: Patrick B Hinfey, MD; Chief Editor: John L Brusch, MD, FACP more...

WORKUP

Laboratory Studies
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. Although the laboratory findings are not diagnostically valuable,
they may help exclude strychnine poisoning.

Blood counts and blood chemical findings are unremarkable. Laboratory studies may
demonstrate a moderate peripheral leukocytosis.

A lumbar puncture is not necessary for diagnosis. Cerebrospinal fluid (CSF) findings are
normal, except for an increased opening pressure, especially during spasms.

Serum muscle enzyme levels (eg, creatine kinase, aldolase) may be elevated.

An assay for antitoxin levels is not readily available. However, a serum antitoxin level of 0.01
IU/mL or higher is generally considered protective, making the diagnosis of tetanus less
likely (though rare cases have been reported to occur despite the presence of protective
antitoxin levels).

Wounds should be cultured in cases of suspected tetanus. It must be kept in mind, however,
that C tetani sometimes can be cultured from the wounds of patients who do not have
tetanus and frequently cannot be cultured from the wounds of patients who do.

Spatula Test
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).
In 400 patients, this test had a sensitivity of 94% and a specificity of 100%. [17] No adverse
sequelae (eg, laryngeal spasm) were reported.

Other Studies
Electromyography (EMG) may show continuous discharge of motor subunits and shortening
or absence of the silent interval normally observed after an action potential.

Nonspecific changes may be evident on electrocardiography (ECG).

Imaging studies of the head and spine reveal no abnormalities.

Treatment & Management