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| __NOTOC__ | | __NOTOC__ |
| {{Tetanus}} | | {{Smoking}} |
| {{CMG}} | | {{CMG}}; {{AE}} |
| {{MJM}} | |
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| ==Overview== | | ==Overview== |
| The diagnosis of tetanus is completed through a physical examination. Tetanus infection produces some very clear symptoms that will be used for a clinical diagnosis.
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| ==Physical Examination== | | ==Physical Examination== |
| Some of the first [[signs]] a patient may present with are [[muscle]] stiffness, especially in the [[jaw]], and [[headaches]]. From there, the patient may complain of symptoms such as [[neck]] stiffness, [[sweating]], [[spasms]], trouble [[swallowing]], and the [[abdominal]] muscles becoming rigid. The following may also result:
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| *Patients can be [[afebrile]]
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| *Late stage [[disease]] will show complications of autonomic dysfunction. For example, episodes of [[hypotension]] and [[bradycardia]] with periods of [[tachycardia]] and [[hypertension]].
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| *Patients with severe tetanus can present with:
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| **[[Opisthotonos]]
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| **[[Extension]] of the [[legs]], [[flexion]] of the [[arms]]
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| **[[Spasms]] of the [[intercostal muscles]] and [[diaphragm]] will cause periods of [[apnea]]
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| **A rigid [[abdominal wall]] will most likely be present as well
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| The physical examination can reveal a few different forms of the infection. These include:
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| *'''Local Tetanus'''
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| **Uncommon form of the [[disease]]
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| **In the same anatomic area of the [[injury]], there will be persistent contraction of the [[muscles]]
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| **[[Contractions]] may last for weeks before subsiding gradually
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| **It may precede generalized tetanus, but it is usually milder
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| **Approximately 1% of the cases are [[fatal]].
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| *'''Cephalic Tetanus'''
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| **Rare form
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| **May occur with [[ear infections]]
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| **May occur following [[head]] injury
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| **There is involvement of [[cranial nerves]], especially the ones in the facial area
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| *'''Generalized Tetanus'''
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| **Approximately 80% of reported cases.
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| **Presents with a descending pattern
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| **First sign is [[trismus]]
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| ***Followed by stiffness of the neck
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| ***Difficulty in [[swallowing]]
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| ***Rigidity of [[abdominal muscles]]
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| **Other symptoms include
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| ***Elevated temperature
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| ***[[Sweating]]
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| ***Elevated [[blood pressure]]
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| ***Episodic rapid [[heart rate]]
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| **[[Spasms]] may occur frequently and last for several minutes
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| **Spasms continue for 3-4 weeks
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| **Complete recovery may take months
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| *'''Neonatal Tetanus'''
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| **Occurs in infants without protective [[passive immunity]] because the mother is not [[immune]]
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| **Usually occurs through [[infection]] of the unhealed [[umbilical]] stump
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| ***This especially occurs when the stump is not cut with a sterile instrument
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| **More common in developing countries (estimated to be around 257,000 annual deaths worldwide in 2000-2003)
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| **Very rare in the USA
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| ===The Spatula Test===
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| The "spatula test" is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a sterile, soft-tipped instrument, and observing the effect. A positive test result is the 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.
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| [[Image:Lock-jaw 2857.jpg|thumb|center|150px|Lock-jaw in a patient suffering from tetanus.]]
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| [[Image:Neonatal tetanus 6374 lores.jpg|center|thumb|200px|An infant suffering from neonatal tetanus.]]
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| [[Category:Disease]]
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| [[Category:Bacterial diseases]]
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| [[Category:Infectious disease]]
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| [[Category:Primary care]]
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |