Pitfalls

Common pitfalls include:

• History of vaccination does not exclude the diagnosis
• Failure to recognise that trismus is characteristic of tetanus
• Failure to perform the spatula test
• Laryngospasm may be severe and occur without warning, or may be precipitated by stimulation
• Severe muscular spasms may compromise respiration
• Administration of penicillin when metronidazole is the drug of choice
• Autonomic instability requires active management to reduce the risk of sudden cardiac death
• Neonatal tetanus could present in at-risk groups where maternal immunity is low, for example in patients migrating from areas where there is a low uptake of vaccination
• The very non specific presentation may mask the diagnosis