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
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