Management

The major objectives of management are to assess and stabilize the patient, to eliminate the source of toxin, to neutralize circulating unbound toxin, to minimize the effect of toxin already bound in the nervous system, and lastly, but no less importantly, to provide general supportive care.

The diagnosis is clinical. There are no laboratory tests specific to tetanus. Wound cultures are non-specific and only positive in less than 30 per cent of cases. The differential diagnosis includes dystonic drug reactions, hypocalcemia, local temporomandibular disease, peritonsillar infections, dental abscesses, various other local oral diseases, meningitis, encephalitis or intracranial hemorrhage, rabies, strychnine poisoning, peritonitis, spinal injury, convulsive status epilepticus, and psychiatric disorders.

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