Tetanus is diagnosed solely on the basis of clinical evidence. Most patients who develop the disease either have an unknown or inadequate immunization history. 2 Tetanus should be immediately suspected in older patients with a puncture wound who present with pain or stiffness in the masseter muscles.

There are no laboratory tests to diagnose tetanus, although serum antitoxin titers of 30.01 lU/mL are usually protective and may be helpful retrospectively. Wound culture is of limited value, since C. tetani may be present in the absence of clinical signs or symptoms of tetanus and cultures are positive in fewer than 50 percent of patients with documented disease.5!.1

The differential diagnosis of tetanus is presented in TiMeJ,.4.0:1.. Strychnine poisoning most closely mimics the clinical picture of generalized tetanus.

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