Difficulty in diagnosis of tetanus in Japan: Report of a case and review of the literature

Although tetanus is a rare condition in Japan, it still has a high mortality rate. As patients show trismus, dysphagia, and rigidity of the neck, they tend to consult specialists in dentistry, otolaryngology, and orthopedics. Sometimes, accurate diagnosis of tetanus is not made at the first consultation. Here, we report a case of tetanus referred to our department that was appropriately managed with early diagnosis. Moreover, we reviewed the literature concerning 47 patients with tetanus from 2000 in Japan regarding which department they visited first, the initial diagnosis, and clinical courses of the patients.The orders of the first visiting departments were otolaryngology, internal medicine, general surgery, orthopedics, emergency, and dentistry. Only 6 patients (6/47: 13%) were correctly diagnosed as having tetanus at the first diagnosis. In contrast, the remaining 41 cases did not receive a correct diagnosis at the first visit. Twenty patients (20/47: 43%) were diagnosed as “unknown etiology”. After additional consultations, the final diagnosis of tetanus was made mainly in dentistry, emergency, otolaryngology, and internal medicine. As for the treatment, the patients received actual treatment for tetanus mainly in the department of emergency, internal medicine, anesthesiology, and neurological medicine. Thirty-two of the patients (32/47: 68%) entered the ICU.In conclusion, head and neck specialists should be equipped to make correct diagnosis in patients with tetanus. Close communication with specialists in the ICU is important, along with education of doctors, staff, and students regarding the importance of rapid diagnosis of tetanus.