Case 3

A 54-year-old diabetic man attends the ED with stiffness and muscular spasms in his left arm for 2 days.

On examination, you notice multiple small scars in the antecubital fossa, and scattered necrotic skin lesions on his fore-arm.

He cannot remember if he had a booster when he cut his hand 5 years ago.

You consider a diagnosis of localised tetanus. What are the features of the history which put him at risk?

You commence diazepam, metronidazole and immunoglobulin treatment in the ED, but later in the day he develops increasing rigidity and pain in his back and limbs, and abdominal cramps.

What is the differential diagnosis, and how would you attempt to distinguish which is the cause?

By which of the following means should this case be notified?