OBJECTIVE: To describe the profile, management, and outcome of adult patients admitted for tetanus. METHODOLOGY: A search of the hospital and department database was conducted for patients with admitting or final diagnosis of tetanus. Patients below 19 years old, with alternative diagnosis, incomplete or unavailable records, transferred to another institution, and went home against medical advice were excluded. Data on patient demographics, source of infection, symptom severity, and management were obtained. Data was described using proportions and averages. RESULTS: Thirty-two patients were included in the study. Twenty-seven were male with a mean age of 45.63 ± 13.39. All cases had no history of tetanus vaccination. The most common focus of infection was acute injuries. More than half of patients would be diagnosed within 72 hours of symptom onset. The most common symptoms on presentation were trismus, rigidity, dysphagia, and spasms. On admission, Cole severity for 11 (34.4%) cases was mild, 17 (53.1%) moderate, and 4 (12.5%) severe. Prophylactic tracheostomy was performed in 31 patients and 19 (59.4%) were placed on assisted ventilation. All cases were treated with metronidazole. A benzodiazepine was started in all cases for spasm control. Baclofen, magnesium sulfate, and antiepileptic drugs such as carbamazepine were also used. Twenty (62.5%) patients suffered from complications, the most common of which was nosocomial pneumonia, which resulted in longer ICU and hospital stays. Eleven patients exhibited progression in Cole severity: 8.6% at stage 1, 57.1% at stage 2, and 34.3% cases were at stage 3. Mortality rate was 19% with the proportion increasing with Cole severity. CONCLUSION We describe the presentation and course of patients admitted for tetanus in our institution. Most cases were males and all cases had no vaccination history. Trismus was the most common presenting symptom. Metronidazole was the antibiotic of choice and benzodiazepines were the mainstay for spasm control. Majority of cases were mild to moderate in severity on presentation. Advanced disease stages were associated with higher fatality rates. Complications were associated with longer ICU and hospital stay. These findings suggest that prevention of progression of disease severity and complications must be the focus of tetanus protocols to shorten hospital stay and decrease mortality rate. Promoting vaccination of at-risk adults is recommended to lower the incidence of tetanus.
Tetanus ; Clostridium tetani ; Clostridium Infections

Tetanus is a neurologic disorder, characterized by increased muscle tone and spasms, that is caused by tetanospasmin, a powerful protein toxin elaborated by Clostridium tetani. In the modern society, tetanus is a rare disease, but it has a high mortality on attack and it 's diagnosis depends on the clinical symptoms. The treatment for tetanus is an injection of human tetanus immunoglobulin (HTIG) to neutralize the circulating tetanospasmin, to control breathing, and to provide systemic supportive care. Recently, the 500 unit of HTIG is recommended. We report one case of generalized tetanus that was treated with 500 units of HTIG. The patient was discharged without complications.
Clostridium tetani ; Diagnosis ; Humans* ; Immunoglobulins* ; Mortality ; Nervous System Diseases ; Rare Diseases ; Respiration ; Spasm ; Tetanus*

Tetanus is a neurologic disorder caused by a tetanospasmin released from Clostridium tetani and usually occurs following a stab wound or dirty abrasion. Tetanus is uncommon in Korea due to the introduction of vaccination programs. Furthermore, tetanus associated with a gangrenous perforation of the small bowel is extremely rare. We report a case of tetanus developed in a patient who was diagnosed with a gangrenous perforation of the small bowel. This is the first reported case in Korea.
Clostridium tetani ; Digestive System Surgical Procedures ; Humans ; Intestinal Perforation ; Korea ; Metalloendopeptidases ; Nervous System Diseases ; Tetanus ; Tetanus Toxin ; Vaccination ; Wounds, Stab

We evaluated tetanus specific IgG, IgM, IgG subclasses after DPT vaccination in infants and children. Tetanus toxoid specific IgG, IgM IgG subclasses were measured to characterize the isotope profile of antibody against tetanus toxoid. The values of the tetanus specific IgG in the positive group were significantly increased compared to those of the control group, and were significantly increased after two inoculation. Tetanus specific IgG was very low in adults and neonates. In our tetanus specific IgG subclasses study, forty-five of 56 cases (80%) showed predominantly IgG1 antibody responses to tetanus toxoid, while twenty-five of 56 cases (45%) showed IgG4 responses. Both IgG1 and IgG4 responses were demonstrated in 17 cases (30%). So we suggest that IgG was mainly involved in humoral immune response after DPT vaccination, and IgG1 may play an important role among IgG subclasses. IgG4, alone or together with IgG1, can also play a role in immune response to tetanus toxoid.
Antibodies, Bacterial/*biosynthesis ; Antibody Specificity ; Child ; Clostridium tetani/immunology ; Diphtheria-Tetanus-Pertussis Vaccine/*immunology ; Human ; Immunoglobulin G/biosynthesis/classification ; Immunoglobulin M/biosynthesis ; Infant

Tetanus is a neurologic disease which features the muscle spasm as the hallmark. It is an infectious disease with high mortality rate triggered by tetanospasmin produced by Clostridium tetani. This report concerns incidence of tetanus consequent to oriental medical care such as acupuncture and moxibustion. Although the tetanus occurrence has shown a remarkable decline since nationwide vaccinations in some of the developed countries, including Korea, it still remains to be an important issue, to be dealt within Korea, as the majority of the patients are old aged and Korean population is rapidly becoming an aging society. Furthermore, since more elders are coming to rely on Oriental medicine in Korea, the Korean elders are at a higher risk than elsewhere. The lack of medical experiences, including those in oriental medical field, has been hindering early diagnosis of Tetanus. This study aims to encourage rapid and accurate decisions in diagnosis and treatment through reviewing symptoms particularly specific to tetanus, and also to arouse attention to the riskiness of invasive procedures involving skin puncture.
Acupuncture ; Aged ; Aging ; Clostridium tetani ; Communicable Diseases ; Developed Countries ; Early Diagnosis ; Humans ; Incidence ; Korea ; Medicine, East Asian Traditional ; Metalloendopeptidases ; Moxibustion ; Punctures ; Skin ; Spasm ; Tetanus ; Tetanus Toxin ; Vaccination

Tetanus is a neurologic disorder caused by a tetanoplasmin which is a neurotoxin elaborated by Clostridium tetani. It is characterized by increased muscle tone and spasm. Since a nationwide childhood vaccination program, tetanus has become a rare disease in Korea. Because many physicians have little experience, misdiagnosis or therapeutic delay may result in unexpected consequences. Although it has high mortality rate on attack, early detection, proper immunization and supportive care can increase survival rate. We report a case of tetanus due to puncture injury by splinter in a 69-year-old woman who has been treated with adjuvant chemotherapy of breast cancer. She was admitted to emergency room with difficulty of opening mouth for 3 days. After two days, we detected that the patient suddenly fell on her back with muscle spasm, so we diagnosed her with tetanus. She was given human tetanus immunoglobulin intramuscularly and supportive care. Forty days after admission, she was discharged without complications.
Aged ; Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Clostridium tetani ; Diagnostic Errors ; Emergencies ; Female ; Humans ; Immunization ; Immunoglobulins ; Korea ; Mouth ; Muscles ; Nervous System Diseases ; Punctures ; Rare Diseases ; Spasm ; Survival Rate ; Tetanus ; Vaccination