Cases Of Tetanus Research Articles

A rare case of tetanus with early manifestation of apnea but without trismus

BackgroundTetanus is a life-threatening disease caused by tetanus neurotoxin (TeNT) produced by Clostridium tetani. Early symptoms of tetanus are trismus and muscle stiffness, both caused by spasticity. TeNT mainly exerts its effect by impairment of inhibitory neurons in the spine and brainstem, resulting in the hyperactivity of motor neurons, which causes spasticity and muscle spasms. Apnea is not a symptom that is predicted to occur in the early stages. Case ReportWe present a rare case of severe tetanus with an early manifestation of apnea but without trismus. We believe that apnea was caused by spasms of the intercostal muscles and its early manifestation was due to a high load of TeNT, considering that the speed of disease progression is related to disease severity. We hypothesize that the absence of trismus was also due to a high load of TeNT, exerting toxic effect at the neuromuscular junction and causing flaccid paralysis of the massetersWhy Should an Emergency Physician Be Aware of This?:Since there is no diagnostic laboratory test for tetanus, emergency physicians must be well aware of symptoms that may or may not appear in tetanus. Tetanus should be considered as a differential diagnosis for patients arriving at the emergency department with apnea as an early symptom. The absence of trismus should not rule out the possibility of tetanus.

Reviewing the Pillars of Immunization: Essential Vaccines and Their Public Health Benefits.

Vaccination has lowered, across the globe, morbidity and mortality from infectious diseases. It is considered one of the basic principles of preventive health measures. The World Health Organization’s Expanded Programme on Immunization defined vaccinations that are required and their tremendous benefits to public health, which are discussed in this review article. These involve the vaccinations taken against most communicable diseases, such as COVID-19, polio, measles, rubella, pneumococcal diseases, rotavirus, human papillomavirus, tuberculosis, Haemophilus influenzae type B, diphtheria, pertussis, and tetanus. The article points out that quite a number of vaccinations have been proven effective and safe and if administered, could prevent serious disease, disability, and death. For example, vaccination against measles has been rated to be vital in the containment of outbreaks within nonimmune populations, while the DTP vaccine is paramount in decreasing the cases of pertussis, tetanus, and diphtheria. The effect of vaccination can be exemplified by the dramatic decrease in the occurrence of serious bacterial contagion in children since the introduction of conjugate vaccines against Hib and pneumococcus. Notwithstanding these successes, there are persistent obstacles, such as vaccine hesitancy, misinformation, and inequities in access to vaccines, all heightened by the COVID-19 pandemic. The article discusses the global impact of vaccination efforts under siege and appeals for further public health efforts toward the attainment of these goals.

Tetanus Cases in Mogadishu-Somalia: A Tragic Disease Despite the Existence of a Century-Old Safe and Efficient Tetanus Vaccine.

Despite the efforts and support of the World Health Organization and other international organizations to reduce the incidence of the disease, tetanus is still an acute condition with serious consequences, including death. The purpose of this study was to assess the tetanus patients we have been monitoring over the past two years in Somalia, a country with a protracted civil conflict, extreme poverty, and restricted access to hospital, social security, and public health facilities. This study includes tetanus patients who were admitted to the Recep Tayyip Erdoğan Training and Research Hospital in Mogadishu, Somalia, Turkey between January 1, 2022, and November 1, 2023. Hospitalization, diagnosis, treatment, complications, death, and test results were all looked at in addition to the patients' sociodemographic details. The average age of the 196 patients was 10 years, with males making up 67.9% of the total (min-max: 7 days-71 years). Acute injury was the cause of 53.1% of tetanus cases, with the legs being the most frequently injured body area (28.8%). A mean duration of stay of 11 days was observed for 82.1% of the patients who were monitored in the hospital (min-max: 1-38 days). The total fatality rate was 14.3%, and 85.7% of patients had never had a tetanus vaccination. The group with severe tetanus had higher rates of intensive care admission (p<0.001), generalized/neonatal tetanus (p<0.001), high non-vaccination rate (p:0.011), antibiotic usage (p<0.001), and a positive blood culture (p<0.001). Almost all of the complications (p<0.001) and all of the deaths (p<0.001) were in the severe group. In sub-Saharan Africa, immunization rates are regrettably still insufficient despite the tetanus vaccine's low cost and great effectiveness. Public education and encouragement on anti-vaccination must continue alongside the enhancement of vaccination programs. Otherwise, low- and middle-income countries will still be plagued by this illness, which has been overlooked in high-income nations.

Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination - Worldwide, 2000-2022.

Tetanus remains a considerable cause of mortality among undervaccinated mothers and their infants following unhygienic deliveries, especially in low-income countries. Strategies of the maternal and neonatal tetanus elimination (MNTE) initiative, which targets 59 priority countries, include strengthening antenatal immunization of pregnant women with tetanus toxoid-containing vaccines (TTCVs); conducting TTCV supplementary immunization activities among women of reproductive age in high-risk districts; optimizing access to skilled birth attendants to ensure clean deliveries and umbilical cord care practices; and identifying and investigating suspected neonatal tetanus cases. This report updates a previous report and describes progress toward MNTE during 2000-2022. By December 2022, 47 (80%) of 59 priority countries were validated to have achieved MNTE. In 2022, among the 50 countries that reported coverage with ≥2 doses of TTCV among pregnant women, 16 (32%) reported coverage of ≥80%. In 2022, among 47 validated countries, 26 (55%) reported that ≥70% of births were assisted by skilled birth attendants. Reported neonatal tetanus cases worldwide decreased 89%, from 17,935 in 2000 to 1,995 in 2021; estimated neonatal tetanus deaths decreased 84%, from 46,898 to 7,719. However, the global disruption of routine immunization caused by the COVID-19 pandemic impeded MNTE progress. Since 2020, reported neonatal tetanus cases have increased in 18 (31%) priority countries. Integration of MNTE strategies into priority countries' national postpandemic immunization recovery activities is needed to achieve and sustain global elimination.

Clinical findings and outcome in feline tetanus: a multicentric retrospective study of 27 cases and review of the literature.

Tetanus is a toxigenic illness caused by the action of Clostridium tetani neurotoxin (TeNT), which results in partial or generalized muscle stiffness in infected mammals and birds. The disease is rarely reported in cats due to their innate resistance to the toxin. This multicentric retrospective study aimed to describe a significant population of cats with a diagnosis of tetanus and report their signalment, clinical and neurological signs, diagnostic findings, treatment, and outcome. A retrospective search through medical records from 11 referral centers in Europe resulted in the identification of 27 cases of feline tetanus from July 2005 to April 2023. These cases were further compared with previously reported cases in the veterinary literature. Young cats were more commonly represented than older cats, with a median age of 4 years. Clinical signs were initially characterized by a lame and/or stiff limb, near the primary injury site, in 17/26 (65%) cats. Signs were focal or multifocal in 21/27 (78%) cats of this study and one typical sign was the inability to flex the most severely affected limbs. Electrodiagnostic studies revealed characteristic changes, such as continuous spontaneous motor unit discharges in both agonist and antagonist muscles. Such studies are particularly useful in focal and multifocal cases and should be performed to further support the diagnosis. The toxin was successfully identified in one case using the mouse bioassay. Treatment included antibiotherapy (metronidazole) in most cases, muscle relaxants, appropriate nursing cares and handling of potential complications. Overall, the outcome appeared to be positive, with only 1/27 (3.7%) cats being euthanized due to financial restrains. 23/25 (92%) cats returned to an independent ambulatory capacity on all limbs within a median delay of 25 days. Mild to moderate long-term sequelae were reported in eight (30%) cats. This multicentric study is the first to bring together such a large number of cats affected with tetanus. Presentation of the disease in cats differs from that observed in humans and dogs, with most cats being locally affected. Compared to previous reports of tetanus, this series of cats had a better outcome overall, especially for cats affected with generalized tetanus.

Reminder of Persistent Public Health concerns: A suspected case of adult tetanus

Reminder of Persistent Public Health concerns: A suspected case of adult tetanus

Evaluation of Tetanus Cases Presenting to the Emergency Department at a Tertiary hospital in Somalia

Aim: Tetanus is an infection characterized by muscle spasms and trismus caused by toxins produced by Clostridium tetani. Although tetanus is a vaccine-preventable disease, it continues to be a public health problem in developing countries with high mortality rates. This study was conducted to evaluate the clinical profile and outcome of tetanus patients and determine the factors affecting the hospitalization unit, the length of hospital stay, and mortality. Materials and Methods: This is a retrospective cross-sectional study conducted with patients diagnosed with tetanus in a Tertiary care emergency department (ED) in Somalia. The relationship of demographic data, symptoms, laboratory findings, applied treatment methods with the hospitalization unit (regular inpatient floor/intensive care unit), length of hospital stay, and mortality were analyzed. Results: Sixty-seven patients diagnosed with tetanus during a 4-year study period were included. The mean patient age was 12,8±14,89 years, and 73,1% were males. Generalized muscle spasm (85,7%) was the most common symptom, benzodiazepines (95,5%.) were the most commonly used medications, and the mean length of hospital stay was 10.73±8.15 days. The rate of patients hospitalized in the ICU was 20,9%. The overall mortality rate was calculated as 19,5%. The presence of opisthotonos, neck stiffness, risus sardonicus, generalized muscle spasm, and dyspnea significantly correlated with mortality (p

Seroprotection against tetanus in the Italian general population

BackgroundTetanus is a non-communicable disease, preventable with vaccination. Despite the implemented vaccination strategy, a certain number of tetanus cases per year continue to occur. The aim of the study was to evaluate the seroprevalence of anti-tetanus antibodies in the Italian population by age, sex and geographical area. MethodsTo determine the level of tetanus-specific antibodies, an immunoenzymatic assay was used. ResultsA total of 3,821 serum samples were collected in the years 2019–20 from healthy subjects aged 6–90 years residing in 13 Italian regions. Overall, 85 % of the tested subjects resulted positive. The rate of subjects protected against tetanus showed a gradual decrease from the younger age groups to the older ones (6–12 years: 93.6 %, 13–24 years: 91.8 %, 25–39 years: 91.0 %, 40–64 years: 78.2 %, ≥ 65 years: 45.3 %); this is particularly evident in the Southern regions and Islands. Moreover, the prevalence of subjects with low protection (<0.1 IU/ml) was significantly higher in the ≥ 65 age group (10.3 %). Males and females’ prevalence showed a significant difference only in the oldest age group (M: 60.8 %, F: 30.4 %). In general, a higher prevalence was observed for Northern (90.8 %) and Central regions (87.3 %) than Southern regions and Islands (80.0 %). ConclusionThese data, compared with epidemiological ones which showed a high number of cases in the elderly, confirmed that the population with lower protection has a greater risk of contracting the disease, demonstrating the need for adequate immunization through both primary vaccination and boosters for all ages and both sexes, in order to provide lifelong protection.

Delayed presentation and management approach of autonomic dysfunction associated with severe tetanus

Introduction: In 2019, there were over 73 000 estimated tetanus cases globally, including more than 27 000 cases of neonatal tetanus, and the worldwide deaths caused by tetanus were almost 34 684. The mortality rate of tetanus is greater than 50% in countries without ICUs and 10% in developed countries, mostly attributed to autonomic dysfunction. Countries with the greatest rates of post-neonatal tetanus mortality (greater than five fatalities per 100 000 people) were Somalia, South Sudan, and Kenya. Case presentation: A 66-year-old unvaccinated male patient came to our hospital emergency department with generalized rigidity, neck stiffness, lockjaw, and an altered level of consciousness for 5 days. His symptoms started with stiffness in his neck and back 4 days before. The patient was diagnosed with tetanus, as he was unimmunized, had a recent injury, and presented clinical findings. The authors started treatment by administering intramuscular human tetanus immunoglobulin and metronidazole. He was admitted to the ICU and placed in an isolation room with minimal auditory and visual stimuli. Following 2 weeks after admission his blood pressure began to fall, and his pulse rate started to fluctuate with alternating tachycardia and bradycardia. After 1 month in the ICU, he was discharged from the ICU and transferred to the ward. A catch-up immunization regimen was established. Clinical discussion: Tetanus is a rare condition in the Western world, primarily due to widespread vaccination programs from infancy to adulthood. There are crucial barriers that still exist to overcoming this disease in our country, including a lack of reliable immunization programs. In tetanus, the increase in survival is associated with the use of intensive care facilities for the management of tetanus, besides expanding the knowledge of the disease, which is a challenge for developing countries. Conclusion: It is essential to have enough immunization at an early stage of trauma since severe autonomic dysfunction linked to tetanus might be lethal.

An unexpected case of tetanus in a fully immunized 20-year-old female: a case report

BackgroundWidespread vaccinations have significantly decreased the number of tetanus cases in developed countries. Today, most cases of tetanus affect the elderly and those with inadequate immunization in developed countries such as Japan. As vaccinations were believed to be nearly 100% effective in preventing tetanus, tetanus in young, immunized individuals were considered unlikely. However, unexpected tetanus infection has been reported in young adequately immunized individuals.CaseWe herein describe a 20-year-old immunized female who visited our emergency department with trismus and painful muscle spasms that started after receiving a puncture wound to her right foot. A physical examination revealed an elevated body temperature (38°C), trismus, muscle spasms in her right leg and neck, and a puncture wound at the sole of her right foot. Following the development of dyspnea after admission to the intensive care unit, the patient was intubated and mechanically ventilated. She fully recovered after six days in intensive care.ConclusionThe present case serves as a stark reminder that tetanus may still occur in young, immunized individuals. Patients with a history of immunization may have a better prognosis than those with no immunizations.

Tétano em equino

Tetanus is caused by toxins (tetanospasmin, tetanolysin and a non-spasmogenic toxin) synthesized by Clostridium tetani, a gram-positive, sporulating and obligate anaerobic bacterium. The equine species has high exposure and sensitivity to the pathogen. Therefore, prophylactic measures such as vaccination, antisepsis of wounds with hydrogen peroxide, and anti-tetanus serum in surgeries carried out in the field are essential for prevention. The clinical signs presented are the main diagnostic tool, as most of the time the signs are pathognomonic, including sawhorse stance, rigid gait, flag tail, protrusion of the 3rd eyelid, sensitivity to sound and light stimuli, dyspnea and dysphagia. Toxi-infection occurs from pre-existing wounds or from gastrointestinal injuries. The objective of this study is to report a case of tetanus in a 10-year-old grade mare, addressing diagnostic and therapeutic characteristics. Clinical treatment proved to be effective, with satisfactory results after intrathecal and intravenous application of anti-tetanus serum, combined with antibiotic therapy and medications that promote muscle relaxation. The animal was discharged after 22 days of clinically stable hospitalization.

DENTIST’S ROLE IN COLLABORATIVE MANAGEMENT OF TETANUS PATIENT

Tetanus was a life-threatening infection causing muscle contractions. The need for qualified collaborative management was crucial due to the potential for poor prognosis and complications. Dentists can contribute significantly to the treatment, as the mouth can be one of the entry points for tetanus-causing bacteria. A 45-year-old male tetanus inpatient was referred from the Intensive Care Unit to the Oral Medicine Unit at Universitas Indonesia Hospital to evaluate the possible source of oral focus infection. A boil was on his back, suspected to be the main port of entry for tetanus bacteria. The definitive diagnosis was Tetanus of moderate to severe severity (Philips score 24, Dakar score 1, Ablett score 2). Extra oral examination shows lip inflammation. An intra-oral examination cannot be done optimally despite his trismus. The oral foci of infection found were chronic gingivitis and pulp necrosis on 47 48, in addition to the diagnosis of cheilitis simplex. Since the comprehensive management of the foci of infection could only be done in an outpatient setting, the nurse was instructed to clean the intra-oral using sterile gauze moistened with NaCl 0.9% solution to improve the patient's oral hygiene (OH). Comprehensive management includes periodically visiting to maintain OH, administering muscle relaxants, antibiotics, and analgesics, and administering Tetanus toxoid vaccination. The patient was recovered. Management of tetanus cases needs a multidisciplinary approach. Dentists are pivotal in identifying oral infection sources and ensuring its management. A dentist's role in the collaborative management of tetanus patients might significantly contribute to the patient's prognosis.

Clinical profile and outcomes of tetanus patients in a tertiary hospital in the Philippines: a ten-year retrospective study

BackgroundTetanus is a life-threatening but preventable neurologic disorder characterized by trismus and muscle spasms. Despite its decreasing global incidence, it remains to be endemic in resource-limited settings such as the Philippines. This study aimed to determine the incidence, demographic characteristics, risk factors, clinical presentation, management, complications, and outcomes of non-neonatal tetanus cases in a tertiary hospital in the Philippines. It also aimed to compare the clinical profile and outcomes between the adult and pediatric subgroups.MethodsThis study used a retrospective cross-sectional design including all adult and pediatric non-neonatal tetanus patients admitted at the University of the Philippines - Philippine General Hospital from January 2012 to June 2023. Data was extracted from department censuses and inpatient charts.ResultsOne hundred thirty-eight cases were included. The incidence rate was 0.03%, while mortality rate was 29%. Majority of patients were males presenting with trismus and spasms after sustaining a puncture wound. Chronic hypertension was associated with an increased hazard of death by 4.5 times (p = 0.004), while treatment with magnesium sulfate was associated with a decreased hazard of death by 35 times (p = 0.005). The mode of infection and the medications administered differed between the adult and pediatric subgroups.ConclusionsAlthough the total number of cases has decreased over the past decade, tetanus remains to have a high incidence and mortality rate in the Philippines. Increasing vaccination coverage, improving public awareness, and educating health professionals can help reduce morbidity and mortality from this disease.

Successful management of severe tetanus in a 10-year-old unvaccinated girl: A case report

Tetanus is a potentially fatal disease caused by Clostridium tetani, which produces muscle spasms, autonomic dysfunction, and respiratory failure by the action of a powerful neurotoxin. Tetanus can be prevented by vaccination, proper wound care, and tetanus prophylaxis, but it remains a significant public health concern in regions with inadequate vaccination coverage. We report a case of severe tetanus in an unvaccinated 10-year-old girl following a tetanus prone injury on her right big toe and was treated with antibiotics, tetanus immunoglobulin, tetanus toxoid, sedatives, neuromuscular blockers, and tracheostomy with mechanical ventilation. She recovered after 28 days of supportive multi-disciplinary intensive care and was discharged with no neurological sequelae.

Reporting Case Study Results for Neonatal Tetanus Case Investigations

Developing countries are facing numerous health challenges. One of the greatest challenges in this regards is the existence of neonatal tetanus disease. Dera Ismail Khan is educationally backward, and the majority of the population lives in rural areas without proper access to health facilities. This study was aimed to intestate the neonatal tetanus cases. Literature review was undertaken, which suggested the use of case approach; therefore, the study used a case method of investigation. The case setting was District Headquarters Zanana (Women) Hospital Dera Ismail Khan, which is the only mother-child hospital in the southern districts of DIKhan, Tank, and Waziristan. The study reported that Tetanus remains a significant public health concern in the areas, with a high mortality rate and a need for improved prevention and management efforts. The majority of tetanus cases in the area occur among unvaccinated individuals, particularly among those who have not received tetanus toxoid-containing vaccine as part of routine immunization. There are significant disparities in tetanus vaccination coverage by region and socioeconomic status, which contribute to the burden of tetanus in vulnerable populations. Improving tetanus vaccination coverage and strengthening surveillance and management systems are important steps to lessen the burden of tetanus in Pakistan.

Tetanus in a vaccinated soil expert - a case report

BackgroundTetanus is a life-threatening vaccine-preventable disease found more commonly in tropical climates. It accounted for up to 60 deaths annually until the introduction of the tetanus toxoid. It is now rare in Canada by immunization. This study aims to describe a case of tetanus in Saskatchewan with possible occupational exposure.Case ReportWe describe the case of a vaccinated soil expert with tetanus resulting from skin abrasions. This report highlights the early diagnosis, atypical presentation with possible vaccine attenuation and management approach, including acute care, intensive care unit referral, surgical management and physical rehabilitation. We also describe the public health management provided in this case. Despite the severity, the patient returned to his previous home environment with minimal motor sequelae.ConclusionOccupational exposure to tetanus is an important risk, even in regions where the disease is rare. Prevention through vaccination is a key public health intervention that must be encouraged to avoid health complications that are often fatal.

Prevalence and factors associated with rural mothers' protection against tetanus: a cross-national analysis in 33 sub-Saharan African countries.

Sub-Saharan Africa (SSA) and South Asia account for most new cases of tetanus. Despite efforts by the World Health Organization to eradicate tetanus, it still causes many maternal mortalities. We examined the prevalence and risk factors associated with tetanus protection among rural mothers in 33 SSA countries. Data were extracted from the most recent Demographic and Health Surveys of 33 SSA countries. A sample of 162601 women from rural areas was drawn. Both descriptive and binary logistic regression analyses were conducted. Overall, approximately half (49.3%) of rural mothers were protected against tetanus. The association between maternal age, education, marital status, working status, distance to the health facility and number of antenatal visits were statistically significant with rural mothers' protection from tetanus. Also, relationship to the household head, household size and frequency of listening to radio, reading a newspaper and watching television were statistically significant in predicting rural mothers' protection from tetanus. Policies and interventions by stakeholders must target high-risk populations, including adult women, those of poorer wealth status, those without media exposure and mothers with low educational attainment.

Tetanus, an infectious disease still topical in Lome (Togo)

Tetanus still remains a public health problem in Togo despite the existence of the Expanded Program on Immunization. A retrospective and descriptive cohort study was performed from January 1, 2008 to December 31, 2018 in the infectious and tropical diseases department of Sylvanus Olympio teaching hospital of Lome (Togo) on tetanus cases. We included 208 tetanus cases accounting for 6.5% of the whole hospitalizations in the infectious and tropical diseases department at this hospital. The median age of the patients was 23 [13-38 years] with male predominance (81.2%). The patients were workers (63.5%) and came mainly from urban areas (65.9%). Tetanus vaccination was only up to date in 9.3% of patients. Gateways were dominated by skin wounds (66.8%). Antitetanus serum was administered in 191 patients (91.8%) mainly through intrathecal route (189 patients (91.1%)). Complications were marked by superinfection of the wound (n=8), septic shock (n=3), acute respiratory failure and skin necrosis in 1 case respectively. The lethality was 27.4%. The morbidity of tetanus, in particular juvenile morbidity, remains high with significant lethality. It is therefore important to place particular emphasis on the vaccine booster component.

A case of tetanus in a previously immunized person

Tetanus is an acute infectious disease of humans and animals caused by anaerobic wound bacteria. The nervous system structural damage caused by toxin of the pathogen leads to tonic tension of the skeletal muscles and periodic generalized convulsions. If proper medical care is not provided in time, tetanus ends fatally. The incidence of tetanus is relatively low due to the widespread vaccination, but this infection can also occur in previously immunized individuals. The infection is widespread mainly in countries with a low economic level and weak health system. The tetanus poses a risk for all population segments, but the newborns and pregnant women are most vulnerable. Accor­ding to the Center for Public Health, 14 cases of tetanus were registered in Ukraine in 2022. The clinical picture of tetanus, as defined by the World Health Organization, includes painful muscle contractions, risus sardonicus (persistent spasm of facial muscles) and trismus (inability to open the mouth). Such patients have a history of trauma or damage to soft tissues, skin or mucous membranes. However, tetanus is a disease with multiple lesions, because in addition to the nervous system, the cardiovascular, respiratory and other systems are involved in the process. In the treatment, it is important to promptly introduce specific human tetanus immunoglobulin, perform debridement, antibiotic therapy and situational therapy. However, it should be borne in mind that the most effective and important direction is tetanus vaccination. The article presents a clinical case of tetanus in an 18-year-old pre-immunized patient who was admitted to a district hospital as a result of an injury. The purpose of publishing this case is to remind physicians to be alert for tetanus. In addition, the authors wanted to emphasize the risk of developing the disease even in previously vaccinated patients. The presence of prior vaccination and a high level of antitoxic antibodies cannot rule out a diagnosis of tetanus.

Neonatal Tetanus: case report in Saudi Arabia

Aims: This paper aims to investigate a case of neonatal tetanus in Saudi Arabia, studying the different factors leading to infection, role and protocols used in hospital in diagnosis and management of the case. Methods: A medical profile of neonatal case confirmed for neonatal tetanus was collected and studied, in addition to collecting literature reviews about epidemiology, diagnosis and management. Results: A newborn 7-day old girl with poor socioeconomical status and poor aseptic delivery had been admitted to hospital with symptoms of jerky repetitive movement and history of decreased feeding and poor sucking for one day. Laboratory tests, cranial computed tomography (CT) and lumbar puncture were performed, all of them with normal results. She was hospitalized on 12 November, 2019 in an environment free of sensorial stimuli in the Pediatric Intensive Care Unit (PICU), with assisted ventilation. The patient was treated with metronidazole 30mg/kg/day, ampicillin 150 mg/kg/day, and cefotaxime 150mg/kg/day. Sedation was maintained with midazolam 6mic/kg/min. Also, we started on muscle relaxation pancuronium 0.1 mg /kg/hr. and Magnesium sulfate. Besides that, we administered human immunoglobulin IM (500 IU), as well as one dose of tetanus toxoid. During hospital admission the condition of the patient was much improved. On 19 December 2019 the patient was extubated and started with baclofen and physiotherapy. Conclusion: This case indicates that non-sterile delivery by non-practical attendants are the biggest cause of neonatal tetanus along with mothers unimmunized against tetanus. However, in the rarest of incidence of neonatal tetanus, physicians should be prepared to suspect, diagnose and treat neonatal tetanus and ensure clear and clean delivery of newborns. A combination of antibiotics and muscular relaxants are used to manage neonatal tetanus. Key words: neonatal tetanus, case report, Saudi Arabia