Tetanus is a severe, potentially fatal disease caused by infection with Clostridium tetani, an anaerobic, spore-forming, Gram-positive bacillus. This organism produces tetanospasmin, a potent neurotoxin that enters nerve terminals and retrogradely travels to the central nervous system, where it blocks inhibitory neurotransmission. This blockage leads to uncontrolled motor neuron activity, resulting in muscle rigidity, painful spasms, and autonomic hyperactivity. The binding of the toxin is essentially irreversible, necessitating the regeneration of nerve terminals for recovery. The incubation period ranges from 1 to 21 days, with the generalized form accounting for approximately 80% of cases. The disease progresses through prodromal symptoms, trismus, and generalized spasms before recovery. Treatment strategies include thorough wound care, bacterial eradication, and toxin neutralization prior to the onset of symptoms. Once clinical signs appear, management focuses on controlling spasms and autonomic instability, often requiring sedation, muscle relaxants, and intensive care. Human tetanus immunoglobulin is critical for early toxin neutralization. Recovery may take weeks to months, and rehabilitation is essential for functional restoration. Prevention through vaccination remains the most effective measure, with most cases occurring in individuals who lack adequate immunization. Early recognition and prompt administration of immunoglobulin significantly improve outcomes and reduce mortality.

Tetanus is a serious but vaccine-preventable disease caused by the toxin produced by germinated spores of Clostridium tetani bacteria. Despite substantial declines in incidence resulting from immunization, cases continue to occur, particularly among unvaccinated and undervaccinated populations. 2009-2023. The National Notifiable Diseases Surveillance System uses national surveillance to identify cases of tetanus using the Council of State and Territorial Epidemiologists' tetanus case definition. Tetanus cases identified through clinical diagnosis are reported to CDC by state health departments. Detailed tetanus-specific case information is requested, which includes tetanus toxoid-containing vaccine (TTCV) vaccination history, wound history, medical care before tetanus disease onset, and the clinical course of illness, including death. During 2009-2023, a total of 402 tetanus cases and 37 associated deaths were reported from 47 states and the District of Columbia, with a mean annual tetanus incidence of 0.08 cases and 0.008 deaths per 1 million population. More than half (62.2%) of all reported tetanus cases occurred in males. Incidence was higher among males than females for all persons aged <65 years and higher among women than men for adults aged ≥80 years. Women aged ≥80 years had the highest overall tetanus incidence (0.27 cases per 1 million population). The overall case-fatality rate among persons with tetanus with known vital status was 12.4% (37 of 299), with deaths predominantly affecting older adults. A total of 45.0% of persons with tetanus who had a substantial wound sought medical care before disease onset. Among patients with wounds eligible for tetanus post-exposure prophylaxis, 2.3% received tetanus immune globulin (TIG) and 26% received TTCV per recommendations. Among persons whose vaccination history was known, a substantial proportion (43.9%) had not received any TTCV doses, highlighting substantial gaps in coverage. Despite being preventable through vaccination, tetanus continues to occur among persons of all age groups in the United States. Overall, males have higher incidence compared with females; the highest incidence is among older women. Approximately 1 in 10 persons who develop tetanus will die, with the highest mortality and case-fatality rates among older adults. Multiple efforts might reduce the incidence of tetanus, including clinicians' assessing for and offering routine tetanus vaccination for children and decennial tetanus boosters for adults. In addition, persons with significant wounds should seek timely medical care, and clinicians should provide recommended wound care, including identifying tetanus-prone wounds and the need for and administration of TTCV and TIG. Because C. tetani is ubiquitous in the environment, continued surveillance and vaccination efforts are crucial to monitor trends, identify opportunities to prevent tetanus cases, and reduce tetanus incidence in the United States.

ABSTRACT The article describes a case of tetanus in a feline, a neuromuscular disease caused by the toxin tetanospasmin, produced by the anaerobic bacterium Clostridium tetani. This toxin interferes with the transmission of nerve impulses, resulting in progressive muscle rigidity, spasms and motor difficulties. Although tetanus is uncommon in cats, when it does occur, it usually manifests as a localized form of the disease. The case report presents a 13-year old male cat with severe neurological clinical signs, including spastic tetraplegia and cranial nerve involvement. After extensive diagnostic investigation, including magnetic resonance imaging and cerebrospinal fluid analysis, other potential causes were ruled out, and the diagnosis of tetanus was established by exclusion. Treatment involved antibiotic therapy, symptomatic support and gradual withdrawal of phenobarbital, which resulted in the patient's complete recovery after two months of follow-up. The report highlights the importance of clinical diagnosis with differential screening of motor neuropathies in cats.

Introduction: Neonatal tetanus, known as tetanus neonatorum, occurs in infants born to mothers who lack adequate immunization against the Clostridium tetani (C. tetani). Tetanus is a disease that affects animals and humans of all ages. The present study aimed to document neonatal tetanus in a 6-day-old male red Sokoto kid.Case report: A 6-day-old male red Sokoto kid weighing 1.4 kilograms, was presented to the Large Animal Clinic of the Veterinary Teaching Hospital, University of Jos, Nigeria, with a chief complaint of inappetence for suckling milk from its mother and weakness lasting 6 days. Clinical examination revealed a rectal temperature of 36.7°C, a pulse rate of 72 beats per minute, and a respiratory rate of 64 cycles per minute. The kid presented with generalized muscle stiffness, trismus (lockjaw), bilateral opisthotonus, hyperesthesia, a characteristic sawhorse stance, and a prolapsed third eyelid. As tetanus is a clinical diagnosis with no definitive laboratory test, therefore, confirmation was based on the pathognomonic clinical signs and the kids’ history. The kid was hospitalized and kept in a dark and quiet room, where procaine penicillin, tetanus antitoxin, piroxicam (analgesic and antipyretic), multivitamin (nerve supplement), diazepam (muscle relaxant), and saline dextrose 5 % (fluid therapy) were administered, but the kid did not survive and died on the third day. Due to the case history, unsanitary environmental conditions where the kid was delivered, and signs observed that were characteristic of tetanus, the disease was diagnosed. Conclusion: Increasing the hygiene during parturition should be encouraged, the umbilicus should be disinfected after parturition, and treatment of open wounds should be treated immediately after a cut or injury occurs. The present findings emphasized the importance of preventing and controlling tetanus through vaccination, which can reduce economic losses and enhance overall animal health.

Tetanus is a life-threatening, preventable infection caused by the neurotoxin of Clostridium tetani. Despite global vaccination initiatives, cases of adult and maternal tetanus still occur even in individuals with prior immunization. A 21-year-old female presented 15 days after a spontaneous home abortion with fever, trismus, neck stiffness, generalized rigidity, and stimulus-induced spasms. She had received the complete tetanus vaccination. Examination revealed risus sardonicus, opisthotonus, and autonomic instability. Laboratory investigations revealed mild anemia and elevated liver enzymes, and protective anti-tetanus IgG levels, while neuroimaging, abdominal imaging, and cultures were unremarkable. She received human tetanus immunoglobulin, antibiotics, benzodiazepines, magnesium sulfate, baclofen, and intensive supportive care, including mechanical ventilation and vasopressors. Despite intensive care unit care, the patient’s condition worsened, resulting in death on day 10. Tetanospasmin irreversibly blocks inhibitory neurons, causing uncontrolled muscle spasms and autonomic dysfunction. Diagnosis is clinical; laboratory tests are often non-contributory. Management focuses on neutralizing circulating toxin, preventing bacterial proliferation, controlling spasms, and providing intensive supportive care. Even with intensive management, mortality remains high, primarily due to respiratory failure and autonomic dysfunction. Maternal generalized tetanus may occur following spontaneous abortion outside a healthcare setting, even in previously vaccinated individuals with protective antibody levels, and carries a high risk of mortality.

Tetanus toxin evaluation has traditionally relied on mouse LD50 bioassays, which require extensive animal use and time, necessitating development of alternative methods in accordance with 3R principles (Replacement, Reduction, and Refinement). We developed and validated a sandwich enzyme-linked immunosorbent assay (ELISA) as an alternative to animal testing for evaluating tetanus toxin biological activity using 18 environmental and clinical isolates of Clostridium tetani, complemented by an immunochromatographic (IC) assay for rapid screening. The ELISA demonstrated excellent analytical performance with a lower limit of quantification of 2.4 ng/mL (equivalent to 85.4 LD50/mL), favorable linearity (R2 = 0.999), precision (CV < 1.7-8.2%), and specificity (<1% cross-reactivity with C. septicum, C. novyi, and C. perfringens). Correlation analysis between ELISA relative potency and observed minimum lethal dose values revealed a robust positive correlation (r = 0.974). Both parallel line assay and single-point quantification methods showed strong correlations with mouse bioactivity measurements (r = 0.998). The IC assay successfully detected all isolates within 15 min. The measurement range of 2.4-45.6 ng/mL effectively covered diverse toxin-production capabilities spanning a 600-fold concentration range. This validated ELISA and IC assay combination provides a reliable, rapid alternative to animal experimentation for tetanus toxin evaluation.

Wound infections and dermatological disorders in goats significantly compromise productivity, welfare, and economic sustainability in small ruminant farming systems. Delayed wound management predisposes animals to secondary bacterial infection, myiasis, septicemia, and potentially fatal tetanus caused by Clostridium tetani. The present prospective clinical field investigation was conducted over six months to evaluate the therapeutic efficacy, safety, and healing kinetics of a topical polyherbal veterinary formulation, HEALYN SPRAY, in naturally occurring caprine wounds. A total of 120 goats presenting with septic wounds, aseptic wounds, deep lacerations, horn injuries, maggot-infested wounds, dermatophytosis and mange were enrolled. Wounds were graded on a standardized ordinal severity scale and treated with twice-daily topical application. Clinical response was evaluated using inflammation score reduction, exudate grading, granulation index, wound contraction percentage and healing time. Statistical analysis was performed using mean±standard deviation and paired t-test comparisons at p

Tetanus, caused by Clostridium tetani, results in rigor spasms and remains as major cause of mortality in areas with poor vaccination and sanitation. Mortality has been cited to be 20%-55% in Ethiopia, possibly due to variation in healthcare, immunization, and intensive care access. However, there is limited data at the local level. This study was conducted to determine Tetanus mortality and identify determinants among adults in the Bahir Dar public hospitals. A multicenter, hospital-based cross-sectional study was conducted using medical records of 251 patients admitted between January 1, 2019, and December 2024. Data were collected using Kobo Collect software and entered into EpiData 4.6, where they were cleaned and checked for completeness. Analysis was performed using SPSS version 27. Binary logistic regression was performed to identify significant factors. A p-value of < 0.05 in the multivariable model was considered statistically significant. The mortality rate for tetanus was 32.27% (95% CI: 26.75%, 38.33%). Several factors were significantly associated with tetanus mortality, including coexisting diseases (AOR = 2.12; 95% CI: 1.65, 6.30), onset of symptoms within 2 days (AOR = 4.10; 95% CI: 1.84, 8.16), generalized tetanus type (AOR = 6.5; 95% CI: 2.05, 11.42), failure to receive tetanus antitoxin (AOR = 2.51; 95% CI: 1.04, 10.43), and undergoing a tracheostomy procedure (AOR = 2.3; 95% CI: 2.3 (1.32, 5.81). The mortality rate among tetanus patients was found to be high. Key factors include coexisting diseases, acute onset (within 2 days), generalized tetanus, failure to administer Tetanus Antitoxin, and the performance of tracheostomy. Hence, the study highlights the importance of early diagnosis and treatment, advocating for the use of antitoxin, providing special care for patients with generalized tetanus, and reconsidering the effectiveness of tracheostomy as a treatment option.

Tetanus is a potentially life-threatening neurologic disorder caused by the toxin-producing bacterium Clostridium tetani. Primary prevention is achieved through vaccination, typically administered during infancy, however, breakthrough cases of tetanus in fully immunized individuals, especially in pediatric populations have been noted posing unique challenges for diagnosis and management. Uganda currently does not provide tetanus booster doses beyond infancy. The World Health Organisation (WHO) recommends 3 dose Tetanus Toxoid (TT) booster doses at ages 12–23 months, 4–7 years and 9–15 years whereas the US-Centers for Disease control (CDC) recommends 3 additional doses at 15–18 months, 4–6 months and at 11–12 years. This case report represents an unusual occurrence of tetanus an 11-year-old male who had completed the standard infant vaccines recommended in Uganda but still manifested with symptoms consistent with the disease. An 11-year-old male Muganda was referred to Mulago National Referral Hospital's Acute Care Unit from a peripheral health facility with worsening backache, trismus, difficulty swallowing, and heightened sensitivity to touch and noise. On admission, he presented with severe pain, an arched back, and frequent muscle spasms indicative of tetanus, despite receiving the standard recommended infant vaccines in Uganda. The patient received intravenous metronidazole, alternate diazepam, and chlorpromazine, leading to a steady improvement in symptoms after which he was discharged on day 29. This case underscores the critical necessity of remaining vigilant for tetanus, even in individuals with a documented history of complete immunization at infancy. Additionally, this scenario highlights the pressing need for reviews of vaccination policies in regions where the recommended booster doses are not currently integrated into routine immunization schedules. Emphasizing adherence to these booster doses is key to enhancing tetanus immunity throughout childhood and adolescence.

Tetanus, a vaccine-preventable disease caused by the neurotoxin of Clostridium tetani , remains a significant cause of morbidity and mortality, particularly in low-income countries with inadequate immunization coverage. Severe generalized tetanus, the most common clinical presentation, is characterized by excruciating muscle spasms, rigidity, and autonomic nervous system dysfunction, often necessitating intensive care unit (ICU) admission. The prognosis is further worsened by life-threatening complications such as respiratory failure and sepsis. We present the case of a 49-year-old male with severe generalized tetanus following a contaminated wound, whose hospital course was complicated by multidrug-resistant septic shock. Despite a prolonged and challenging ICU stay, the patient made a remarkable and complete neurological recovery. This case highlights the critical importance of early diagnosis, aggressive multidisciplinary ICU management, and comprehensive rehabilitation in achieving favorable outcomes in the face of overwhelming complications.

Tetanus, a disease caused by the neurotoxin-producing bacteria Clostridium tetani (C. tetani), remains a serious threat, particularly among individuals who are unvaccinated or under-vaccinated. Although public health guidelines in the United States continue to recommend a well-established, multi-dose vaccination schedule to prevent tetanus, recent revisions to the Centers for Disease Control and Prevention webpage language on vaccine safety prompted renewed public discussion. Despite this, extensive evidence continues to demonstrate the effectiveness and safety of tetanus immunization, and certain demographic groups remain disproportionately at risk. Globally and within the United States, natural disaster zones remain especially high-risk environments for tetanus infection. This review examines the pathophysiology of tetanus, current vaccination recommendations, and the social and geographic inequities that influence vaccine uptake. It also evaluates strategies of protection and prevention. Particular emphasis is placed on tetanus risk in disaster settings, where disrupted infrastructure, greater likelihood of contaminated wounds, and preexisting disparities in vaccination coverage compound vulnerability. A clearer understanding of these factors is essential for strengthening public health preparedness and ensuring equitable protection against tetanus, especially for populations disproportionately affected by disasters.

Background: Tetanus is a serious infectious disease caused by the bacterium Clostridium tetani. Tetanus often causes symptoms of muscle spasms, especially in the jaw and neck area. Clostridium tetani bacteria are commonly found in soil, dust, human and animal feces that produce exotoxins. These bacteria can infect the body through improper wound care. Lack of public knowledge regarding tetanus prevention management can result in complications and even death. Providing health education is one effort that can be done to increase public knowledge in preventing tetanus in wounds. Objective: This health education activity aims to increase public understanding and knowledge in preventing tetanus, especially in patients at risk, namely patients with wounds. Method: Health education is carried out through interactive lecture methods, and distribution of information media in the form of leaflets. Evaluation is carried out using pre-test and post-test instruments to measure the level of knowledge of participants. Results: A significant increase was seen from the pre-test results of 40% correct answers to 80% correct answers after health education. Conclusion: Health education is effective in increasing public literacy regarding tetanus prevention. Ongoing support from the community health center is essential to ensure safe wound care practices in the home environment.

The composition of the microbial community of the small intestine of rats under chronic restraint stress of varying duration (14 and 28 days) was studied. Identification and quantitative determination of microorganisms were carried out using gas chromatography-mass spectrometry of microbial markers. It was found that under stress exposure, the number of Bifidobacterium spp., Lactobacillus spp., Enterococcus spp., Enterobacteriaceae spp., Actinomyces viscosus, Nocardia asteroides, Clostridium tetani, Clostridium ramosum decreased and the number of Clostridium difficile, Helicobacter pylori, Streptococcus mutans, Propionibacterium freudenreichii, Peptostreptococcus anaerobius increased. It was shown that enterococci are capable of self-restoring their population levels under stress conditions, whereas bifidobacteria, lactobacilli and enterobacteria do not exhibit adaptive capacity.

Tetanus is an infection caused by Clostridium tetani characterized by fever, cramped-up jaw, muscle spasms, headache, seizures, sweating, and trouble swallowing 3–21 days following exposure. About 10% of cases prove to be fatal. C. tetani produce toxins that interfere with normal muscle contractions. Some infections seem to be both heritable and endogenous contradicting the traditional infection paradigm consistent with the germ theory-and contamination as the exclusive pathway of infection. Objective: To project the mathematical odds of “ Tetanus is endogenous”. Method: We applied the probability theory to relevant data to project, the mathematical odds of certainty that “Tetanus is endogenous” . Results: Eight observations consistent with” tetanus is endogenous “and inconsistent with” tetanus is not endogenous” suggests the mathematical certainty that “tetanus is endogenous” is % 99.7. Discussion: Converging evidence suggest some tetanus infections may represent endogenous infections that are produced independent of contamination. At present we do not know the precise biological processes involved in causing tetanus. Conclusion: Some tetanus infections maybe endogenous. Highlights: Tetanus is caused by Clostridium tetani characterized by muscle spasms, fever and seizures. Endogenous infections may develop through pathways independent of contamination. Animals and humans harbor clostridium tetani without sickness. Clostridium tetani is almost always associated with traumatic injuries. Neonatal tetanus (trismus nascentium) occurs from healthy mothers(5). The dramatic difference of incidence of tetanus between developed and developing countries for neonatal tetanus but not for tetanus suggests immunity by vaccination against the toxin produced by Clostridium tetani. Mathematical certainty that tetanus is endogenous= % 99.9

Tetanus is a life-threatening neuroparalytic disease caused by the potent exotoxin tetanospasmin, produced by Clostridium tetani. This anaerobic, spore-forming bacterium enters the host primarily through deep or necrotic wounds. Although tetanus is often sporadic in ruminants, outbreaks may follow invasive procedures such as ear tagging, tail docking, or castration. In this report, we present a field case of tetanus in a herd of sheep from Muğla province, Türkiye. Following clinical suspicion, bacteriological culture and molecular PCR analysis, we have confirmed C. tetani from an ear wound. The case emphasizes the critical role of wound hygiene and vaccination in disease prevention. Comparative outbreak data and recent literature are used to contextualize the case within regional and global patterns of ovine tetanus.

Tetanus, though vaccine preventable, is a commonly occurring life-threatening affliction of new-borns and pregnant women in low- and middle-income countries, including Nigeria. This is mostly due to the infection of wounds with Clostridium tetani from unhygienic delivery and cord care practices. While tetanus cannot be eradicated, elimination is possible through a combination of strategies. A literature review from 2015 to 2024 was conducted in PubMed/MEDLINE, African Journals Online, Google Scholar, and the Grey literature, following PRISMA guidelines to identify relevant publications. Eight studies met the inclusion criteria and were assessed for evidence quality using an expanded PRISMA checklist. The studies identified the several interventions operationalized for the elimination of tetanus in Nigeria and the outcomes of these interventions, inclusive of: conditional cash transfer (single conditionality – N5 vs N300 vs N800) for maternal vaccination with tetanus toxoid vaccine, single dose (versus none) maternal tetanus toxoid vaccination during pregnancy (AOR=3.2; 95% CI =1.1, 10; p=0.04), improved maternal antenatal care follow-up (AOR=3.3; 95% CI= 1.2, 8.3; p=0.03), and improved access to tetanus toxoid immunization information in pregnancy (last 12 months: AOR = 2.5; 95% CI = 1.1, 2.5; p=0.02). The key demand-side and supply-side factors influencing these outcomes include: lack of knowledge of the current immunization schedule, dependence on physician referral for immunization, inefficient immunization records keeping systems, poor health staff attitude as well as lack of community participation. Targeted health education and promotion, maximisation of opportunities for vaccination of high-risk groups, adequate financing of immunization and improved disease surveillance at all levels are essential for achieving elimination targets.

Tetanus is a life-threatening infection caused by Clostridium tetani, particularly affecting high-risk groups in low- and middle-income countries in sub-Saharan Africa, Africa, and Asia. This is often due to unhygienic birth practices. Vaccination with tetanus toxoid-containing vaccine during and around pregnancy provides protection. A literature review from 1995 to 2024 was conducted in PubMed/MEDLINE, African Journals Online, and Google Scholar following PRISMA guidelines to identify relevant publications. Thirteen studies met the inclusion criteria and were assessed for evidence quality using an expanded PRISMA checklist. The studies identified key factors influencing poor vaccination uptake among women of childbearing age, including age(25-35years: AOR; 0.510-0.925), marital status (Married: AOR; 0.400-1.038), parity (3-4 Children: AOR; 0.200-5.050), antenatal care visits (Four or more: AOR; 0.048-1.710), place of delivery (Health facility: AOR; 1.130-23.380), distance to health facilities (&lt;30 minutes: AOR;1.050-4.600), media exposure (Yes: AOR;1.968-2.820), wealth index (Rich: AOR; 0.630-7.230 or poor), educational level (Secondary: AOR; 0.600-6.200), and knowledge of tetanus and the vaccine (Yes: AOR; 0.900-3.450). Health education, engagement of women, and targeted vaccination of high-risk groups are essential strategies to improve vaccination rates.

Abstract Introduction Tetanus is a neuromuscular illness caused by Clostridium tetani, which is an anaerobic spore-forming bacteria, found in soil and faeces. Even though C. tetani is present everywhere, mostly found in poor and crowded areas. Primary vaccination campaigns have led to a decline in the prevalence of tetanus in developed nations. If tetanus is identified and treated early, the prognosis is favourable. It is important to raise awareness of this potentially fatal and debilitating illness. Method We present a case of a 50-year-old male diagnosed with generalised tetanus purely on clinical grounds and successfully managed with prolonged diazepam infusion with maintenance of safety and ventilatory support, cost-effective ICU care and reducing the cost of treatment in the absence of immunoglobulin. Results The patient showed gradual improvement with diazepam infusion and ICU care and was discharged with complete resolution of tetanic spasms by the time of discharge. Conclusion Timely diagnosis, strong clinical suspicion, and quality ICU care can ensure recovery in this rare but potentially fatal disease.

A 69-year-old man developed generalized muscle spasms 9 days after undergoing surgery for a strangulated intestinal obstruction. He subsequently experienced respiratory failure and required mechanical ventilation in the intensive care unit. Tonic spasms were exacerbated by external stimuli, such as sound, and trismus emerged following tracheostomy. The patient was diagnosed as having tetanus, and targeted therapy was initiated, resulting in gradual clinical improvement. Tetanus is a neurotoxic syndrome caused by tetanospasmin, an exotoxin produced by Clostridium tetani, a bacterium commonly found in soil and present in human feces. Although rare, endogenous tetanus can occur following gastrointestinal surgery, likely due to translocation of the organism from the gut. This case highlights the need for clinicians to consider the gastrointestinal tract as a potential source of tetanus in postoperative patients presenting with muscle rigidity or spasms.

Currently a rarity in high-income countries, tetanus is a diagnosis not to miss. Deaths from tetanus fell by almost 90% between 1990 and 2019, largely reflecting the success of WHO's Maternal and Neonatal Tetanus Elimination campaign. However, deaths among children and adults have plateaued, and tetanus remains an important vaccine-preventable cause of morbidity and mortality, notably in southern Asia, southeast Asia, and sub-Saharan Africa. Tetanus results from infections with spore-forming Clostridium tetani bacteria, usually acquired via contaminated wounds and burns. C tetani releases a potent neurotoxin, causing muscle spasms, rigidity, and dysautonomia. Important complications include laryngeal spasm and resultant airway obstruction and respiratory arrest, nosocomial infections, and sequelae of prolonged immobility. Tetanus is usually diagnosed on the basis of clinical signs and symptoms, but microbiological tests can serve as useful adjuncts. Treatment is multifaceted, requiring source control, antibiotic therapy, and antitoxin administration. With prolonged, quality intensive care, many patients survive with good functional outcome. However, due to challenges in leveraging routinely-collected health-care data and performing high-quality trials in resource-constrained settings, several key questions remain unanswered and optimal treatment strategies are contested. In this Review, we provide a state-of-the-art summary of global tetanus epidemiology, its clinical features and differential diagnosis, principles of management, and prognosis.