Tetanus Patients Research Articles

Timing of Tracheostomy and Outcomes in Adults with Moderate and Severe Tetanus

Objective: This study aimed to evaluate the timing of tracheostomy and relationship to outcomes (length of hospital stay, length of mechanical ventilation, morbidity and mortality rate) in adults with moderate and severe tetanus. 
 Methods: 
 Design: Cross-Sectional Study
 Setting: Tertiary Government Training Hospital
 Patients: All adult patients (19 years old and above) diagnosed with moderate and severe stage tetanus from January 2015 to January 2018 were considered for inclusion.
 Results: There were 109 patients included in this study, majority were males (n=95) with a male to female ratio of 7:1. Most belonged to the 51-60 years age group (mean: 53.7 SD: +/-16.1). Based on Cole Tetanus staging, the majority presented with severe stage tetanus (67.9%; n=74). Only 35.8% (n=39) were admitted at the Intensive Care Unit. Early tracheostomy was performed in 56.0% (n=61) of the patients (mean 6.3 hours SD: +/- 4.61). Mortality rate was noted to be 52.3% (n=57). Overall, early tracheostomy among moderate to severe stage tetanus patients showed shorter length of hospital stay and length of mechanical ventilation than late tracheostomy (tracheostomy >24 hours) (p-value < .05). However, no significant difference was noted for timing of tracheostomy in terms of morbidity and mortality rate (p-value > .05).
 Conclusion: Early tracheostomy within less than 24 hours from time of admission for moderate and severe tetanus is associated with shorter length of hospital stay and mechanical ventilation than late tracheostomy, and may play a role in tetanus management.
 Keywords: tracheostomy; tetanus; hospital stay; mechanical ventilation; morbidity; mortality

Multicenter Study of Tetanus Patients in Fujian Province of China

Multicenter Study of Tetanus Patients in Fujian Province of China

TO EVALUATE THE ROLE OF INTRATHECAL HATG AND ITS COMPARISON WITH INTRAVENOUS AND INTRAMUSCULAR HATG IN TREATMENT OF TETANUS

Background: Tetanus is a vaccine-preventable disease that continues to occur despite several decades of sustained global health programs. Recently outbreaks of tetanus have been reported after natural disasters such as tsunamis and earthquakes.
 Methods: The present study was carried out among 30 patients of tetanus irrespective of age, sex and severity, admitted in P.B.M. Hospital, Bikaner.
 Results: Overall mortality was 30% in present study. Out of 10 patients in each group one in group I, 4 in group II and 4 in group III expired respectively. So the mortality was 10% in group I, 40% in group II & III. In mild tetanus mortality was nil in all groups. In moderate tetanus mortality was 9.9%. All patients of moderate tetanus in group I and II survived. In group III mortality in moderate tetanus patients was 20%. In severe tetanus patients over all mortality was 53.3%, in group I 25%, in group II and 50% and in group 10% respectively.
 Conclusion- Intrathecal HTAT is safe and effective treatment.
 Keywords: Intrathecal, Intravenous, Mortality, HTAT.

Blood Bilirubin Content in Neonatal Tetanus Patient with Hyperbilirubinemia during Treatment with Intravenous Diazepam

An evaluation on 128 neonatal tetanus patients with hyperbilirubinemia was done at the Department of Child Health, Dr. Cipto Mangunkusumo General Hospital, Jakarta. The patients were treated with high dosages of diazepam intravenously. This drug is potential to cause the increase of blood bilirubin, and in turn this latter condition is potential to cause kernicterus.
 Of the 128 patients there were 70 males and 58 females. The age of the patients were mostly (79.6 %) 4- 7 days.
 Fourteen of the 128 patients showed the increase of their blood bilirubin content during the second day of treatment, but after that it declined gradually during the next 3 days. The mortality of the 14 patients was 8 (57.1 %), so far no kernicterus was recorded among them.
 Among the 128 patients, 114 patients showed the decrease of their blood bilirubin content during the treatment. During 3 days the blood bilirubin content became less than 10 mg/dL. No kernicterus was recorded among those patients.
 It was concluded that intravenous diazepam is not dangerous in patients with mild and moderate hyperbilirubinemia, and no kernicterus was recorded during evaluation.

Evaluation of Mortality of Patients with Neonatal Tetanus

During 8 years, 405 patients of neonatal tetanus were hospitalized in the Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta. Diagnosis of neonatal tetanus was based on clinical signs and symptoms. Of the 405 patients, 56.3% were males and 43.7 %. were females. Two hundreds and sixty nine (66.3 %) patients were delivered by traditional birth attendants, and only 33.6% were delivered by midwives or physicians. The overall mortality was 54.4%, with the corrected mortality of 46.7%. Severity of the disease, short incubation period, short period of onset, and the accompanying diseases were responsible for the high mortality of patients with neonatal tetanus.

Pre-post effects of a tetanus care protocol implementation in a sub-Saharan African intensive care unit.

BackgroundTetanus is a vaccine-preventable, neglected disease that is life threatening if acquired and occurs most frequently in regions where vaccination coverage is incomplete. Challenges in vaccination coverage contribute to the occurrence of non-neonatal tetanus in sub-Saharan countries, with high case fatality rates. The current WHO recommendations for the management of tetanus include close patient monitoring, administration of immune globulin, sedation, analgesia, wound hygiene and airway support [1]. In response to these recommendations, our tertiary referral hospital in Tanzania implemented a standardized clinical protocol for care of patients with tetanus in 2006 and a subsequent modification in 2012. In this study we aimed to assess the impact of the protocol on clinical care of tetanus patients and their outcomes.Methods and findingsWe examined provision of care and outcomes among all patients admitted with non-neonatal tetanus to the ICU at Bugando Medical Centre between 2001 and 2016 in this retrospective cohort study. We compared three groups: the pre-protocol group (2001–2005), the Early protocol group (2006–2011), and the Late protocol group (2012–2016) and determined associations with mortality by univariable logistic regression.We observed a significant increase in provision of care as per protocol between the Early and Late groups. Patients in the Late group had a significantly higher utilization of mechanical ventilation (69.9% vs 22.0%, p< 0.0001), provision of surgical wound care (39.8% vs 20.3%, p = 0.011), and performance of tracheostomies (36.8% vs 6.7%, <0.0001) than patients in the Early group. Despite the increased provision of care, we found no significant decrease in overall mortality in the Early versus the Late groups (55.4% versus 40.3%, p = 0.069), or between the pre-protocol and post-protocol groups (60.7% versus 50.0%, p = 0.28). There was also no difference in 7-day ICU mortality (30.1% versus 27.8%, p = 0.70). Analysis of the causes of death revealed a decrease in deaths related to airway compromise (30.0% to 1.8%, p<0.001) but an increase in deaths due to presumed sepsis (15.0% to 44.6%, p = 0.018).ConclusionThe overall mortality in patients suffering non-neonatal tetanus is high (>40%). Institution of a standardized tetanus management protocol, in accordance with WHO recommendations, decreased immediate mortality related to primary causes of death after tetanus. However, this was offset by an increase in death due to later ICU complications such as sepsis. Our results illustrate the complexity in achieving mortality reduction even in illnesses thought to require few critical care interventions. Improving basic ICU care and strengthening vaccination programs to prevent tetanus altogether are essential components of efforts to decrease the mortality caused by this lethal, neglected disease.

Tetanus in children: current concepts of the infection management

The review presents current data on epidemiology, prophylaxis and treatment of tetanus in children. The highest rates of morbidity and mortality, primarily those for neonatal tetanus, are seen in the warm climatic zone countries with a low level of medical care. According to World Health Organization estimates, in 2013, neonatal tetanus killed about 49,000 newborns. Due to active immunization in Russia, only isolated cases of tetanus do occur. However, due to rare incidence and absence of causal treatment, its diagnosis and management can be challenging. The article focuses on the surgical management of wounds as an important element of non-specific disease prevention. The concept of active surgical strategy is proposed in tetanus, based on a one-stage radical excision of infected tissues, up to the amputation of the limb if vitally indicated. The effectiveness of treatment of tetanus patients depends on a combination of several conditions, such as the presence of highly skilled experienced personnel in a specialized multidisciplinary center, modern equipment and medical preparations, as well as rational use of specific therapy.

Functional and proteomic comparison of different techniques to produce equine anti-tetanus immunoglobulin F(ab′)2 fragments

Tetanus is still a major cause of human deaths in several developing countries. In particular, the neonatal form remains a significant public health problem. According to the World Health Organization, administration of tetanus toxoid is recommended for neonatal tetanus patients. Furthermore, tetanus antitoxin or anti-tetanus immunoglobulin (Ig) are used for mild case or intensive care. This paper discusses a novel purification technique for improving equine anti-tetanus Ig production. First, equine plasma dealt with two steps salting out with ammonium sulfate; second, ultrafiltration concentration liquid purified by one successive protein G based affinity chromatography steps; finally, the purified F(ab′)2 fragments was characterized using biochemical and proteomic methods and shown to be pure and homogeneous. Compared with the original technique product, specific activity increased by 80% (about 90,000 IU/g) and recovery of F(ab′)2 is approximately equal 75%. Furthermore, Proteomic profiling of total technique process is demonstrated by nano-HPLC-MS and bioinformatics analysis. New technique to produce equine anti-tetanus immunoglobulin F(ab′)2 fragments from crude plasma in high quality and yield. And it also could be used for industrial amplification.

Outcome of Early Tracheostomy in the Management of Grade II (Moderate) Tetanus Patient

The study was carried out in ENT Department ofKEMU, Lahore from December 2012 to November 2015 to assess theoutcome of early tracheostomy in grade II (moderate) tetanus patients.A total of fifty-six adults of both genders, diagnosed as grade II tetanus patients, were included. Clinical characteristics,mode of trauma, incubation period, vaccination status and investigations were recorded. All patients were managed in ICU and early tracheostomy was performed in addition to standardized medical treatment. A total of 86% males with age 32±8.3 years presented the study participants. Results demonstrated thatmost common mode of trauma was road traffic accident, and majority (54%) of patients were never vaccinated. Incubation period noted was 7±1 days. Tracheostomy was performed in 16±3 hours of admission and tracheostomy decannulation was performed in 23±3 days. Patients were discharged in 27±3 days.Weconcludethat early control of airway with tracheostomy in grade II tetanus patients helped in better patient management with early recovery and decreased hospital stay with minimal morbidity.

Diagnosis and management of tetanus outside the intensive care unit: a case report

Tetanus is an acute, toxin-mediated disease caused by Clostridium tetani infection. Under favorable anaerobic conditions, such as in the unclean environment, necrotic wounds, this ubiquitous bacillus may produce tetanospasmin, an extremely potent neurotoxin. A 38-year-old man was admitted to an emergency room, at Zainoel Abidin General Hospital, with the main complaint of back-muscle stiffness. Based on physical examination, he was fully alert with a slightly rapid breathing, trismus with the maximum oral cavity opening was only about one finger width, but rhisus sardonicus was not evident. Ten days before admission, while gardening, his left foot accidentally stabbed by wooden tree stake. We immediately started a single dose of tetanus immunoglobulin followed by intravenous metronidazole, penicillin G, and intravenous diazepam. Tetanus diagnosed by physical clinical finding. The management of tetanus patients including the use of immunoglobulin and antibiotic therapy, analgesia, sedation and neuromuscular blockade management and mechanical ventilation, the care was delivered outside the Intensive care unit.

Frequency of Acute Kidney Injury in tetanus patients of Paedriatic Intensive Care Unit: A Public Hospital Experience.

Background and Objective:Tetanus is a potentially fatal but preventable disease. Mortality is related to severity of the disease, cardiovascular, pulmonary and renal complications. Acute kidney injury (AKI) is a frequent and lethal complication of tetanus. The objective was to determine the frequency of AKI in tetanus patients managed in a public hospital.Methods:Children aged 1-12 years admitted in Paediatric Intensive Care Unit (PICU) with the clinical diagnosis of tetanus over three and half years were recruited for the retrospective study. pRIFLE (Pediatric Risk, Injury, Failure, Loss, End) criteria was applied to all cases of tetanus to categorize them as having AKI or not, on the basis of estimated creatinine clearance (ECCL). Comparison was done between AKI and non-AKI cases, as well as between AKI survivors and AKI non-survivors. The study was conducted at PICU of Dr. Ruth K.M. PFau Civil Hospital Karachi for tetanus cases admitted during July 2013 to December 2016Results:During the study period, 44 patients of tetanus were enrolled. Nearly 32 % of tetanus patients developed acute renal dysfunction according to PRIFLE criteria. There were overall 15 (34.09%) expiries among tetanus patients among which nine (60%) had AKI. Oliguria was observed in five (35.71%) cases. All the AKI non-survivors had ECCL below 50% and all had autonomic instability. AKI developed towards the end of first week in three cases, mid of second week in four cases and third week in seven cases. Renal replacement therapy (RRT) i.e. peritoneal dialysis (PD) was done in four AKI cases but it did not improve the outcome. CRP was more than 50 in 24 (54.54%) cases. Ventilatory support was given to 85.71% with AKI as compared to 66.66% of non AKI patients.Conclusion:Development of AKI in tetanus is multifactorial. Major contributors are severity of the tetanus itself, presence of autonomic instability, ventilator dependency, and sepsis. Presence of AKI worsens the outcome of tetanus in terms of survival, length of stay, hospital cost and ventilator days.

Rocuronium for control of refractory muscle spasms in a tetanus patient with substance abuse disorder: A case report

Rocuronium for control of refractory muscle spasms in a tetanus patient with substance abuse disorder: A case report

Clinical Profile and Outcome of Pediatrics Tetanus: The Experience of a Tertiary Hospital in Ethiopia.

Tetanus is an acute vaccine preventable illness manifested by neuromuscular dysfunction due to a potent exotoxin, tetanospasmin produced by Clostridium tetani. It is a common health problem in developing countries like Ethiopia. The aim of this study was to assess clinical profile and outcome of Pediatrics tetanus in a referral hospital, South Ethiopia. This is a retrospective cross-sectional study of medical records of 24 Pediatric tetanus patients who were admitted from July 2014 to June 2016 to the Pediatrics Department of Hawassa University Comprehensive Specialized Hospital, Hawassa-Ethiopia. Tetanus was diagnosed clinically. Data were entered and analyzed using SPSS statistical software. The median age at diagnosis was 8 years with 19 (79.2%)of the study subjects being males. There were 3 male neonatal tetanus cases with 2 deaths. From post-neonatal cases, only 8(38.1%) were fully vaccinated for infant Expanded Period of Immunization (EPI). Booster vaccination with TT (tetanus toxoid) was only given to 5(29.4%) of discharged patients. Trauma was common in above 5 years of age and documented in 19(79.2%) of patients. All tetanus cases were generalized type with mild, moderate and severe grades comprising 7(29.2%), 8(33.3%), 7(29.2%) and 2(8.3%) respectively. Case fatality rate was 29.2% (7) with more deaths in higher grades. Respiratory failure 6(85.7%), and aspiration pneumonia 1(14.3%) were causes of death. In this study, case fatality rate was high. Hence, health promotion with scale-up of EPI for infant tetanus immunization and large scale studies to provide support for booster vaccination schedules are recommended.

Vitamin C and Infections.

In the early literature, vitamin C deficiency was associated with pneumonia. After its identification, a number of studies investigated the effects of vitamin C on diverse infections. A total of 148 animal studies indicated that vitamin C may alleviate or prevent infections caused by bacteria, viruses, and protozoa. The most extensively studied human infection is the common cold. Vitamin C administration does not decrease the average incidence of colds in the general population, yet it halved the number of colds in physically active people. Regularly administered vitamin C has shortened the duration of colds, indicating a biological effect. However, the role of vitamin C in common cold treatment is unclear. Two controlled trials found a statistically significant dose–response, for the duration of common cold symptoms, with up to 6–8 g/day of vitamin C. Thus, the negative findings of some therapeutic common cold studies might be explained by the low doses of 3–4 g/day of vitamin C. Three controlled trials found that vitamin C prevented pneumonia. Two controlled trials found a treatment benefit of vitamin C for pneumonia patients. One controlled trial reported treatment benefits for tetanus patients. The effects of vitamin C against infections should be investigated further.

Tetanus in adults: results of the multicenter ID-IRI study.

Tetanus is an acute, severe infection caused by a neurotoxin secreting bacterium. Various prognostic factors affecting mortality in tetanus patients have been described in the literature. In this study, we aimed to analyze the factors affecting mortality in hospitalized tetanus patients in a large case series. This retrospective multicenter study pooled data of tetanus patients from 25 medical centers. The hospitals participating in this study were the collaborating centers of the Infectious Diseases International Research Initiative (ID-IRI). Only adult patients over the age of 15 years with tetanus were included. The diagnosis of tetanus was made by the clinicians at the participant centers. Izmir Bozyaka Education and Research Hospital's Review Board approved the study. Prognostic factors were analyzed by using the multivariate regression analysis method. In this study, 117 adult patients with tetanus were included. Of these, 79 (67.5%) patients survived and 38 (32.5%) patients died. Most of the deaths were observed in patients >60 years of age (60.5%). Generalized type of tetanus, presence of pain at the wound area, presence of generalized spasms, leukocytosis, high alanine aminotransferase (ALT) and C-reactive protein (CRP) values on admission, and the use of equine immunoglobulins in the treatment were found to be statistically associated with mortality (p < 0.05 for all). Here, we describe the prognostic factors for mortality in tetanus. Immunization seems to be the most critical point, considering the advanced age of our patients. A combination of laboratory and clinical parameters indicates mortality. Moreover, human immunoglobulins should be preferred over equine sera to increase survival.

Outcome of tetanus patients admitted in Rangpur Medical College Hospital

Background: Tetanus remains one of the major public health hazards of the developing world. Mortality is much lower in the developed world because of the availability of facilities, unlike in most developing countries' Objectives: This study was aimed to determine the outcome of tetanus patients admitted in infectious disease unit of Rangpur Medical College Hospital. Methods: A total of 91 cases of tetanus patients were seen in the 18 month period with a mean of 5 cases per month; they are diagnosed and managed for tetanus in the medical wards from January 2011 to June 2012. The data were retrieved from their case records and analyzed. Results: There were thirty one deaths, accounting for an overall mortality of 34.16o.Total fifty six patients were cured among which sixteen (17.67%) were cured with complication and four (4.4%) patient were absconded. Mortality was high 45.84% (11 patients out of 24) ?40 years age, whereas low 29.85 (20 patient out of 87) in &lt;40 yea15 age (45.84% vs 29.85%). Mortality rate was also higher among female than male patients (34.66% vs 33.85%). Farmers experienced more death than non-farmer (4l.l8% vs 29-82%, P&lt;0.05). Mortality was higher in patients who had not received any medical treatment for their wound than in patients who had received it for their wound (52.78% vs 21.81%, p&lt;0.05). Patients with short incubation period of less than one week had higher mortality in comparison with those who had incubation period more than one week (53.33% vs 23.25%, P&lt;0'05). Of the 91 patients, fifty six (64.34%) were alive, though four remained in a persistent vegetative state due to tetanus toxin-induced brain damage and another two required a below knee amputation of the left leg. Hence, 40 were discharged well and 16 were discharged with permanent disabilities. Conclusion: The case fatality rate of tetanus has remained consistently high in the medical college. Factors that were significantly associated with high mortality included older age, and incubation period of less than 7 days. It is recommended that preventive immunization against tetanus be given to all Bangladeshis with secondary vaccination at adulthood.

Clinical profile of tetanus patients attended at Felege Hiwot Referral Hospital, Northwest Ethiopia: a retrospective cross sectional study.

BackgroundTetanus is an acute, often fatal, disease caused by an exotoxin produced by the bacterium Clostridium tetani. It is characterized by generalized rigidity and convulsive spasms of skeletal muscles. Tetanus remains a major public health problem in Ethiopia like other developed nations. The aim of the present study was to assess the clinical profile and outcome of tetanus patients in a referral hospital, Northwest Ethiopia.MethodsThis is a retrospective cross sectional study in which we collected, compiled and analyzed medical records of patients aged greater than 15 years who were admitted at Felege Hiwot Referral Hospital from Sep 2012 to Sep 2015. Tetanus was diagnosed using clinical observations. Data were entered, cleared, and analyzed using SPSS statistical software package.ResultsAmong 110 tetanus cases 84 (76.4 %) were males. Trauma was the most common antecedent cause. Most of the patients had no history of tetanus toxoid immunization. Aspiration pneumonia at 34.5 % and dysautonomia at 11.8 % were found to be the most frequently observed complications. About 36 (32.7 %) patients were died due to tetanus and the most common immediate cause of death was respiratory failure at (83.3 %). Patients’ area of residence (p = 0.004), type of complications (p = 0.00) and severity of tetanus (p = 0.00) were found statistically associated with the type of treatment outcomes.ConclusionsIn the study, the case-fatality rate was found to be very high. Therefore, there is a need to universal tetanus immunization and health information dissemination.

TETANUS SITUATION IN PAKISTAN

Objectives: To determine demographic and clinical profile of Tetanus patientsand to highlight various management strategies as well as the outcome of the tetanus patients.Background: Tetanus, a preventable disease still found in high frequency in developing world.Globally one million cases are recorded annually. This disease found more frequently in patientswho are either non vaccinated or partially immunized. Diagnosis of Tetanus is solely made onclinical grounds with no definitive investigation available to confirm the diagnosis. Mortality ofTetanus is directly related to the grade of tetanus at presentation. Study Design: Descriptiveobservational study. Setting: Public and private sector hospitals of Hyderabad, Pakistan. Period:1st Nov 2008 to 31st Oct 2015. Materials &amp; methods: It includes patients of either sex abovethe age of 13 years who were clinically diagnosed as case of Tetanus. Data was collected forvariables related to demography, incubation period, site of injury, history of tetanus vaccination,co morbidity, stage of presentation, management &amp; outcome of treatment, complications &amp;mortality. Results: Total 131 patients of Tetanus were finally analyzed. It includes 124 (94.65%)male and 07 (5.34%) female patients with mean age of 34.06 years. 69 (52.67%) were farmers byoccupation. History of injury was present in 109(83.20%) patients &amp; incubation period was &lt; 10days in 39(29.77%) patients. Lower limb was the commonest site of injury noted in 86(65.64%)patients. Tetanus immunization history was positive in 63 (48.09 %) patients. Among the clinicalfindings, generalized bodyache or stiffness with backache was noted in 107(81.67%) patients,restricted mouth opening in 101 (70.09%) patients. Grade I Tetanus was noted in 63(48.09%)patients. Complications of tetanus were noted in 43(32.82%) patients. Mortality rate was notedin 33 (25.19%) patients. Mean hospital stay was 12.3±9.0 days. Conclusion: Tetanus is foundin significant frequency in our setup which carries substantial morbidity and mortality.

The burden of tetanus in Uganda

BackgroundThe successful scale-up of safe male circumcision (SMC) in Uganda has been hinged on client’s safety and quality of services. However, after the recent three tetanus deaths after circumcision a review of all tetanus cases in one of the hospitals where the cases occurred was initiated. This was to ascertain the potential for an association between tetanus infection and circumcision. Routinely collected national data were also reviewed to determine the burden of tetanus in Uganda and contextualize these incidents.MethodsA review of medical charts of tetanus cases identified from the inpatients registry at Masafu hospital, Busia district for the period 2009/2010–2013/2014. Data were abstracted from the inpatients registries, charts and HMIS annual reports, and a key informant interview conducted with the in-charge of the ward that treats tetanus patients. All quantitative data were captured in an electronic database. Routine facility data from the National District health Information Software-2 (DHIS-2) for all the 112 districts were also used. Descriptive analysis and Poisson regression models were used for statistical analysis using STATA version 13.0.ResultsData from the routine DHIS-2 showed a high and increasing burden of tetanus from the emergency/out-patient department records over the 4 year period, highest among females aged 5+ years in all the regions. At the Masafa hospital, the chart review revealed a total of 25 tetanus cases and all were males. Nearly a third (32 %) was aged 7–15 years, with no evidence of circumcision apart from only one case. The rate of tetanus infection among male inpatients over the review period was 2–6 per 1000. The case fatality rate was nearly a half (47.4 %) with deaths occurring within 2 days after admission, and rates of patients’ self-discharge against medical advice were high, 36.8 %. The most common tetanus entry wounds were due to road traffic accidents, followed by diabetic foot. Anti-tetanus serum was only not readily available.ConclusionThe burden of tetanus is increasing, especially among females aged 5+ years. Tetanus entry wounds among the inpatients in Masafa hospital were mostly due to road traffic accidents, and young males. The tetanus case fatality was very high (47.4 %) and so was patient requested discharge. There is a need to do more to protect the population against tetanus infection, especially among females, and males who need either initial or booster tetanus immunization as SMC is scaled up.

English

Objectives: To determine demographic and clinical profile of Tetanus patientsand to highlight various management strategies as well as the outcome of the tetanus patients.Background: Tetanus, a preventable disease still found in high frequency in developing world.Globally one million cases are recorded annually. This disease found more frequently in patientswho are either non vaccinated or partially immunized. Diagnosis of Tetanus is solely made onclinical grounds with no definitive investigation available to confirm the diagnosis. Mortality ofTetanus is directly related to the grade of tetanus at presentation. Study Design: Descriptiveobservational study. Setting: Public and private sector hospitals of Hyderabad, Pakistan. Period:1st Nov 2008 to 31st Oct 2015. Materials &amp; methods: It includes patients of either sex abovethe age of 13 years who were clinically diagnosed as case of Tetanus. Data was collected forvariables related to demography, incubation period, site of injury, history of tetanus vaccination,co morbidity, stage of presentation, management &amp; outcome of treatment, complications &amp;mortality. Results: Total 131 patients of Tetanus were finally analyzed. It includes 124 (94.65%)male and 07 (5.34%) female patients with mean age of 34.06 years. 69 (52.67%) were farmers byoccupation. History of injury was present in 109(83.20%) patients &amp; incubation period was &lt; 10days in 39(29.77%) patients. Lower limb was the commonest site of injury noted in 86(65.64%)patients. Tetanus immunization history was positive in 63 (48.09 %) patients. Among the clinicalfindings, generalized bodyache or stiffness with backache was noted in 107(81.67%) patients,restricted mouth opening in 101 (70.09%) patients. Grade I Tetanus was noted in 63(48.09%)patients. Complications of tetanus were noted in 43(32.82%) patients. Mortality rate was notedin 33 (25.19%) patients. Mean hospital stay was 12.3±9.0 days. Conclusion: Tetanus is foundin significant frequency in our setup which carries substantial morbidity and mortality.