title: Clinical characteristics of adult tetanus in a Taiwan medical center.
abstract: OBJECTIVE
  Despite effective vaccine programs, tetanus is occasionally observed in adults. We reviewed clinical presentation data for adult patients with tetanus in the post-vaccine era in Taiwan.
  
  
  METHODS
  We retrospectively reviewed the medical records of all adult patients (age >18 years) discharged from Chang-Gung Memorial Hospital at Lin-Ko (CGMHLK) after treatment for tetanus between January 1996 and July 2005. Data regarding demographic characteristics, clinical manifestation, treatment, and outcome were collected. To assess the features for different age groups, patients were divided into those aged ≥65 years and those aged <65 years. To identify risk factors for respiratory failure, the patients were classified as those with and without respiratory failure.
  
  
  RESULTS
  Twenty-three patients with tetanus, 11 (48%) women and 12 (52%) men, were included in the study. The average age was 57 ± 18 years (range 18-84 years). Eighteen (78%) patients had a history of acute injury. The average incubation period was 8 ± 5 days. The most common clinical presentation at onset was trismus (78%). Thirteen (57%) patients developed respiratory failure and underwent endotracheal intubation. The most common complication was pneumonia (30%). All the patients survived and recovered. Age ≥65 years was significantly associated with trismus, dysphagia, dysarthria, and pneumonia. Generalized tetanus subtype and pneumonia were significant risk factors for respiratory failure.
  
  
  CONCLUSIONS
  This study revealed several characteristics of adult tetanus cases in the post-vaccine era in Taiwan. Further serological studies and improved tetanus vaccinations may be needed to ensure better protection, especially for high-risk populations. The exceptionally good prognosis for our patients confirms that appropriate treatment, including wound care, early diagnosis, proper medication, and prevention of complications, is essential in managing this traditional curable disease.
authors: Department of Neurology, Chang-Gung Memorial Hospital at Keelung, 222 Mai-Chin Rd., Keelung, Taiwan.
authors: Wei-Chieh
authors: WC
authors: Weng
authors: Wen-Yi
authors: WY
authors: Huang
authors: Tsung-I
authors: TI
authors: Peng
authors: Yu-Yi
authors: YY
authors: Chien
authors: Kuo-Hsuan
authors: KH
authors: Chang
authors: Long-Sun
authors: LS
authors: Ro
authors: Rong-Kuo
authors: RK
authors: Lyu
authors: Chia-Lun
authors: CL
authors: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D013742:Tetanus / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D016896:Treatment Outcome