title: Tetanus in adults: clinical presentation, treatment and predictors of mortality in a tertiary hospital in Ethiopia.
abstract: BACKGROUND
  Tetanus remains a major health problem in the developing world. The aim of this study was to evaluate the clinical presentation, risk factors, complications, treatment, outcome and predictors of death in patients with tetanus.
  
  
  METHODS
  Patients aged ≥ 13 years admitted to Tikur Anbessa Hospital from June 2001 to May 2009 with the diagnosis of tetanus were included in this retrospective study.
  
  
  RESULTS
  Data from 68 patients were analyzed; majority (77.9%) were males, the mean age was 33.8 years. None of them was vaccinated for tetanus. The types were: generalized (91.2%), cephalic (7.4%), localized (1.5%), severe (72.1%), moderate (19.1%) and mild (8.8%). One or more complication(s) occurred in 75%; dysautonomia (58.8%), pneumonia (44.1%) and hypoxemia (41.2%). Tracheostomy and mechanical ventilation was used in 45.6% and 11.8%, respectively. Case-fatality was 35.3%. Predictors of mortality were age ≥ 40 years, duration of symptoms prior to presentation < 4 days, severe tetanus, incubation period < 7 days, period of onset < 3 days and dysautonomia. The cause of death was early acute respiratory failure due to uncontrolled spasms in 87.5%.
  
  
  CONCLUSIONS
  Most tetanus patients were young males and there was high case fatality due to acute respiratory failure. Age ≥ 40 years and dysautonomia were independent predictors of mortality. Preventing tetanus by vaccination and treating patients in a well equipped ICU is recommended.
authors.affiliation: Addis Ababa University, Medical Faculty, Department of Neurology, Addis Ababa, Ethiopia. amanuelaw@yahoo.com
authors.forename: Amanuel
authors.initials: A
authors.lastname: Amare
authors.forename: Yilma
authors.initials: Y
authors.lastname: Melkamu
authors.forename: Desalew
authors.initials: D
authors.lastname: Mekonnen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006784:Hospitals, Teaching / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D054969:Primary Dysautonomias / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013742:Tetanus / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome; D014611:Vaccination / Q000639:trends; D055815:Young Adult