Clinical profile and management of tetanus: A scoping review of evidence in the 21st century
NITIN GUPTA, PRAVEEN KUMAR TIRLANGI, SHREYA DAS ADHIKARI, MARTIN P. GROBUSCH, MANISH SONEJABackground
Tetanus, a vaccine-preventable but potentially fatal infection caused by Clostridium tetani, remains a public health concern, particularly in low-resource settings. This scoping review examines the clinical features, treatment strategies, and outcomes of tetanus in the 21st century.
Methods
A systematic search of PubMed and Embase (2000–2024) identified studies on tetanus epidemiology, clinical presentation, treatment, and outcomes. Data extraction and synthesis followed the Arksey and O’Malley framework and PRISMA for scoping reviews guidelines.
Results
The inclusion criteria were met by 34 studies. Tetanus primarily affects older adults in developed regions due to waning immunity, while younger populations in developing nations remain at risk due to insufficient immunization practices. Generalized tetanus was the most severe form, often requiring prolonged intensive care unit (ICU) admission and mechanical ventilation. Management includes toxin neutralization, antibiotics, benzodiazepines, magnesium sulphate, and supportive care. Human tetanus immunoglobulin (HTIG) is preferred for neutralizing unbound toxins; however, equine tetanus antitoxin (TAT) is an alternative in resource-limited settings. Intrathecal administration of HTIG has demonstrated greater efficacy compared to the intramuscular route. Siltartoxatug, a recombinant monoclonal antibody targeting tetanus toxin, has shown promise in providing faster and more durable seroprotection. Mortality ranged from 5.26% to 52.8%, with higher rates linked to short incubation periods, severe symptoms, and lack of ICU access.
Conclusion
Tetanus remains an important preventable global disease. Strengthening immunization programmes, maternal vaccination, and post-exposure prophylaxis is crucial in decreasing its incidence. Expanding ICU access, improving diagnostics, and optimising treatment strategies are key to reducing mortality and improving outcomes.