Evidence map›Paper›PMID 40543524›Full record

ReviewThe Lancet. Infectious diseases2025

Tetanus: recognition and management.

Raghav Sudarshan, Ana Ria Sayo, David Roman Renner, Sophia de Saram, Gauri Godbole, Clare Warrell, Ha Thi Hai Duong, C Louise Thwaites, Arpan R Mehta, Charles Coughlan

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in The Lancet. Infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
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  5. Multiple Independent Origins of TnAntibiotics (Basel, Switzerland) · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Raghav SudarshanPeterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK.
Ana Ria SayoDepartment of Infectious Diseases, San Lazaro Hospital, Manila, Philippines.
David Roman RennerDepartment of Neurology, University of Utah, Salt Lake City, UT, USA; Kenya Moi Teaching and Referral Hospital, Eldoret, Kenya.
Sophia de SaramUniversity College London Hospitals NHS Foundation Trust, London, UK.
Gauri GodboleUniversity College London Hospitals NHS Foundation Trust, London, UK; UK Health Security Agency, London, UK.
Clare WarrellUniversity College London Hospitals NHS Foundation Trust, London, UK; Imported Fever Service, Rare and Imported Pathogen Laboratory, Porton Down, Salisbury, UK; London School of Hygiene & Tropical Medicine, London, UK.
Ha Thi Hai DuongHospital for Tropical Diseases, Ho Chi Minh City, Viet Nam; Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
C Louise ThwaitesOxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
Arpan R MehtaUniversity College London Hospitals NHS Foundation Trust, London, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Medical Research Council Protein Phosphorylation and Ubiquitylation Unit, School of Life Sciences, University of Dundee, Dundee, UK. Electronic address: arpan.mehta@nhs.net.
Charles CoughlanUniversity College London Hospitals NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK. Electronic address: charles.coughlan@nhs.net.

Funding

Wellcome Trust 107367
6 · The paper itself

Abstract

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.

Indexed as

TetanusAnti-Bacterial AgentsClostridium tetaniDisease ManagementGlobal HealthHumansAnti-Bacterial Agents

Identifiers

PMID40543524
PMCPMC7617864

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.