{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T18:13:22Z","timestamp":1788200002370,"version":"build-2803163510"},"reference-count":13,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2026,8,18]]},"abstract":"<jats:p>Tetanus is a devastating toxin-mediated neurological disease that continues to exact high mortality in resource-constrained settings despite an effective and inexpensive vaccine. With just 10 cases diagnosed in the UK each year, few neurologists will encounter the condition over the course of their career. Nonetheless, a working knowledge of its clinical features, staging and management remains important, given the positive clinical outcomes that can be achieved through prompt recognition and aggressive treatment, even in older, comorbid patients. Here, we describe two cases of generalised tetanus in adults presenting to the apex hospital for infectious diseases in Metro Manila, the Philippines, and outline practical steps for clinical management.<\/jats:p>","DOI":"10.1136\/pn-2026-005390","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:20:12Z","timestamp":1788196812000},"page":"pn-2026-005390","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Generalised tetanus: the San Lazaro Hospital experience"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3907-3859","authenticated-orcid":false,"given":"Charles","family":"Coughlan","sequence":"first","affiliation":[{"name":"Imperial College London Department of Infectious Disease, London, UK"},{"name":"Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su Myat","family":"Han","sequence":"additional","affiliation":[{"name":"Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Nagasaki Prefecture, Japan"},{"name":"San Lazaro Hospital - Nagasaki University Collaborative Research Office, Manila, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann Christine","family":"Santos","sequence":"additional","affiliation":[{"name":"San Lazaro Hospital, Manila, NCR, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5715-5025","authenticated-orcid":false,"given":"Arpan R","family":"Mehta","sequence":"additional","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust, London, UK"},{"name":"School of Life Sciences, University of Dundee, MRC Protein Phosphorylation and Ubiquitylation Unit, Dundee, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Smith","sequence":"additional","affiliation":[{"name":"Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Nagasaki Prefecture, Japan"},{"name":"San Lazaro Hospital - Nagasaki University Collaborative Research Office, Manila, Philippines"},{"name":"London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Ria","family":"Sayo","sequence":"additional","affiliation":[{"name":"San Lazaro Hospital - Nagasaki University Collaborative Research Office, Manila, Philippines"},{"name":"San Lazaro Hospital, Manila, NCR, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"2026083110200806000_pn-2026-005390v1.1","doi-asserted-by":"crossref","first-page":"e645","DOI":"10.1016\/S1473-3099(25)00292-0","article-title":"Tetanus: recognition and management","volume":"25","author":"Sudarshan","year":"2025","journal-title":"Lancet Infect Dis"},{"key":"2026083110200806000_pn-2026-005390v1.2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.2000.80.2.717"},{"key":"2026083110200806000_pn-2026-005390v1.3","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.ijid.2023.04.402","article-title":"Global epidemiology and burden of tetanus from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"132","author":"Li","year":"2023","journal-title":"International Journal of Infectious Diseases"},{"key":"2026083110200806000_pn-2026-005390v1.4","doi-asserted-by":"crossref","unstructured":"Leone T , Alburez-Gutierrez D , Ghandour R . Maternal and child access to care and intensity of conflict in the occupied Palestinian territory: a pseudo longitudinal analysis (2000 \u2013 2014). Confl Health 2019. doi:10.1186\/s13031-019-0220-2","DOI":"10.1186\/s13031-019-0220-2"},{"key":"2026083110200806000_pn-2026-005390v1.5","doi-asserted-by":"crossref","DOI":"10.1093\/braincomms\/fcab013","article-title":"Tetanus in a rural low-income intensive care unit setting","volume":"3","author":"Olum","year":"2021","journal-title":"Brain Commun"},{"key":"2026083110200806000_pn-2026-005390v1.6","doi-asserted-by":"crossref","first-page":"3343","DOI":"10.1017\/S095026881600128X","article-title":"Current epidemiology of tetanus in England, 2001-2014","volume":"144","author":"Collins","year":"2016","journal-title":"Epidemiol Infect"},{"key":"2026083110200806000_pn-2026-005390v1.7","unstructured":"UK Health Security Agency . Guidance on the management of suspected tetanus cases and the assessment and management of tetanus-prone wounds. 2024. Available: https:\/\/www.gov.uk\/government\/publications\/tetanus-advice-for-health-professionals\/guidance-on-the-management-of-suspected-tetanus-cases-and-the-assessment-and-management-of-tetanus-prone-wounds [Accessed 20 Jun 2026]."},{"key":"2026083110200806000_pn-2026-005390v1.8","doi-asserted-by":"crossref","DOI":"10.12688\/wellcomeopenres.16731.1","article-title":"The management of tetanus in adults in an intensive care unit in Southern Vietnam","volume":"6","author":"Hao","year":"2021","journal-title":"Wellcome Open Res"},{"key":"2026083110200806000_pn-2026-005390v1.9","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1093\/brain\/awag104","article-title":"What comes next for global neurology?","volume":"149","author":"Coughlan","year":"2026","journal-title":"Brain"},{"key":"2026083110200806000_pn-2026-005390v1.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69444-0"},{"key":"2026083110200806000_pn-2026-005390v1.11","doi-asserted-by":"crossref","first-page":"e862","DOI":"10.1016\/S2214-109X(22)00117-6","article-title":"Human versus equine intramuscular antitoxin, with or without human intrathecal antitoxin, for the treatment of adults with tetanus: a 2\u2008\u00d7\u20082 factorial randomised controlled trial","volume":"10","author":"Van Hao","year":"2022","journal-title":"Lancet Glob Health"},{"key":"2026083110200806000_pn-2026-005390v1.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-021-05935-w","article-title":"Clinical outcomes and healthcare costs of inpatients with tetanus in Korea, 2011-2019","volume":"21","author":"Bae","year":"2021","journal-title":"BMC Infect Dis"},{"key":"2026083110200806000_pn-2026-005390v1.13","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.jcrc.2017.12.025","article-title":"Clinical features and outcomes of tetanus: Analysis using a National Inpatient Database in Japan","volume":"44","author":"Nakajima","year":"2018","journal-title":"J Crit Care"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/pn-2026-005390","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:20:14Z","timestamp":1788196814000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/pn-2026-005390"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":13,"alternative-id":["10.1136\/pn-2026-005390"],"URL":"https:\/\/doi.org\/10.1136\/pn-2026-005390","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]}}}