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. 2025 Dec;57(1):2543980.
doi: 10.1080/07853890.2025.2543980. Epub 2025 Aug 6.

Delirium in tetanus patients: a review of clinical features, pathophysiology, and integrated management strategies

Yanwei Rao  1   2 , Xinzao Xu  1   2 , Lijing Chen  1   2 , Di Wang  1   2 , Lin Liu  3 , Tingting Jiang  1   2 , Yang Chen  2   4 , Yongjie Wang  1   2
Affiliations

Delirium in tetanus patients: a review of clinical features, pathophysiology, and integrated management strategies

Yanwei Rao et al. Ann Med. 2025 Dec.

Abstract

Introduction: Tetanus remains a significant public health concern in resource-limited settings, with high mortality rates despite advances in critical care. The symptoms associated with tetanus are all triggers for delirium, and delirium exacerbates morbidity and complicates management in tetanus patients. Current research on tetanus-associated delirium is limited to extremely scarce case reports, which fail to provide sufficient evidence-based guidance for the clinical management of patients with tetanus-related delirium. Our review briefly introduced tetanus-related delirium of symptoms and features, pathophysiology, risk factors, early recognition and treatment strategies.

Methods: A systematic search was conducted in multiple databases such as PubMed, Embase, and Web of Science, for literature published within the past six decades. Search terms included 'Tetanus, Delirium, Symptoms and Features, Early Recognition, Treatment', etc. Inclusion criteria included original research articles, review papers and case reports that provided relevant information on the topic. Exclusion criteria were non-relevant studies, duplicates and articles with insufficient data.

Results: Systematic analysis elucidated tetanus-related delirium in terms of symptoms and features, pathophysiology, risk factors, early recognition. Comprehensive management protocols should integrate strategies for neurotoxin clearance, autonomic modulation, and spasm control through pharmacological and rehabilitative interventions.

Conclusion: Current research on tetanus-related delirium, encompassing symptomatology, pathophysiology, risk stratification, early recognition, and therapeutic interventions, remains insufficient. Large-scale prospective studies are essential to validate proposed management algorithms and refine evidence-based treatment protocols. Advancing this understanding is crucial for enhancing clinical outcomes in this vulnerable patient population.

Keywords: Tetanus; delirium; early recognition; symptoms and features; treatment.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

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