Majority (51.0%) of the tetanus patients in this study were farmers which is in agreement with other studies [6, 8]. This observation is in contrast to a Nigerian study which reported students and civil servants as the majority of cases [16]. This pattern of occupational risk group in our study can be Vorinostat explained by the fact that farmers or the peoples who live in the rural areas and engage themselves in the agricultural sector are more likely to be exposed to the causal check details organism as well as the injury necessary for the organism to enter the body. In agreement

with other studies [8, 9, 16, 17], the most common portal of entry in this study was injuries in the lower limbs. This is in contrast to Joshi et al [12] who reported upper limbs as the most common portal of entry. This lower limb preponderance in this study could be explained by the fact that C. tetani exists in soil; hence, any lower limb injury would be open to contamination and infection by this organism, bearing in mind too that most tetanus patients were rural farming folks. Also, the preponderance of lower limbs in our study is thought to result from poor protective footwear. The portals of entry were not identified in 33.6% of cases reflecting that the injuries were likely to be trivial to be recalled. Trivial wounds on the lower limbs as possible

portals of entry for tetanus infection are common because most people in the rural areas do not wear shoes. Body stiffness/spasm, trismus and dysphagia, selleck compound in that order, were the commonest complaints of the tetanus patients in our series which is in agreement with other studies [8, 9, 11, 14]. Hence, a high index of suspicion for tetanus is of paramount whenever patients present with any of these symptoms as tetanus is essentially a clinical diagnosis and laboratory results as well as cultures are of little diagnostic value [5]. If a patient presents with

all the three complaints, the probability of tetanus would be extremely high. The treatment of tetanus patients requires a well established intensive care facility with a medical and nursing staff experienced in treating artificially ventilated and haemodynamically unstable patients. The majority NADPH-cytochrome-c2 reductase (82.4%) of study patients required ICU management an observation which is also reported in other studies [9, 11]. However, ICU admission in this study did not significantly improve the prognosis of these patients in terms of mortality. This may be attributed to low levels of tracheostomy and mechanical ventilation which were performed in only 15.7% and 31.4% of cases respectively. In this study, tracheostomy to circumvent the problem of laryngeal spasm (which could lead to asphyxiation and hypoxia) and to enable tracheal suction and toilet to be carried out efficiently (airway protection) was performed in only 15.7% of patients which is similar to what was reported by Feroz and Rahman in Bangladesh [8].