SHORT COMMUNICATIONS and Letters to the Editors A continuing problem of tetanus in the southeast of Turkey Clin Microbiol Infect 1997; 3: 690-692 Tetanus continues to represent a serious health problem in developing countries [1,2]. Although tetanus is a rare disease in the developed countries [3], it is still common enough to cause concern in Turkey. During the years 1992-3, 75 deaths caused by tetanus were reported from Turkey [4]. Clinical details of 88 adult patients with tetanus who received treatment at our hospital are summarized in this report. We reviewed the hospital records of all 88 adult patients (> 16 years, 56 men, 32 women) with a clinical diagnosis of tetanus managed at the Dicle University Hospital over a 10-year period. Cases were included in this series if they fulfilled the following criteria; a disease the onset of which was characterized by muscle rigidity and hyperreflexia, with a normal conscious state, and which could not be explained on the other grounds, the subsequent course being consistent with tetanus, and there being no history of poisoning with strychnine [5]. The following factors were analyzed: 25 I age, sex, immunization status, incubation period, type and location of wounds, presentation symptoms, clinical course, treatment, complications and mortality. The factors that might be expected to influence mortality were compared using the Kruskal-Wallis test. The incubation period is defined as the time between the injury and the onset of clinical symptoms. Cases were distributed unevenly through the 12 months of the year. The mean age of the patients was 36.5215.3 years. The majority of tetanus cases occurred in two decades of life: 16-19 years (17 patients) and 40-49 years (24 patients) (Figure 1). The mortality rate was 29% (14/48) in patients under age 40, and 55% (22/40) in patients over age 40, and the difference was statistically significant between the two groups by the chi-squared test (p<0.05). The overall mortality was 41% (36 cases: 22 male and 14 female). The immunization status of 46 (52%) patients was known and only six (7%) of them had received tetanus toxoid recently. Fifty-six patients (64%) sought initial treatment for their wounds, but only eight (9%) of them had received their first active immunization after 16-19 20-29 30-39 40-49 50-59 >60 Ages Figure 1 Age distribution and mortality of 88 patients with tetanus. 690