Tetanus, Botulism, and Diphtheria

PURPOSE OF REVIEW This article reviews the pathophysiology, epidemiology, clinical manifestations, diagnosis, and treatment of tetanus, botulism, and diphtheric neuropathy. RECENT FINDINGS Tetanus is most common in lower-income settings, but rare cases are seen in higher-income settings because of the inadequate maintenance of vaccination status. Foodborne botulism remains rare, but botulism can also be caused by IV drug use (wound botulism) and medical use of botulinum toxin (iatrogenic botulism); botulinum toxin has also been considered a potential agent of bioterrorism. Diphtheric neuropathy is rare but has been seen in recent epidemics in the former Soviet Union, and vaccination status is inadequate in a significant proportion of older individuals, creating the potential for subsequent epidemics. SUMMARY Tetanus, botulism, and diphtheric neuropathy are rare in higher-resource settings where most neurologists practice; however, familiarity with the unique clinical manifestations of and laboratory evaluation for these disorders is essential for the rapid diagnosis and treatment of patients with these conditions.