Botox alarm, 67 cases of botulism after injections to lose weight

ECDC reports cases of botulism linked to intragastric injections of botulinum neurotoxin in 4 countries

From the end of February to 10 March 2023, 67 cases of botulism related to intragastric injections of botulinum neurotoxin were reported in Germany (12), Austria (1), Switzerland (1) and Turkey (53). All patients, from the information currently available, “underwent medical interventions” to lose weight, practices aimed “to help them lose weight, performed between February 22 and March 1, 2023. Of the 63 cases with available information, 60 cases are related to a private hospital in Istanbul while three cases are linked to a private hospital in Izmir”, Turkey.

The alarm was sounded by the ECDC, the European Center for Disease Prevention and Control. Who warns: “People who” in those days “went to Istanbul and Izmir for treatment” based on stomach botox injections to lose weight, “are advised to consult a doctor, especially if they experience symptoms such as weakness, difficulty breathing and/or swallowing”, informs the EU agency in a note. The ECDC strongly encourages citizens of the EU/European Economic Area to avoid intragastric botulinum toxin treatments for obesity in Turkey as this is currently associated with a significant risk of developing botulism. it is clear whether it is a therapeutic or procedural problem in the hospitals involved or if there is a problem with the administered product”.

Reported symptoms ranged from mild to severe, and several patients were hospitalized. Among the hospitalized, a proportion would have been admitted to an intensive care unit (ICU) and would have received treatment with botulinum antitoxin. The investigations conducted by the Turkish authorities found that authorized botulinum toxin products were administered in the treatments, but these products are not approved for the treatment of obesity by intragastric injection. As a result, the activity of the relevant departments of both hospitals has been suspended and investigations have been launched against the parties involved”.

Botulism, recalls the ECDC, is a serious neuroparalytic disease caused by the botulinum toxin produced mainly by the bacterium Clostridium botulinum. The disease occurs naturally in four different forms: foodborne botulism, caused by the ingestion of foods containing the toxin; intestinal botulism, when botulinum spores germinate in the intestines of adults, or in the intestines of children under 1 year of age (infant botulism), and wound botulism, when a wound becomes infected with botulism spores. There are two other forms of botulism that do not occur naturally: inhalation botulism and drug-induced botulism. The latter can occur as an adverse event following the administration of botulinum neurotoxin for therapeutic or aesthetic reasons.

Although considered rare, people who receive botox injections for cosmetic purposes (for example, for facial wrinkles) or therapeutic treatments (for example, management of muscle spasticity), can develop botulism if an overdose of the toxin is injected . Symptoms of drug-induced botulism include weakness and fatigue. Toxicities following cosmetic treatment may include blurred vision, drooping eyelids, difficulty swallowing, and dry mouth, while toxicities following therapeutic treatments include breathing difficulties, indicating overdose.

The symptoms of botulism can be very severe and require intensive care treatment and the administration of botulinum antitoxin. Even when such treatments are available, full recovery usually takes weeks or months. As for botulism mortality, limited information is available to quantify it in cases related to medical interventions. For foodborne botulism, 5-10% of cases are fatal, reports the ECDC.