Botulism Cases Linked to Intragastric Injections for Obesity

Between late February 2023 and March 10, 2023, 67 cases of botulism linked to intragastric injection of the botulism neurotoxin (BoNT) were reported in Germany (12), Austria (1), Switzerland (1), and Turkey (53). These data come from the European Centre for Disease Prevention and Control (ECDC).

According to current information, all patients had medical interventions that were intended to help them lose weight. The interventions were performed between February 22 and March 1. Of 63 cases for which information is available, 60 are linked to a private hospital in Istanbul, while three cases are linked to a private hospital in Izmir, Turkey.

The symptoms have ranged from mild to severe, and several patients have been hospitalized. Among those hospitalized, several patients are reported to have been admitted to intensive care units and to have received treatment with botulinum antitoxin.

Individuals who have traveled to Istanbul and Izmir for intragastric BoNT treatment between February 22 and March 1, 2023, are encouraged to seek medical advice from their healthcare provider, particularly if they experience symptoms such as weakness and difficulty breathing or swallowing.

In the International Society of Aesthetic Plastic Surgery’s International Survey on Aesthetic/Cosmetic Procedures Performed in 2020, Turkey was ranked fifth in total number of procedures, including those that involve BoNT. BoNT injections are used to relax the muscles of the stomach wall to slow the emptying of the stomach. As a result, the feeling of being full arrives sooner and lasts longer.

The procedure, which is suggested for individuals seeking to lose a moderate amount of weight (less than 5% of their body weight), can be performed every 6 months. The effects last about 3 months.

The ECDC strongly encourages EU/EEA citizens to avoid intragastric treatments with BoNT for obesity in Turkey, as this is currently associated with a significant risk of developing botulism. It is unclear whether this event represents a therapeutic or procedural problem in the involved hospitals or whether there is a problem with the product being administered.

Investigations carried out by Turkish authorities revealed that licensed BoNT products were administered in the treatments but that these products had not been approved for the treatment of obesity by intragastric injection. Consequently, in the relevant departments of both hospitals, activities have been suspended, and investigations of the parties involved have been launched.

While it is considered rare, individuals who receive BoNT injections for cosmetic purposes (for example, for facial wrinkle lines) or therapeutic treatments (for example, for the management of muscle spasticity) may develop botulism if they are injected with an excessive dose of the BoNTs.

Symptoms of iatrogenic botulism include weakness and fatigue. Toxicities following cosmetic treatment can include blurred vision, drooping eyelids, difficulty in swallowing, and dry mouth, while toxicities following therapeutic treatments include difficulty in breathing, indicating an administration of an overdose.

The symptoms of botulism can be very severe and can require intensive-care treatment, as well as the administration of botulinum antitoxin. Even when such treatments are available, complete recovery usually takes weeks to months. According to the ECDC, limited information is available regarding mortality in botulism cases caused by medical interventions. For food-borne botulism, 5% to 10% of cases are fatal.

This article was translated from Univadis Italy, part of the Medscape Professional Network.

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