Alert in Europe for 14 cases of iatrogenic botulism —that is, caused by a medical examination or treatment—, 12 of them in Germany, contracted after those affected underwent weight-loss surgical treatments in Turkey. This is alerted by a Report on threats of communicable diseases from the European Center for Disease Prevention and Control (ECDC).
The country that has reported the most cases —12— has been Germany. The cases have occurred in middle-aged adults, originating from different regions of Germany, who underwent treatments with intragastric injections of botulinum neurotoxin (BoNT) between February 22 and 25, 2023.
At first, the cases were mild, but their symptoms became serious as the days went by. Several cases have been hospitalized, among which it is reported that several were admitted to Intensive Care Units (ICU). Among eight cases with known information, all received treatment at the same clinic in Istanbul and three of them recalled being treated with the same product.
Austria and Switzerland have also reported two cases – an Austrian woman aged 25-44 and a Swiss woman aged 45-64 – of apparently iatrogenic botulism after receiving both intragastric injections of BoNT administered in Turkey on 22 February 2023. These two cases reported receiving treatment at the same clinic as the cases from Germany.
As early as 2022, a WHO medical product alert noted five counterfeit batches of a BoNT product detected in five countries: Jordan, Turkey, Kuwait, the United Kingdom, and Poland. It is not known, however, whether these batches have been used for treatment in the cases reported so far.
Botulism, as the ECDC points out, is a severe neuroparalytic disease caused by BoNTs produced mainly by the Clostridium botulinum bacterium. The disease occurs naturally in four different forms: foodborne botulism, intestinal botulism, infant botulism, and wound botulism. There are two other forms of botulism that do not occur naturally: inhalation and iatrogenic.
The symptoms of iatrogenic botulism are characterized by weakness and difficulty swallowing. Post-cosmetic treatment toxicities include ophthalmologic and oropharyngeal symptoms (blurred vision, drooping eyelid, difficulty swallowing, and dry mouth), while post-therapeutic treatment toxicities are related to shortness of breath and weakness. These can be very severe symptoms and require intensive care treatment, as well as administration of an antitoxin. Even when such treatments are available, full recovery usually takes weeks to months.
