European Officials Warn of Illness After Botulinum Injections

Over 60 cases of botulism have been linked to intragastric injection of the botulinum neurotoxin in two Turkish clinics.

Botulinum neurotoxin (BoNT) is a medication used to reduce wrinkles and treat various conditions, including chronic migraine or spastic disorders. When injected into the stomach, BoNT is known to help in weight loss.

BoNT's are mainly produced by the bacterium Clostridium botulinum may cause botulism, a serious neuroparalytic illness. Botulism may occur in a few forms, one of which is iatrogenic botulism — an adverse event following the administration of BoNTs.

As of March 10, 67 cases of botulism have been reported in Europe, according to the European Centre for Disease Prevention and Control (ECDC). Most of the cases are linked to two private hospitals in Istanbul and Izmir in Turkey.

Both hospitals administered products that weren’t approved for the treatment of obesity by intragastric injection, an investigation by Turkish authorities found. At this time, the hospitals suspended their activities.

The symptoms of botulism have ranged from mild to severe, with several people having been hospitalized. Of those, a number have been admitted to Intensive Care Units (ICU) and received treatment with botulinum antitoxin.

When used for therapeutic purposes, symptoms of iatrogenic botulism may include weakness, fatigue, and difficulty in breathing. Following cosmetic treatment, patients may experience blurred vision, drooping eyelids, difficulty in swallowing, and dry mouth. All forms of botulism are considered to be fatal.

C. botulinum is found naturally in the environment. The bacteria make spores that help them to survive but usually do not make people sick. However, the spores can grow and become one of the most lethal toxins under certain conditions, such as in environments low in oxygen, acid, salt, or sugar. For example, improperly home-canned, preserved, or fermented foods can create conditions for botulinum toxin.

The ECDC strongly encourages citizens to avoid intragastric treatments with BoNT for obesity in Turkey due to the increased risk of developing botulism.