By Stan Deresinski, MD, FACP, FIDSA
Clinical Professor of Medicine, Stanford University
SYNOPSIS: An outbreak of botulism after intragastric injection of botulinum toxin to cause weight loss has, to date, affected at least 87 patients.
SOURCES: European Centre for Disease Prevention and Control. Iatrogenic botulism, exposure in Türkiye. Weekly Communicable Disease Threats Reports, Week 10, 5-11 March 2023. https://www.ecdc.europa.eu/sites/default/files/documents/Communicable-Disease-Threats-Report-10-Mar-2023.pdf
European Centre for Disease Prevention and Control. Update on iatrogenic botulism cases in Europe. April 3, 2023. https://www.ecdc.europa.eu/en/news-events/botulism-iatrogenic-update-cases-europe-march-2023
On March 10, 2023, The European Centre for Disease Prevention and Control (ECDC) reported an outbreak of at least 14 cases of botulism related to intragastric injections of botulinum toxin for weight loss. Twelve of the reports were from Germany, with one each from Switzerland and Austria. At least 10 of the cases had received the toxin injection at the same Istanbul clinic. All 14 received their injection on Feb. 22-25, 2023. Illness ranged from mild to severe, with several patients requiring hospitalization.
These 14 cases proved to be only the tip of the iceberg. On April 3, 2023, ECDC updated the report to include a new total of 87 cases, with 53 from Türkiye, 30 from Germany, two from Switzerland, and one each from France and Austria. All 87 had received the injections at one of two private hospitals in either Istanbul or Izmir. The German patients were reported to have received doses of 1,000 units to 2,500 units of botulinum toxin.
Precise clinical information has not been provided, but the illnesses have ranged from mild to severe, with some requiring intensive care. However, there was no mention of deaths.
COMMENTARY
The endoscopic injection of botulinum toxin into multiple sites in the gastric muscular layer is reported to delay gastric emptying, which presumably prolongs the sensation of fullness after a meal. While some studies report apparent benefit with regard to weight loss, others fail to confirm this.1,2
REFERENCES
- Chang PC, Jhou HJ, Chen PH, et al. Intragastric botulinum toxin A injection is an effective obesity therapy for patients with BM > 40 kg/m2: A systematic review and meta-analysis. Obes Surg 2020;30:4081-4090.
- Bustamante F, Brunaldi VO, Bernardo WM, et al. Obesity treatment with botulinum toxin-A is not effective: A systematic review and meta-analysis. Obes Surg 2017;27:2716-2723.
