The number of people affected by severe cases of botulism in Europe now rises to 67 cases. The European Center for Disease Control (ECDC) launched an alert on Monday after detecting fourteen cases linked to weight loss surgeries performed at various clinics in Turkey. It was an initial calculation, it was feared that the outbreak had just begun. A day later, the figure has already multiplied.

Information currently available indicates that all patients underwent medical interventions aimed at helping them to lose weight, carried out between 22 February and 1 March 2023. Of the 63 cases with available information, 60 cases are attached to a private hospital in Istanbul while three cases are related to another health center in the city of Izmir, also in Turkey.

All were treated with a technique called intragastric BoNT, which consists of injecting botulinum toxin into the stomach mucosa. This technique is not endorsed for use in the scientific community. It was used ten years ago in some countries, but the experience was not positive. Patients were unable to lose weight and, what was worse, were the side effects, which is why it was abandoned.

Botox is botulinum toxin, a very powerful poison that paralyzes the nerves. This virtue is used in aesthetic medicine to reduce wrinkles. In medicine it is also used in many applications, to combat sweating, migraines or strabismus, among others.

To lose weight, it is injected into the stomach looking for the rigidity of the stomach mucosa. The aim is to reduce appetite, the problem is that the lining of the stomach is highly vascularized, there are many blood vessels and the toxin can directly enter the bloodstream, causing botulism. This could be a cause of the outbreak or also the use of adulterated products. The body that oversees European health still does not have all the data.

Symptoms ranged from mild to severe, and several cases required hospital admission, reports the ECDC. Among those hospitalized, several had to be admitted to Intensive Care Units (ICU), where they received treatment with botulinum antitoxin.

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

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

Investigations by the Turkish authorities revealed that authorized products were administered in the treatments, but these products are not approved for the treatment of obesity by intragastric injection. Turkish hospitals suspended their activities and investigations were launched against the parties involved.

The symptoms of botulism can be very severe and require intensive treatment as well as administration of botulinum antitoxin. Even when these treatments are available, full recovery often takes weeks to months. Limited information is available that quantifies mortality in cases of botulism caused by medical interventions. For foodborne botulism, 5-10% of cases are fatal.