Have you heard of the “Botox” that many people use to give their skin a more youthful appearance? Although its use in the medical field is generally very safe, sometimes a miscalculation of the dose or some contamination in its formulation can lead to an unwanted side effect.

An outbreak of botulinum poisoning was recently reported in two private hospitals in Türkiye (Turkey, a European country), where patients underwent a medical procedure designed to help them lose weight.

Botox is a product used to reduce wrinkles on the skin, as well as in other more innovative applications such as weight reduction in patients.

This product is based on the use of botulinum toxin, which is produced in bacteria Clostridium tetani.

the bacteria Clostridium tetani it is a type of anaerobic gram-positive bacteria, which means that it can be found in oxygen-free environments and has a characteristic cell structure. It is responsible for causing tetanus, a fatal disease that affects the central nervous system.

Tetanus occurs when the bacteria C. tetani enters the body through a wound or injury. The bacteria produces a toxin called tetanospasmin, which affects nerves and muscles. The toxin binds to the nerves and prevents the muscles from relaxing, leading to muscle stiffness, spasms and painful seizures. Left untreated, tetanus can cause serious complications and even death.

Tetanus prevention is possible through vaccination. The tetanus vaccine is included in the children’s immunization schedule and it is recommended to update it with a booster dose every ten years. In addition, proper wound cleaning and application of antibiotics can help prevent infection by C. tetani.

Outbreak of Botox paralysis cases

Although no deaths were reported, some of the most severe cases of patients who received Botox were taken to intensive care.

In “milder” cases, Botox can cause blurred or double vision, nausea, diarrhea, or slurred speech. If the poisoning is severe, breathing can be blocked and death can occur in 5-10% of cases.

According to the European Center for Disease Prevention and Control (ECDC) report, a total of 67 cases of botulism have been reported so far, the majority in Turkey, with 12 patients in Germany, one in Austria and one in Switzerland.

In the latest update of available information, it is known that all patients underwent medical procedures aimed at weight loss, which were performed between February 22nd and March 1st, 2023.

Of the 63 reported cases with available information, 60 cases are linked to a private hospital in Istanbul and the other 3 cases to a private hospital in Izmir, Turkey.


According to the ECDC, it is recommended that patients who have traveled to Istanbul and Izmir for intragastric treatment with BoNT between 22 February and 1 March 2023 seek medical consultation with their doctor, especially if they experience symptoms such as weakness, difficulty breathing or swallow.

Furthermore, ECDC recommends that EU/EEA 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 procedural or therapeutic issue at the hospitals involved or whether there is a problem with the administered product.

This report has been published on the ECDC Europe official website.

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