Iatrogenic botulism after intragastric botulinum neurotoxin injections - a major outbreak.

Botulinum neurotoxin Iatrogenic botulism Intensive care Off-label use

Journal

Neurological research and practice
ISSN: 2524-3489
Titre abrégé: Neurol Res Pract
Pays: England
ID NLM: 101767802

Informations de publication

Date de publication:
29 Oct 2024
Historique:
received: 18 01 2024
accepted: 05 10 2024
medline: 30 10 2024
pubmed: 30 10 2024
entrez: 30 10 2024
Statut: epublish

Résumé

Intragastric botulinum neurotoxin injections (IBNI) are offered off-label in the private medical sector in a few European countries as a safe and effective weight-loss measure. In February and March 2023, an outbreak of iatrogenic botulism occurred in several European countries following IBNI treatment in Turkey. This case series describes the clinical features of severe iatrogenic botulism after IBNI. We retrospectively summarize the clinical course and emergency department and intensive care unit interventions in ten cases of severe iatrogenic botulism that occurred after receiving IBNI in this sudden outbreak in Austria and Germany. Seven out of ten cases initially showed characteristic symptoms of botulism with diplopia, dysphagia, dysarthria, dysarthrophonia, and descending paralysis. All patients were hospitalized, six in an intensive care unit and partially requiring mechanical ventilation. All patients recovered and were discharged without relevant permanent deficits. Our study highlights ten clinical cases in this iatrogenic botulism outbreak, representing the largest reported outbreak worldwide. Clinicians should be aware of the risks associated with medical procedures involving botulinum neurotoxins and ensure measures to minimize the risk of iatrogenic botulism.

Sections du résumé

BACKGROUND BACKGROUND
Intragastric botulinum neurotoxin injections (IBNI) are offered off-label in the private medical sector in a few European countries as a safe and effective weight-loss measure. In February and March 2023, an outbreak of iatrogenic botulism occurred in several European countries following IBNI treatment in Turkey. This case series describes the clinical features of severe iatrogenic botulism after IBNI.
METHODS METHODS
We retrospectively summarize the clinical course and emergency department and intensive care unit interventions in ten cases of severe iatrogenic botulism that occurred after receiving IBNI in this sudden outbreak in Austria and Germany.
RESULTS RESULTS
Seven out of ten cases initially showed characteristic symptoms of botulism with diplopia, dysphagia, dysarthria, dysarthrophonia, and descending paralysis. All patients were hospitalized, six in an intensive care unit and partially requiring mechanical ventilation. All patients recovered and were discharged without relevant permanent deficits.
CONCLUSION CONCLUSIONS
Our study highlights ten clinical cases in this iatrogenic botulism outbreak, representing the largest reported outbreak worldwide. Clinicians should be aware of the risks associated with medical procedures involving botulinum neurotoxins and ensure measures to minimize the risk of iatrogenic botulism.

Identifiants

DOI: 10.1186/s42466-024-00350-3 PMID: 39472968 PMC: PMC11520667
pubmed: 39472968
doi: 10.1186/s42466-024-00350-3
pii: 10.1186/s42466-024-00350-3
pmc: PMC11520667
doi:

Types de publication

Journal Article

Langues

eng

Pagination

52

Informations de copyright

© 2024. The Author(s).

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Auteurs

Tsepo Goerttler (T)

Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany. lt.goerttler@gmail.com.
ORCID: 0000-0002-1868-440X

Martin B Dorner (MB)

National Consultant Laboratory for Neurotoxin-producing Clostridia (Botulism, Tetanus), ZBS3, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.

Christina van der Linden (C)

Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Ricardo Kienitz (R)

Department of Neurology, Goethe University Frankfurt, University Hospital, Epilepsy Center Frankfurt Rhine- main, Schleusenweg 2-16, 60590, Frankfurt am Main, Germany.

Stephan Petrik (S)

Clinic of Neurology and Neurophysiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Breisacher Str. 64, 79106, Freiburg im Breisgau, Germany.

Stephan Blechinger (S)

Department of Neurology, Rudolfstiftung C. Landstrasse, Vienna Healthcare Group, Juchgasse 25, Vienna, 1030, Austria.

Jonah Spickschen (J)

Department of Neurology, Rudolfstiftung C. Landstrasse, Vienna Healthcare Group, Juchgasse 25, Vienna, 1030, Austria.

Iris R Betz (IR)

Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.

Carl Hinrichs (C)

Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.

David Steindl (D)

Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Poison Control Center, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.

Frederike Weber (F)

Department of Neurology, University Hospital Würzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany.

Thomas Musacchio (T)

Department of Neurology, University Hospital Würzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany.

Gilbert Wunderlich (G)

Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Maria Adele Rueger (MA)

Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Leo-Brandt- Str, 52425, Jülich, Germany.

Michael T Barbe (MT)

Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Haidar Dafsari (H)

Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Seda Demir (S)

Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Sriramya Lapa (S)

Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, 60590, Frankfurt am Main, Germany.

Pia S Zeiner (PS)

Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, 60590, Frankfurt am Main, Germany.
Dr. Senckenberg Institute of Neurooncology, Goethe University Frankfurt, University Hospital, Schleusenweg 2- 16, 60590, Frankfurt am Main, Germany.

Adam Strzelczyk (A)

Department of Neurology, Goethe University Frankfurt, University Hospital, Epilepsy Center Frankfurt Rhine- main, Schleusenweg 2-16, 60590, Frankfurt am Main, Germany.

Peter Tinnemann (P)

Competence Center for High Consequence Infectious Diseases (HCID), Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Germany.
Global Health Sciences Unit, Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstraße 57, 10117, Berlin, Germany.

Christian Kleine (C)

Competence Center for High Consequence Infectious Diseases (HCID), Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Germany.

Andreas Totzeck (A)

Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.

Stephan Klebe (S)

Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.

Agata Mikolajewska (A)

Strategy and Incident Response (ZBS7), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.

Brigitte G Dorner (BG)

National Consultant Laboratory for Neurotoxin-producing Clostridia (Botulism, Tetanus), ZBS3, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.

Elisabeth Fertl (E)

Department of Neurology, Rudolfstiftung C. Landstrasse, Vienna Healthcare Group, Juchgasse 25, Vienna, 1030, Austria.

Christian Grefkes-Hermann (C)

Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, 60590, Frankfurt am Main, Germany.

Gereon Fink (G)

Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Leo-Brandt- Str, 52425, Jülich, Germany.

Christoph Kleinschnitz (C)

Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.

Tim Hagenacker (T)

Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.

Classifications MeSH