Neurological Research and Practice (Oct 2024)
Iatrogenic botulism after intragastric botulinum neurotoxin injections – a major outbreak
- Tsepo Goerttler,
- Martin B. Dorner,
- Christina van der Linden,
- Ricardo Kienitz,
- Stephan Petrik,
- Stephan Blechinger,
- Jonah Spickschen,
- Iris R. Betz,
- Carl Hinrichs,
- David Steindl,
- Frederike Weber,
- Thomas Musacchio,
- Gilbert Wunderlich,
- Maria Adele Rueger,
- Michael T. Barbe,
- Haidar Dafsari,
- Seda Demir,
- Sriramya Lapa,
- Pia S. Zeiner,
- Adam Strzelczyk,
- Peter Tinnemann,
- Christian Kleine,
- Andreas Totzeck,
- Stephan Klebe,
- Agata Mikolajewska,
- Brigitte G. Dorner,
- Elisabeth Fertl,
- Christian Grefkes-Hermann,
- Gereon Fink,
- Christoph Kleinschnitz,
- Tim Hagenacker
Affiliations
- Tsepo Goerttler
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen
- Martin B. Dorner
- National Consultant Laboratory for Neurotoxin-producing Clostridia (Botulism, Tetanus), ZBS3, Centre for Biological Threats and Special Pathogens, Robert Koch Institute
- Christina van der Linden
- Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne
- Ricardo Kienitz
- Department of Neurology, Goethe University Frankfurt, University Hospital, Epilepsy Center Frankfurt Rhine- main
- Stephan Petrik
- Clinic of Neurology and Neurophysiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg
- Stephan Blechinger
- Department of Neurology
- Jonah Spickschen
- Department of Neurology
- Iris R. Betz
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
- Carl Hinrichs
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
- David Steindl
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
- Frederike Weber
- Department of Neurology, University Hospital Würzburg
- Thomas Musacchio
- Department of Neurology, University Hospital Würzburg
- Gilbert Wunderlich
- Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne
- Maria Adele Rueger
- Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne
- Michael T. Barbe
- Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne
- Haidar Dafsari
- Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne
- Seda Demir
- Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne
- Sriramya Lapa
- Department of Neurology, Goethe University Frankfurt, University Hospital
- Pia S. Zeiner
- Department of Neurology, Goethe University Frankfurt, University Hospital
- Adam Strzelczyk
- Department of Neurology, Goethe University Frankfurt, University Hospital, Epilepsy Center Frankfurt Rhine- main
- Peter Tinnemann
- Competence Center for High Consequence Infectious Diseases (HCID), Gesundheitsamt Frankfurt am Main
- Christian Kleine
- Competence Center for High Consequence Infectious Diseases (HCID), Gesundheitsamt Frankfurt am Main
- Andreas Totzeck
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen
- Stephan Klebe
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen
- Agata Mikolajewska
- Strategy and Incident Response (ZBS7), Centre for Biological Threats and Special Pathogens, Robert Koch Institute
- Brigitte G. Dorner
- National Consultant Laboratory for Neurotoxin-producing Clostridia (Botulism, Tetanus), ZBS3, Centre for Biological Threats and Special Pathogens, Robert Koch Institute
- Elisabeth Fertl
- Department of Neurology
- Christian Grefkes-Hermann
- Department of Neurology, Goethe University Frankfurt, University Hospital
- Gereon Fink
- Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne
- Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen
- Tim Hagenacker
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen
- DOI
- https://doi.org/10.1186/s42466-024-00350-3
- Journal volume & issue
-
Vol. 6,
no. 1
pp. 1 – 6
Abstract
Abstract 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 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 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 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.
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