Iatrogenic botulism after intragastric botulinum neurotoxin injections - a major outbreak

Tsepo Goerttler¹, Martin B Dorner², Christina van der Linden³, Ricardo Kienitz⁴, Stephan Petrik⁵, Stephan Blechinger⁶, Jonah Spickschen⁶, Iris R Betz⁷, Carl Hinrichs⁷, David Steindl^{7

8}, Frederike Weber⁹, Thomas Musacchio⁹, Gilbert Wunderlich³, Maria Adele Rueger^{3

10}, Michael T Barbe³, Haidar Dafsari³, Seda Demir³, Sriramya Lapa¹¹, Pia S Zeiner^{11

12}, Adam Strzelczyk⁴, Peter Tinnemann^{13

14}, Christian Kleine¹³, Andreas Totzeck¹⁵, Stephan Klebe¹⁵, Agata Mikolajewska¹⁶, Brigitte G Dorner², Elisabeth Fertl⁶, Christian Grefkes-Hermann¹¹, Gereon Fink^{3

10}, Christoph Kleinschnitz^#¹⁵, Tim Hagenacker^#¹⁵

Affiliations

¹ 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.
² 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.
³ Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
⁴ Department of Neurology, Goethe University Frankfurt, University Hospital, Epilepsy Center Frankfurt Rhine- main, Schleusenweg 2-16, 60590, Frankfurt am Main, Germany.
⁵ Clinic of Neurology and Neurophysiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Breisacher Str. 64, 79106, Freiburg im Breisgau, Germany.
⁶ Department of Neurology, Rudolfstiftung C. Landstrasse, Vienna Healthcare Group, Juchgasse 25, Vienna, 1030, Austria.
⁷ 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.
⁸ Poison Control Center, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
⁹ Department of Neurology, University Hospital Würzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany.
¹⁰ Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Leo-Brandt- Str, 52425, Jülich, Germany.
¹¹ Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, 60590, Frankfurt am Main, Germany.
¹² Dr. Senckenberg Institute of Neurooncology, Goethe University Frankfurt, University Hospital, Schleusenweg 2- 16, 60590, Frankfurt am Main, Germany.
¹³ Competence Center for High Consequence Infectious Diseases (HCID), Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Germany.
¹⁴ Global Health Sciences Unit, Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstraße 57, 10117, Berlin, Germany.
¹⁵ 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.
¹⁶ Strategy and Incident Response (ZBS7), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.

^# Contributed equally.

PMID: 39472968
PMCID: PMC11520667
DOI: 10.1186/s42466-024-00350-3

Iatrogenic botulism after intragastric botulinum neurotoxin injections - a major outbreak

Tsepo Goerttler et al. Neurol Res Pract. 2024.

. 2024 Oct 29;6(1):52.

doi: 10.1186/s42466-024-00350-3.

Authors

Affiliations

¹ 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.
² 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.
³ Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
⁴ Department of Neurology, Goethe University Frankfurt, University Hospital, Epilepsy Center Frankfurt Rhine- main, Schleusenweg 2-16, 60590, Frankfurt am Main, Germany.
⁵ Clinic of Neurology and Neurophysiology, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Breisacher Str. 64, 79106, Freiburg im Breisgau, Germany.
⁶ Department of Neurology, Rudolfstiftung C. Landstrasse, Vienna Healthcare Group, Juchgasse 25, Vienna, 1030, Austria.
⁷ 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.
⁸ Poison Control Center, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
⁹ Department of Neurology, University Hospital Würzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany.
¹⁰ Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Leo-Brandt- Str, 52425, Jülich, Germany.
¹¹ Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, 60590, Frankfurt am Main, Germany.
¹² Dr. Senckenberg Institute of Neurooncology, Goethe University Frankfurt, University Hospital, Schleusenweg 2- 16, 60590, Frankfurt am Main, Germany.
¹³ Competence Center for High Consequence Infectious Diseases (HCID), Gesundheitsamt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Germany.
¹⁴ Global Health Sciences Unit, Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstraße 57, 10117, Berlin, Germany.
¹⁵ 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.
¹⁶ Strategy and Incident Response (ZBS7), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.

^# Contributed equally.

PMID: 39472968
PMCID: PMC11520667
DOI: 10.1186/s42466-024-00350-3

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.

Keywords: Botulinum neurotoxin; Iatrogenic botulism; Intensive care; Off-label use.

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Conflict of interest statement

Gereon Fink, Christian Grefkes-Hermann, Christoph Kleinschnitz and Adam Strzeczyk are editorial board members of Neurological Research and Practice.

References

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Iatrogenic botulism after intragastric botulinum neurotoxin injections - a major outbreak

Affiliations

Iatrogenic botulism after intragastric botulinum neurotoxin injections - a major outbreak

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources