European health officials have warned of an outbreak of botulism linked to a failed weight-loss procedure aimed at paralyzing stomach muscles due to anorexia implemented in Turkey. So far, authorities have identified 67 cases, 53 in Turkey, 12 in Germany, 1 each in Austria and Switzerland.
Botulism is a life-threatening neuroparalytic condition caused by botulinum toxin produced by a bacterial species. Clostridium botulinumThere are several forms of botulism, but this outbreak has cases of a form called iatrogenic botulism, which occurs when too much toxin is injected during a medical procedure. . Iatrogenic botulism is associated with generalized muscle weakness, drooping eyes, difficulty swallowing, and breathing. According to the European Center for Disease Prevention and Control (ECDC), outbreak cases ranged from mild to severe, with many reported to be in intensive care.
Botulinum toxin is one of the most toxic natural substances known. A dose of just 1 nanogram per kilogram of body weight is lethal. Nevertheless, it is used for cosmetic purposes, such as smoothing facial wrinkles, and for therapeutic purposes, such as treating overactive bladder and chronic migraines.
It has also been used on the stomach for weight loss purposes, but research on this application is mixed as to its effectiveness. This is intended to keep you feeling fuller longer and reduce your appetite for about 3 months as long as the toxin’s effects persist. Injections are done using a tube-like device called an endoscope, equipped with a syringe that snakes through the mouth and throat and then injects the toxin directly into the stomach muscles.
outbreak
But too many botulism injections, like in Turkey, make things worse. European officials traced cases from Germany, Austria and Switzerland to a single clinic in Istanbul. Cases in Turkey are also linked to that clinic, with the exception of his three, who were traced to a private hospital in Izmir, Turkey. ECDC noted that a European patient coordinated a risky medical trip via her WhatsApp group.
In the past, such iatrogenic botulism clusters have been associated with counterfeit toxin products, as was the case in the 2017 Egyptian outbreak. Last August, the World Health Organization warned of counterfeit batches of a botulinum toxin product called Dysport. Defective products have been detected in several countries, including Turkey. But a Turkish investigation into the current outbreak found it involved a legally licensed product, although not approved for use in the stomach, he reports, ECDC. Turkish authorities have reportedly suspended medical procedures at both identified medical facilities and launched further investigations into the health care providers involved.
Botulism sufferers, on the other hand, face a long and harrowing road. Recovery may take weeks or months. In her 2017 outbreak associated with counterfeit goods, it took the patient 6 weeks to 12 weeks to fully recover. Because iatrogenic botulism is relatively rare, mortality is unknown. But foodborne botulism, caused by ingestion of toxin-contaminated, improperly stored or canned foods, has a fatality rate of 5-10%, he notes, ECDC.
antivenom hero
Treatment of botulism includes mechanical ventilation in case of respiratory failure and administration of an antitoxin made from horses called heptavalent botulinum antitoxin (HBAT). HBAT contains antibodies from horses that have been immunized with minute doses of botulinum toxin.HBAT antibodies act to bind to presynaptic nerve endings while the toxin is in the blood before causing paralysis. It works by binding toxins to As such, antivenom can only prevent further paralysis. Paralysis that has already occurred cannot be reversed. Still, according to the U.S. Centers for Disease Control and Prevention, the current fatality rate is less than 10%, whereas before the antitoxin was developed the fatality rate was 50%.
Horses are often used for such antibody-based therapies. Because horses are big and have a lot of blood, they can collect a lot of antibodies (or other valuable proteins). In the United States, from its initial development in the 1970s to his 1990s, a single Thoroughbred named First Flight was the only source of botulism antivenom.
First Flight was a retired racehorse who reportedly worked briefly as a caisson horse at a military funeral at the Arlington National Ceremony before bolting a general’s coffin. In 1978, at the age of 10, he was transferred to the United States Army Institute of Infectious Diseases and Medicine in Fort Detrick, Maryland, where he became the nation’s only living factory producing antivenom for botulism. From the 1980s he retired from First Flight after donating about 16,000 liters of blood throughout the 1990s. He died at his ranch of natural causes at Fort Detrick at the young age of 31. His halter and lead are kept at the Smithsonian National Museum of American History.
