go to the doctor A warning to all those who have undergone wild obesity treatments

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Cases of botulism have recently appeared in Turkey, Switzerland, but also in neighboring Germany and Austria. Therefore, before this relatively rare disease he warned and the Czech State Institute of Health (SZÚ).

Infection can usually occur after eating food contaminated with botulinum toxin. However, the aforementioned cases refer to people who underwent obesity treatment by injecting botulinum toxin (botox for short) into the stomach.

“Botulism acquired in this way is not an infection, but the application of poison for aesthetic or other purposes. Therefore, it is not transmissible,” explains Hanuš Rozsypal, head of the Bulovka Infectious Diseases Clinic and the 1st Faculty of Medicine at Charles University.

This is confirmed by Kateřina Kotíková, head physician of the Toxicological Information Center (TIS) at the University General Hospital in Prague.

“Foreign toxicological databases, which we use for our work, mention rare cases where symptoms of botulism appeared after unlicensed cosmetic application of botulinum toxin intended for scientific research,” he describes. However, TIS has not yet encountered this type of poisoning.

The European Center for Disease Control and Prevention urges EU citizens not to receive treatment in Turkey. In addition, according to experts, the effectiveness of the treatment has not been proven. “It’s a very dubious form of therapy. There are much better ways to treat obesity,” notes Rozsypal.

Fatal consequences

The SZÚ recommends a visit to the doctor for people who have undergone the so-called intragastric Botox treatment in Turkey. However, doctors have not yet registered such a case in the Czech Republic.

“If botulism is reasonably suspected and immediately after the development of symptoms, anti-botulinum serum is administered. Treatment of symptoms is also important,” emphasizes Kotíková.

“Since the greatest threat is sudden respiratory failure, the mainstay of treatment is early intensive respiratory support in the intensive care unit,” he adds.

After the incubation period, which is usually 12 to 48 hours, digestive problems first appear: nausea, vomiting or diarrhea. Later, blurred or double vision, dilated pupils and droopy eyelids appear. Symptoms include dry mouth, hoarseness, swallowing disorders and general muscle weakness, doctors describe.

“Sometimes it looks as if people have been poisoned by a toad. They start to have visual impairments and various movement disorders are added to it. It starts mainly with the face,” explains Rozsypal.

An untreated disease can be fatal. “The botulinum toxin produced by the bacterium Clostridium botulinum blocks the neuromuscular plates and paralysis of the muscles occurs, paralysis of the respiratory muscles can also quickly occur,” warns Kotíková.

“Death can occur from respiratory arrest or heart failure. Even in twenty-four hours,” he adds.

“Wild Method”

Rozsypal does not recommend undergoing the aforementioned obesity treatment. “It’s a pretty wild method. It’s not used at all in the Czech Republic. Its use elsewhere in the world is also exceptional,” he describes.

“When the botulinum toxin is applied, the stomach relaxes. You will suddenly defecate reluctantly after eating. This should lead to a state of satiety,” explains the essence of the method.

Until March 10, 53 cases of the disease were registered in Turkey, 12 in Germany and one each in Austria and Switzerland. Of the 63 cases for which details are known, 60 are reported in connection with treatment in a private hospital in Istanbul and three in Izmir.

It is not yet clear whether the health problems that have arisen are related to the procedures in the aforementioned Turkish hospitals, or whether there is a problem with the preparation administered.

Although patients in Turkey received licensed botulinum toxin products, they were not approved for this particular type of obesity treatment. Therefore, the activities of the respective departments of both hospitals have been suspended and the entire case is under investigation.

In the vast majority of cases, people become infected with botulism through food, most often by ingesting salted or otherwise preserved home-made foods, such as sausages, ham, pate, or home-made preserves. meat, vegetables and fruits.

A rare disease

The most common type of botulism in Europe is foodborne botulism. It is a rare disease in the Czech Republic: from 2008 to 2022, only 11 cases were reported in our country, of which two in 2022 were probably after ingestion of contaminated pate.

“It’s so rare that doctors often don’t even think about it when diagnosing it,” thinks Rozsypal.

Last year, the University General Hospital in Prague issued antiserum to five patients with suspected botulism. “In all cases, it was a suspicion of food contamination. In one case, it was definitely not botulism, a different diagnosis was established later,” says Kotíková.

Full recovery usually takes weeks or months. In addition to the administration of antibodies, intensive care or connection to artificial lung ventilation was sometimes necessary in the recorded cases.

Suspected botulism due to weight loss after the use of botox injections in Egypt was already reported in France in the past, in 2019 in a middle-aged woman. In the past, similar cases also occurred after various clinical procedures in Turkey.

The World Health Organization (WHO) warned against fake batches of botulinum toxin products as early as August 2022. However, experts have yet to prove the link between these batches and the current cases.

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