Alert in Europe after 14 serious cases of botulism in patients who traveled to Turkey to undergo an operation to lose weight

The health authorities of the European Union (EU) have been put on alert after the detection of 14 cases of botulism in patients who traveled to Istanbul (Turkey) at the end of February to undergo a weight loss operation that consists of injecting botulinum toxin. in the digestive system.

Several of those affected have been hospitalized and some of them have required admission to the ICU, according to the risk bulletin published by the European Center for Disease Control and Prevention (ECDC).

The Directorate General of Health of the European Commission, the office on the continent of the World Health Organization (WHO) and the authorities of Germany (which has diagnosed 12 people), Austria (one) and Switzerland - which is not a member of the EU, but has France as a link and which has registered another case— held a first telephone meeting last Friday to assess the situation.

The ECDC has called on all European countries "to notify any information that may be relevant in relation to this outbreak."

All Spanish hospitals have been informed of the outbreak through the usual channels to maximize vigilance.

The Ministry of Health has informed at 11:40 this Monday that it has no information on any case in Spain.

"Active surveillance and constant monitoring" of the outbreak is maintained, a spokesperson explained.

The fear of the authorities is that the cases detected are only the first and that more may be reported in the near future, either because those affected have not yet begun to suffer symptoms or because they are already being treated in hospitals on the continent, but the doctors are still they have not linked their clinical process to the outbreak.

cheap aesthetic operations

Tens of thousands of Europeans travel to Turkey every year to undergo cosmetic operations, which are much cheaper than in EU countries.

The operation that is at the center of the investigations is the intragastric injection of botulinum toxin, an intervention that according to the most common prices observed by EL PAÍS usually costs about 8,000 euros in Spain and less than 2,000 in Turkey.

But there is more, such as the use of the same botulinum toxin to remove facial wrinkles, hair implants and rhinoplasty (nose jobs), among others.

The intragastric injection of this toxin blocks a neurotransmitter that causes "a powerful and long-lasting inhibitory effect on the contraction of the smooth and striated muscles" of the digestive system, according to a scientific article published by researchers from the University of Malaga.

This would cause "the delay of gastric emptying and the induction of early satiety, with the consequent decrease in intake and weight loss."

Authorities advise anyone who has traveled to Turkey to undergo cosmetic surgery involving the use of botulinum toxin and who suffer from symptoms consistent with botulism, such as muscle weakness or difficulty swallowing or breathing, "seek medical assistance." urgently".

A simple search on the Internet reveals that there are dozens of clinics in that country and companies specialized in this health tourism.

But, in addition, many people organize the trips on their own, like the majority of those now affected, which increases the uncertainty about the number of possible affected.

The first investigations place the center of the

outbreak in a clinic in Istanbul, where all those affected underwent the intervention between February 22 and 25.

The first alerts went off in Germany about a week ago.

"As of March 10, the country has reported 12 cases of botulism, apparently iatrogenic, due to intragastric injections of botulinum toxin," says the ECDD bulletin.

Iatrogenic botulism, which is usually due to an excess in the doses administered, is one of the most serious side effects that can occur in this type of intervention.

It manifests with increasing muscle weakness and paralysis that compromises vital functions such as breathing.

The 12 cases detected in Germany correspond to "middle-aged adults from various regions of the country."

Interviews with those affected reveal that the trip was organized by the patients themselves, who "contacted the clinic through a WhatsApp group."

Of the eight cases for which more information is available, all were operated on in the same clinic.

Austria has notified the case of a woman between the ages of 25 and 44, who traveled to Istanbul on her own and underwent surgery on February 22 at the same health center.

She was hospitalized already back in her country with "ptosis [drooping of the eyelid over the eye], difficulty swallowing and breathing, neck weakness and generalized muscle weakness," according to the ECDC.

Switzerland has notified another suspected case through France, that of a woman between 45 and 64 years of age, who also received an intragastric injection of botulism on the same date and clinic.

fraudulent batches

According to the ECDC report, the WHO launched an alert in August last year after detecting fraudulent batches of botulinum toxin sold irregularly in Jordan and Turkey (May), Kuwait and the United Kingdom (June) and Poland during the previous months.

"It is unknown, however, if any of these batches is related to the outbreak," say the European authorities.

The ECDC recalls that this is not the first time that similar episodes have occurred: "Outbreaks of iatrogenic botulism, sometimes related to smuggled or unlicensed botulinum toxin, have been detected in the past after its use in different types of interventions in countries such as Egypt and Turkey.

The European authorities warn that "the symptoms of botulism can be very serious and require admission to intensive care units", after which recovery usually lasts for "weeks or months".

Although there is very little published literature on mortality from iatrogenic botulism, the ECDC recalls that in other forms of botulism this amounts to "between 5% and 10% of cases".