A New Transmission Route of Botulism Documented: Armen Muradyan

The Rector of Yerevan State Medical University, Armen Muradyan, writes on his Facebook page: "Botulism is a severe foodborne toxin produced by consuming food containing the toxin released by Clostridium botulinum. The disease affects both the central and vegetative nervous systems. Clostridium botulinum is a gram-positive, spore-forming, anaerobic bacterium. Currently, there are seven types of Cl. botulinum: A, B, C, D, E, F, and G, each with different effects of their toxins on humans.

The pathogen exists in the external environment, mainly in the soil as spores, from where it can transfer to vegetables and other foods. The growth and development of this pathogen require anaerobic conditions, allowing spores to convert into vegetative forms, multiply, and produce the toxin—botulinum toxin.

Botulinum toxin is the strongest toxin found in nature, with a lethal dose for humans estimated at 5–50 ng per kg body weight. In the case of botulism, transmission mainly occurs through preserved foods (fish, meat, vegetables), where favorable circumstances exist for pathogens and their toxin accumulation. Foodborne botulism is a serious, potentially fatal illness that is relatively rare. It usually develops due to the intake of botulinum toxins present in foods, particularly in home-canned goods, with symptoms typically appearing 12 to 36 hours after exposure. The disease can be fatal in 5-10% of cases.

Among the preventive measures against foodborne botulism, one of the most important is to heat the contents of home canning for 15-20 minutes before consumption and to avoid home-prepared canned foods as much as possible. Infant botulism mainly occurs in infants under six months old when they ingest Cl. botulinum spores, which then colonize the intestines, convert into vegetative forms, and produce toxins. This toxin is then absorbed systemically. Often, infant botulism is associated with honey consumption. Pulmonary botulism is transmitted by inhaling aerosolized botulinum toxin, which is then systemically absorbed.

All types of toxin have been weaponized and can cause disease among primates. Wound botulism occurs when a common wound is infected with Clostridium botulinum. Cases of this have also been reported among intravenous drug users, particularly with subcutaneous and intramuscular heroin injections. According to the analytical report of the "Heraci" group, it is crucial to note that a patient with botulism poses no risk to a healthy individual.

Recently, a new transmission method of botulism has been documented. Side effects from pure toxins have arisen in patients due to their medical or cosmetic use. The first medical use of botulinum toxin (Botox) was performed by American ophthalmologist Alan Scott, who treated patients suffering from blepharospasm with the organic toxin. Following Scott's example, many other doctors have adopted similar practices. In addition to its positive medical effects, the cosmetic effects of botulinum toxin have been discovered, as wrinkles and folds smoothen during injections.

According to data, from 1989 to 2003, Botox injections were associated with 28 deaths. Given the millions of injections during a 15-year period, this figure is relatively insignificant (less than 0.01%). Moreover, in many cases, it was injected for medical purposes. For cosmetic purposes, botulinum toxin is used in much smaller doses, which are hundreds of times less than a lethal dose. For medical reasons, it is used for various neurological diseases such as chronic migraines, muscle spasms, and overactive bladder. It is also used to treat Frey’s syndrome, with the primary treatment method being intradermal injections of botulinum toxin.

According to a recent article published by the European Centre for Disease Prevention and Control, between the end of February 2023 and March 30, 2023, there were 87 cases of botulism associated with intragastric injections of botulinum neurotoxin, reported in Germany (30), Austria (1), France (1), Switzerland (2), and Turkey (53). The information indicates that all cases involved medical procedures aimed at patient weight loss, conducted between February 3 and March 1, 2023, in Turkey. Patients received intragastric botulinum neurotoxin injections to combat obesity in two private hospitals located in Istanbul and Izmir. Germany reported that the doses given to German patients ranged from 1000 to 2500 units of botulinum neurotoxin.

Symptoms varied from mild to severe, with some patients requiring hospitalization. A few of those hospitalized received treatment in intensive care units with botulinum antitoxin. In all recorded cases, the vials used were missing the production date. This type of botulism is referred to as iatrogenic botulism, which can occur as a side effect of using botulinum neurotoxin for therapeutic or cosmetic purposes. Although it is rarely reported, people receiving botulinum neurotoxin injections for cosmetic or treatment purposes may develop botulism if they are given an excessively large dose.

Post-cosmetic treatment toxic manifestations can include blurred vision, drooping eyelids, difficulty swallowing, dry mouth, diplopia, and blurry vision. In such cases, immediate medical care is necessary. Avoid non-professional and non-sterile injections and interventions. Stay informed!"