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Published Date: 2019-11-17 19:44:47
Subject: PRO/EDR> Botulism, cosmetic use - Taiwan
Archive Number: 20191117.6783339
BOTULISM, COSMETIC USE - TAIWAN
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Date: Sun 17 Nov 2019
Source: Taipei Times [edited]
http://www.taipeitimes.com/News/taiwan/archives/2019/11/17/2003726003


Yang Chen-chang, director of clinical toxicology and occupational medicine at Taipei Veterans General Hospital, spoke at a forum in Taipei yesterday, 16 Nov 2019, about intoxication caused by Botox injections. The nation's 1st case of poisoning caused by a botulinum toxin injection was reported by toxicologist Yang Chen-chang at a conference at Taipei Veterans General Hospital (TVGH).

Yang, TVGH clinical toxicology and occupational medicine department director, disclosed the case during a lecture on botulism related to cosmetic procedures at this year's [2019] International Conference for Poison Control and Research Development. The case involved 2 sisters in their 50s who received botulinum toxin injections in June 2019 at an unlicensed workshop that used botulinum products from an unknown source, resulting in botulism symptoms 5 days later.

The older sister developed unclear speech, a hoarse voice and difficulty swallowing after getting multiple injections in the face. However, she was not diagnosed with botulism when she sought treatment at a clinic, so her condition worsened, and she began experiencing weakness in her limbs and required feeding through a nasogastric tube. The younger sister only received injections near the eyes, and suffered a sore throat, drooping eyelids and an inability to look upwards.

Yang said the sisters told him that a stranger approached them on the street and claimed he could take them to see a Korean doctor who could provide Botox injections at a discounted price. The women sought treatment at TVGH in July 2019, 3 weeks after the injections. Botulism was suspected, so the hospital reported the case to the Centers for Disease Control (CDC), he said. Yang said doctors suspected the sisters had been injected with excessive doses of botulinum toxin, or that there were problems with the quality of the substance used.

Usually patients suspected of food-borne botulism are immediately given an antitoxin, within 24 hours for the best results, and no later than 7 days. The younger sister's symptoms gradually resolved, and she recovered in September 2019. However, the elder sister still needed to be fed through a tube, although she improved enough to be able to swallow, he said, adding that serious botulism can result in flaccid paralysis or respiratory failure.

CDC Deputy Director-General Philip Lo said the local health department could not locate the person who provided the injections, as the sisters got in a taxi with the man and did not remember where they were taken. He said that the 1st case of suspected botulism from a botulinum toxin injection was reported by a woman in her 40s late in 2018, but the patient received the injection at a clinic in China. The sisters were the 1st cases of botulism caused by injections received in Taiwan.

The CDC said Hong Kong received its 1st report of suspected poisoning from a botulinum toxin injection in May 2016, and as of November 2018, a total of 17 cases had been reported. 11 of those cases involved people who had received the injections in China.

Lo urged people to carefully choose licensed aesthetic medical clinics for botulinum toxin and other treatments, and to make sure the procedures are implemented by licensed medical practitioners who use products with a legal drug license number.

[Byline: Lee I-chia]

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Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Clinical botulism has occurred following approved use of licensed types of botulinum toxin and also after injection of toxin not approved for human injection, as can be seen in the See Also citations below.

ProMED awaits more information about the source of the injected product and how it was used by the administrator. - Mod.LL

HealthMap/ProMED map available at:
Taiwan: http://healthmap.org/promed/p/193]

See Also

2018
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Botulism, cosmetic use - China: (Hong Kong) 20181102.6124403
2017
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Botulism, cosmetic use - China: (Hong Kong) 20170801.5219480
2016
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Botulism, cosmetic use - China (09): (Hong Kong) 20161216.4702473
Botulism, cosmetic use - China (08): (HK ex GD) 20160822.4428848
Botulism, cosmetic use - China (07): (HK ex GD) 20160807.4400520
Botulism, cosmetic use - China (06): (HK ex GD) 20160720.4357184
Botulism, cosmetic use - China (05): (HK ex GD) 20160630.4319061
Botulism, cosmetic use - China (04): (HK ex GD) 20160622.4302949
Botulism, cosmetic use - China (03): (HK ex GD) 20160615.4288686
Botulism, cosmetic use - China (02): (HK ex GD) 20160608.4273066
Botulism, cosmetic use - China: (HK ex GD) RFI 20160605.4266429
2008
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Botulism, cosmetic & therapeutic treatments - USA: alert 20080127.0339
2005
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Botulism risk, cosmetic treatment - USA (FL): alert 20050110.0082
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