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Suspected Botulism following Unregulated Cosmetic Injections:

New South Wales,

Alert Status:
Active
Issued Date:
24 Jan 2025

Please distribute to all staff in your facility
Background
• Botulism is a rare but serious illness caused by toxins produced by Clostridium botulinum. It can
result in flaccid paralysis and requires prompt recognition and management.
• Iatrogenic botulism occurs when botulinum toxin is administered incorrectly, such as through
unregulated cosmetic injections.
• Symptoms can appear within a few days to up to two weeks after the cosmetic injection.
• Botulism is initially a clinical diagnosis and is often the only diagnostic approach, as laboratory
confirmation can be challenging, not always feasible, and time-consuming.
• Presenting symptoms of botulism may include:
o Blurred or double vision (diplopia)
o Drooping eyelids (ptosis)
o Difficulty swallowing (dysphagia)
o Progressive weakness
o Respiratory distress
• Early treatment with botulism antitoxin (BAT) and supportive care, including ventilatory support
if necessary, can be critical for patient outcomes.
Assessment
• There have been at least three reports of suspected botulism symptoms following unregulated
cosmetic injections in Australia over the past 12 months.
• Symptoms have ranged from mild to moderate weakness to severe respiratory distress.
• A recent case in NSW required ventilatory support in ICU and administration of BAT.
• Further cases may emerge due to unregulated cosmetic procedures.
Recommendations
• Consider botulism in patients presenting with progressive weakness or paralysis, particularly if
cranial nerve involvement is suspected.
• Assess whether the patient has received recent cosmetic injections, especially in unregulated
settings.