Massachusetts health officials are warning the public about a growing cluster of botulism cases in people who’ve gotten Botox injections at a spa in Milton.

In an updated advisory shared Saturday, the Massachusetts Department of Public Health said ten suspected cases are now under investigation, all associated with procedures performed at Rodrigo Beauty, located at 464 Granite Ave. in Milton, Mass.

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Massachusetts health care providers should be on the look out for botulism in people who’ve gotten Botox injections, health officials said Thursday.

In its advisory, the Massachusetts Department of Public Health didn’t share specific details on the ten cases that are being investigated, including whether anyone had died. Botulism is a rare but serious illness that can be deadly.

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The notice urged patients and healthcare providers to be alert for symptoms such as double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, and difficulty breathing following Botox injections. These symptoms may be followed by a descending, symmetric muscle weakness that progresses over hours to days.

Anyone who received Botox injections at Rodrigo Beauty between May 1 and June 4 this year is strongly urged to contact the Massachusetts Department of Public Health at 617-983-6800 or their local board of health immediately, even if they are not currently experiencing symptoms.

Anyone who had Botox injections at this location and is experiencing symptoms should go to the nearest emergency department. Early recognition and treatment can significantly improve outcomes, health officials say.

Botulism is a rare but severe illness that attacks the nerves in the body.

Health officials previously said four cases were under investigation on the South Shore and were all tied to cosmetic Botox injections — the procedure involves injecting the toxin, created by bacteria, into the skin to smooth out wrinkles. (It can also be used to treat medical conditions, like migraines.)

Injecting too much of the botulinum toxin can cause what’s known as iatrogenic botulism, the Centers for Disease Control and Prevention say. It’s one of five ways to get the illness, which can cause paralysis or death.

The Massachusetts Department of Public Health noted in its advisory Thursday that Botox is usually safe, when given by trained professionals, but there are conditions that increase the risk, including dosing variance, products that aren’t approved by the FDA and improper technique.

It wasn’t immediately clear if the cases under investigation involved licensed Botox injections, but state health officials said Saturday that they continue to emphasize the importance of seeking cosmetic procedures only from licensed professionals in accredited medical settings.