Relatively alcohol-resistant mycobacteria are emerging pathogens in patients receiving acupuncture treatment

Abstract

Acupuncture has been gaining popularity as a form of alternative medicine. In the past, only blood-borne viruses and anecdotal reports of bacterial infections have been associated with acupuncture. We report on four patients with mycobacterial infections complicating acupuncture who were encountered in a 2-year period. All had clinical and/or radiological lesions at acupuncture point- and meridian-specific locations. There was no other history of trauma or other clinical foci of infections, and the chest radiographs were normal. Histological studies of biopsy specimens of all four patients showed changes compatible with chronic inflammation, with granulomatous inflammation present in three patients and acid-fast bacilli present in two. Conventional biochemical tests and whole-cell fatty acid analysis for identification were inconclusive for all four nonpigmented mycobacteria recovered from tissue biopsies. 16S rRNA gene sequencing showed that the strains from two patients were Mycobacterium chelonae and that those from the other two were Mycobacterium nonchromogenicum. Alcohol resistance assay using the quantitative suspension test revealed that all four strains showed prolonged survival in 75% alcohol compared to other skin flora. Mycobacterial infections transmitted by acupuncture are an emerging problem. A high index of suspicion is essential to recognize this clinical syndrome, and strict implementation of proper infection control guidelines for acupuncture is mandatory.

FIG. 1.

Phylogenetic tree showing the relationship of the four isolates to related species. The tree was inferred from 16S rRNA sequence data by the neighbor-joining method. The scale bar indicates the estimated number of substitutions per 100 bases, using the Jukes-Cantor correction. Names and accession numbers are given as cited in the GenBank database.

FIG. 2.

Survival curves of the four clinical strains of Mycobacterium species, M. smegmatis, S. epidermidis, and C. jeikeium after incubation with 75% alcohol. Error bars indicate standard errors of the means.