An outbreak of post-acupuncture cutaneous infection due to Mycobacterium abscessus

Abstract

Background: Despite the increasing popularity of acupuncture, the importance of infection control is not adequately emphasized in Oriental medicine. In December 2001, an Oriental medical doctor in Seoul, South Korea, encountered several patients with persistent, culture-negative skin lesions on the trunk and extremities at the sites of prior acupuncture treatment. We identified and investigated an outbreak of Mycobacterium abscessus cutaneous infection among the patients who attended this Oriental medicine clinic.

Methods: Patients were defined as clinic patients with persistent cutaneous infections at the acupuncture sites. Medical records for the previous 7 months were reviewed. Clinical specimens were obtained from the patients and an environmental investigation was performed. M. abscessus isolates, cultured from patients, were compared by pulsed-field gel electrophoresis (PFGE).

Results: Forty patients who attended the Oriental medicine clinic and experienced persistent cutaneous wound infections were identified. Cultures from five of these patients proved positive, and all other diagnoses were based on clinical and histopathologic examinations. All environmental objects tested were negative for M. abscessus, however, most were contaminated by various nosocomial pathogens. Molecular analysis using PFGE found all wound isolates to be identical.

Conclusion: We have identified a large outbreak of rapidly growing mycobacterial infection among patients who received acupuncture at a single Oriental medicine clinic. Physicians should suspect mycobacterial infections in patients with persistent cutaneous infections following acupuncture, and infection control education including hygienic practice, should be emphasized for Oriental medical doctors practicing acupuncture.

Figure 1

Cases of post-acupuncture Mycobacterium abscessus cutaneous infection in an Oriental medicine clinic during an outbreak between September and November 2001. The patients started to receive acupuncture in early August, and the index case was identified in early September. Most cases were concentrated between September and October. After sterilization and a regular towel change in mid-November, no further cases occurred.

Figure 2

The back of a 58-year-old woman with typical disease presentation.

Figure 3

Pulsed-field gel electrophoresis of representative isolates from patients, digested with the restriction enzyme XbaI. Lanes 2 – 6 show M. abscessus isolates from five patients, lanes 1 and 7 are a 48.5-kb molecular-weight marker.