title: Abscesses due to mycobacterium abscessus linked to injection of unapproved alternative medication.
abstract: An unlicensed injectable medicine sold as adrenal cortex extract (ACE*) and distributed in the alternative medicine community led to the largest outbreak of Mycobacterium abscessus infections reported in the United States. Records from the implicated distributor from January 1, 1995, to August 18, 1996, were used to identify purchasers; purchasers and public health alerts were used to identify patients. Purchasers and patients were interviewed, and available medical records were reviewed. Vials of ACE* were tested for mycobacterial contamination, and the product was recalled by the U.S. Food and Drug Administration. ACE* had been distributed to 148 purchasers in 30 states; 87 persons with postinjection abscesses attributable to the product were identified. Patient and vial cultures contained M. abscessus identical by enzymatic and molecular typing methods. Unusual infectious agents and alternative health practices should be considered in the diagnosis of infections that do not respond to routine treatment.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. kcg7@cdc.gov
authors.forename: K
authors.initials: K
authors.lastname: Galil
authors.forename: L A
authors.initials: LA
authors.lastname: Miller
authors.forename: M A
authors.initials: MA
authors.lastname: Yakrus
authors.forename: R J
authors.initials: RJ
authors.lastname: Wallace
authors.forename: D G
authors.initials: DG
authors.lastname: Mosley
authors.forename: B
authors.initials: B
authors.lastname: England
authors.forename: G
authors.initials: G
authors.lastname: Huitt
authors.forename: M M
authors.initials: MM
authors.lastname: McNeil
authors.forename: B A
authors.initials: BA
authors.lastname: Perkins
mesh_terms: D000038:Abscess / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D017291:Clarithromycin / Q000627:therapeutic use; D000529:Complementary Therapies; D004196:Disease Outbreaks; D004322:Drainage; D004340:Drug Contamination; D016521:Electrophoresis, Gel, Pulsed-Field; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D017291:Clarithromycin