title: 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.
authors.affiliation: Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: Patrick C Y
authors.initials: PC
authors.lastname: Woo
authors.forename: Kit-Wah
authors.initials: KW
authors.lastname: Leung
authors.forename: Samson S Y
authors.initials: SS
authors.lastname: Wong
authors.forename: Ken T K
authors.initials: KT
authors.lastname: Chong
authors.forename: Elim Y L
authors.initials: EY
authors.lastname: Cheung
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D019840:2-Propanol / Q000494:pharmacology*; D015670:Acupuncture Therapy / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D004275:DNA, Ribosomal / Q000032:analysis; D024881:Drug Resistance, Bacterial; D005227:Fatty Acids / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000187:drug effects; D009164:Mycobacterium Infections / Q000382:microbiology; D009165:Mycobacterium Infections, Nontuberculous / Q000382:microbiology; D016926:Mycobacterium chelonae / Q000187:drug effects*; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA
chemical_list: D004275:DNA, Ribosomal; D005227:Fatty Acids; D012336:RNA, Ribosomal, 16S; D019840:2-Propanol