title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea. infection@medimail.co.kr
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Song
authors.forename: Jang Wook
authors.initials: JW
authors.lastname: Sohn
authors.forename: Hye Won
authors.initials: HW
authors.lastname: Jeong
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Cheong
authors.forename: Woo Joo
authors.initials: WJ
authors.lastname: Kim
authors.forename: Min Ja
authors.initials: MJ
authors.lastname: Kim
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects* / Q000592:standards; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000145:classification; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000635:transmission*; D012867:Skin / Q000473:pathology; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents