title: Outbreak of Mycobacterium abscessus wound infections among "lipotourists" from the United States who underwent abdominoplasty in the Dominican Republic.
abstract: BACKGROUND
  Some US residents travel abroad to undergo cosmetic surgery for fat removal, a practice referred to as "lipotourism." Mycobacterium abscessus can cause postsurgical wound infection.
  
  
  METHODS
  US residents who developed M. abscessus wound infection after undergoing cosmetic surgery in the Dominican Republic in 2003 and 2004 were identified using the Emerging Infections Network listserv.
  
  
  RESULTS
  Twenty returning US travelers with M. abscessus infection were detected. Eight patients had matching isolates, as determined by pulsed-field gel electrophoresis and repetitive element polymerase chain reaction. All 8 patients, who had previously been healthy Hispanic women, underwent abdominoplasties at the same clinic in the Dominican Republic. Symptoms first developed 2-18 weeks after the procedure (median interval, 7 weeks). Only 2 of the 8 patients received a correct diagnosis at the initial presentation. Most patients presented with painful, erythematous, draining subcutaneous abdominal nodules. Seven patients underwent drainage procedures. Six patients received a combination of antibiotics that included a macrolide plus cefoxitin, imipenem, amikacin, and/or linezolid; 2 received clarithromycin monotherapy. All patients but 1 were cured after a median of 9 months of therapy (range, 2-12 months). Because of a lack of access to the surgical clinic, the cause of the outbreak of infection was not identified. The patients who were infected with nonmatching isolates underwent surgeries in different facilities but otherwise had demographic characteristics and clinical presentations similar to those of the 8 patients infected with matching isolates.
  
  
  CONCLUSIONS
  This case series of M. abscessus infection in US "lipotourists" highlights the risks of traveling abroad for surgery and the potential role of the Internet in identifying and investigating outbreaks.
authors.affiliation: Department of Medicine, New York-Presbyterian Hospital-Columbia University Medical Center, New York, New York, USA.
authors.forename: E Yoko
authors.initials: EY
authors.lastname: Furuya
authors.forename: Armando
authors.initials: A
authors.lastname: Paez
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Robert
authors.initials: R
authors.lastname: Cooksey
authors.forename: Michael
authors.initials: M
authors.lastname: Augenbraun
authors.forename: Miriam
authors.initials: M
authors.lastname: Baron
authors.forename: Karen
authors.initials: K
authors.lastname: Brudney
authors.forename: Phyllis
authors.initials: P
authors.lastname: Della-Latta
authors.forename: Concepcion
authors.initials: C
authors.lastname: Estivariz
authors.forename: Staci
authors.initials: S
authors.lastname: Fischer
authors.forename: Mary
authors.initials: M
authors.lastname: Flood
authors.forename: Pamela
authors.initials: P
authors.lastname: Kellner
authors.forename: Carmen
authors.initials: C
authors.lastname: Roman
authors.forename: Mitchell
authors.initials: M
authors.lastname: Yakrus
authors.forename: Don
authors.initials: D
authors.lastname: Weiss
authors.forename: Eric V
authors.initials: EV
authors.lastname: Granowitz
mesh_terms: D050153:Abdominal Fat / Q000601:surgery*; D000328:Adult; D004196:Disease Outbreaks; D004293:Dominican Republic / Q000453:epidemiology; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D015187:Lipectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D009161:Mycobacterium / Q000235:genetics / Q000302:isolation & purification; D009164:Mycobacterium Infections / Q000208:ethnology / Q000209:etiology*; D016133:Polymerase Chain Reaction / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D014195:Travel; D014481:United States / Q000208:ethnology