title: An outbreak of cutaneous infection due to Mycobacterium abscessus associated to mesotherapy.
abstract: BACKGROUND
  In February 2009 an outbreak of subcutaneous abscesses due to Mycobacterium abscessus was detected in Spain which affected healthy women who had undergone mesotherapy procedures in an aesthetic clinic.
  
  
  METHODS
  Epidemiological research, health inspection and microbiological studies were conducted. The patients were given antibiotic treatment (according to susceptibility testing) with clarithromycin, and in some cases, combined with amikacin.
  
  
  RESULTS
  Seventeen out of 77 patients treated in the clinic were affected. The products used for the injections were homeopathic drugs in multi-dose vials. The environmental samples were negative. The sterile injection equipment and the clinical procedures were evaluated as correct. The storage conditions for the drugs were also correct, and all the samples tested negative for Mycobacteria. However Paenibacillus provencensis was isolated from samples of unused multi-dose vials and the withdrawal of the product from distribution was ordered. Deficiencies were detected in the sterile products process of at the homeopathic drug factory, so the production line was suspended.
  
  
  CONCLUSIONS
  The results of environmental investigation suggest the most likely cause of the outbreak could have been the contamination of the products in the factory, although there was no laboratory confirmation. The widespread use of homeopathic products in invasive procedures requires extreme control during the manufacturing, handling and packaging process. It is important to consider mesotherapy and parenteral use of homeopathic medicines as potential sources of infection and therefore the same precautions in the procedures and quality assurance of products should be applied as with any other drug or medical activity.
authors.affiliation: DG de Salut Pública i Participació, Illes Balears, Palma, Spain. agalmes@dgsanita.caib.es
authors.forename: Antònia
authors.initials: A
authors.lastname: Galmés-Truyols
authors.forename: Jaume
authors.initials: J
authors.lastname: Giménez-Duran
authors.forename: Catalina
authors.initials: C
authors.lastname: Bosch-Isabel
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolau-Riutort
authors.forename: Joana
authors.initials: J
authors.lastname: Vanrell-Berga
authors.forename: Margarita
authors.initials: M
authors.lastname: Portell-Arbona
authors.forename: Bartolomé
authors.initials: B
authors.lastname: Seguí-Prat
authors.forename: Mercedes
authors.initials: M
authors.lastname: Gumá-Torá
authors.forename: Isabel
authors.initials: I
authors.lastname: Martí-Alomar
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Rojo-Arias
authors.forename: Mikel
authors.initials: M
authors.lastname: Ruiz-Veramendi
mesh_terms: D000038:Abscess / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D000328:Adult; D000368:Aged; D000583:Amikacin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D004196:Disease Outbreaks; D004340:Drug Contamination / Q000517:prevention & control; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects; D008419:Materia Medica / Q000008:administration & dosage / Q000009:adverse effects*; D057748:Mesotherapy / Q000009:adverse effects*; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D016926:Mycobacterium chelonae / Q000187:drug effects / Q000302:isolation & purification*; D056507:Paenibacillus / Q000302:isolation & purification; D012867:Skin / Q000293:injuries; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D013030:Spain / Q000453:epidemiology; D013242:Sterilization / Q000379:methods / Q000592:standards; D013678:Technology, Pharmaceutical / Q000592:standards; D014946:Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D008419:Materia Medica; D000583:Amikacin; D017291:Clarithromycin