title: Mycobacterium abscessus bacteremia after receipt of intravenous infusate of cytokine-induced killer cell therapy for body beautification and health boosting.
abstract: BACKGROUND
  We report the first series of Mycobacterium abscessus bacteremia after cytokine-induced killer cell therapy for body beautification and health boosting.
  
  
  METHODS
  The clinical manifestations, laboratory and radiological investigations, cytokine/chemokine profiles, and outcomes were described and analyzed.
  
  
  RESULTS
  Four patients were admitted, and 3 patients had septic shock. Chest radiographs showed pulmonary infiltrates in all patients. Three patients developed peripheral gangrene, and 1 patient required lower limb and finger amputations. Patient 1 also developed disseminated infection including meningitis and urinary tract infection. Postmortem examination of patient 1 showed focal areas of pulmonary hemorrhage and diffuse alveolar damage, splenic infarct, adrenal necrosis, and hemorrhage, and acid-fast bacilli (AFB) were seen in the lung, liver, kidney, and adrenal gland. Patient 2 developed inguinal granulomatous lymphadenitis about 40 days after onset of lower limb gangrene. Wedge-shaped pulmonary infarcts were found in patient 3, and retinitis and subcutaneous lesions developed in patient 4. Patients in septic shock had dysregulated cytokine/chemokine profiles. Patient 4 with relatively milder presentation had increasing levels of interleukin 17 and cytokines in the interferon-γ/interleukin 12 pathway. All survivors required prolonged intravenous antibiotics. Blood cultures grew M. abscessus for all patients, and admission peripheral blood smear revealed AFB for 3 patients. Mycobacterium abscessus was also isolated from respiratory specimens (2 patients), urine (1 patient), and cerebrospinal fluid (1 patient). Time to initial blood culture positivity (patients 1, 2, and 3: ≤52 hours; patient 4: 83 hours) appeared to correlate with disease severity.
  
  
  CONCLUSIONS
  Empirical coverage for rapidly growing mycobacteria should be considered in patients with sepsis following cosmetic procedures.
authors.affiliation: Department of Medicine, Ruttonjee Hospital.
authors.forename: Raymond
authors.initials: R
authors.lastname: Liu
authors.forename: Kelvin K W
authors.initials: KK
authors.lastname: To
authors.forename: Jade L L
authors.initials: JL
authors.lastname: Teng
authors.forename: Garnet K Y
authors.initials: GK
authors.lastname: Choi
authors.forename: Ka-Yi
authors.initials: KY
authors.lastname: Mok
authors.forename: Kin-Ip
authors.initials: KI
authors.lastname: Law
authors.forename: Eugene Y K
authors.initials: EY
authors.lastname: Tso
authors.forename: Kitty S C
authors.initials: KS
authors.lastname: Fung
authors.forename: Tak-Chiu
authors.initials: TC
authors.lastname: Wu
authors.forename: Alan K L
authors.initials: AK
authors.lastname: Wu
authors.forename: Shing-Hoi
authors.initials: SH
authors.lastname: Fung
authors.forename: Sally C Y
authors.initials: SC
authors.lastname: Wong
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Trendell-Smith
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000276:immunology* / Q000382:microbiology; D003357:Cosmetic Techniques / Q000009:adverse effects*; D055612:Cytokine-Induced Killer Cells / Q000276:immunology*; D017809:Fatal Outcome; D005260:Female; D005734:Gangrene / Q000276:immunology / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D016219:Immunotherapy, Adoptive / Q000009:adverse effects*; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000276:immunology* / Q000382:microbiology; D009170:Nontuberculous Mycobacteria / Q000276:immunology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Mycobacterium abscessus; bacteremia; beauty; cytokine-induced killer cell therapy; sepsis