title: Outbreak of primary inoculation tuberculosis in an acupuncture clinic in southeastern China.
abstract: Outbreak of Mycobacterium tuberculosis infections associated with acupuncture has not been reported. Thirteen patients with a painful swollen lump were referred to our hospital. The index patient received acupuncture and paraspinal muscular injection at a local acupuncture clinic in April 2011 and was diagnosed with M. tuberculosis 1 month later. From May 2011 to August 2011, 12 more patients with a swollen lump on the nuchal region or in the lower back or the buttocks region were referred to our hospital. Tuberculin skin test (TST), T-SPOT.TB, acid-fast stain, M. tuberculosis culture, chest radiograph, and lump magnetic resonance imaging (MRI) were performed and the patients were diagnosed with tuberculous abscess of the lump. All 13 patients received intramuscular injection at the paraspinal muscle by two acupuncturists at a local clinic and reported a swollen lump at the injection site. The needles and syringes were reused after autoclave sterilization. The TST was positive in all patients. Twelve patients had positive acid-fast stains. Mycobacterial cultures of abscess specimens were positive in all 13 patients. T-SPOT.TB tests were positive in all patients who underwent the test. The lesions and biopsies were subjected to polymerase chain reaction (PCR) and gene sequencing by the Disease Control Center of Zhejiang Province, China and the causative agent was identified as M. tuberculosis, Beijing type. In conclusion, physicians should consider the possibility of mycobacterial infections, apart from other bacterial agents, in patients with a swollen paraspinal lump following intramuscular injection.
authors.affiliation: Department of Spine Surgery,First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,China.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery,First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,China.
authors.forename: M Y
authors.initials: MY
authors.lastname: Zhu
authors.affiliation: Department of Spine Surgery,First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,China.
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Spine Surgery,First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,China.
authors.forename: H B
authors.initials: HB
authors.lastname: Zhang
authors.affiliation: Department of Spine Surgery,First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,China.
authors.forename: G B
authors.initials: GB
authors.lastname: Zuo
authors.affiliation: Department of Radiology,First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,China.
authors.forename: M H
authors.initials: MH
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery,First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,China.
authors.forename: H L
authors.initials: HL
authors.lastname: Teng
mesh_terms: D000038:Abscess / Q000453:epidemiology* / Q000382:microbiology; D015670:Acupuncture Therapy / Q000009:adverse effects* / Q000295:instrumentation; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009339:Needles; D064170:Paraspinal Muscles; D014376:Tuberculosis / Q000453:epidemiology* / Q000635:transmission
keywords: paraspinal abscess