title: Outbreak of extrapulmonary tuberculosis infection associated with acupuncture point injection.
abstract: Mycobacterium tuberculosis infection is rarely reported to be associated with acupuncture practices. We performed a retrospective outbreak investigation of a unique outbreak of 33 extrapulmonary M. tuberculosis infections related to acupuncture point injection therapy (AIT) among clients who visited a private traditional Chinese medicine clinical centre in China. The lumps, abscesses and ulcers occurred mostly on the neck, shoulders, waist, knees and hips, localized at acupuncture point meridian sites. These symptoms appeared from January to November 2011, with a peak cluster of infections in September 2011 (nine cases). M. tuberculosis Beijing strain was isolated and confirmed by DNA sequencing. All diagnosed patients were treated empirically with appropriate antibiotic treatment, and their condition improved. Our study indicated that this outbreak was most likely resulted from contaminated AIT. Drafting standard guidelines for AIT is urgently needed, and routine medical supervision should be provided, including obligating health providers to perform routine physical examinations that include testing for infectious diseases.
authors: National Institute of Drug Dependence, Peking University, Beijing 100191, PR China; Takemi Program in International Health, Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
authors: Z
authors: Z
authors: Jia
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310006, PR China.
authors: S
authors: S
authors: Chen
authors: School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, PR China; Takemi Program in International Health, Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
authors: C
authors: C
authors: Hao
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors: Y
authors: Y
authors: Huang
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310006, PR China.
authors: Z
authors: Z
authors: Liu
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310006, PR China.
authors: A
authors: A
authors: Pan
authors: Office of Scientific Research, Peking University, Beijing 100871, PR China. Electronic address: liaorikun@pku.edu.cn.
authors: R
authors: R
authors: Liao
authors: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310006, PR China. Electronic address: xmwang@cdc.zj.cn.
authors: X
authors: X
authors: Wang
authors: Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, PR China. Electronic address: zhlu@pku.edu.cn.
authors: Z
authors: Z
authors: Lu
mesh_terms: D015669:Acupuncture Points; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D012867:Skin / Q000382:microbiology / Q000473:pathology*; D014382:Tuberculosis, Cutaneous / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology
chemical_list: D000995:Antitubercular Agents
keywords: Acupoint injection; China; extrapulmonary Mycobacterium tuberculosis infection; outbreak; routine medical supervision