Rapid-Growing Mycobacteria Infections in Medical Tourists: Our Experience and Literature Review.
BACKGROUND
"Medical tourism" has gained popularity over the past few decades. This is particularly common with patients seeking elective cosmetic surgery in the developing world. However, the risk of severe and unusual infectious complications appears to be higher than for patients undergoing similar procedures in the United States.


OBJECTIVE
The authors describe their experience with atypical mycobacterial infections in cosmetic surgical patients returning to the United States postoperatively.


METHODS
A review of patient medical records presenting with infectious complications after cosmetic surgery between January 2010 and July 2015 was performed. Patients presenting with mycobacterial infections following cosmetic surgery were reviewed in detail. An extensive literature review was performed for rapid-growing mycobacteria (RGM) related to cosmetic procedures.


RESULTS
Between January 2010 and July 2015, three patients presented to our institution with culture-proven Mycobacterium abscessus at the sites of recent cosmetic surgery. All had surgery performed in the developing world. The mean age of these patients was 36 years (range, 29-44 years). There was a delay of up to 16 weeks between the initial presentation and correct diagnosis. All patients were treated with surgical drainage and combination antibiotics with complete resolution.


CONCLUSIONS
We present series of patients with mycobacterial infections after cosmetic surgery in the developing world. This may be related to the endemic nature of these bacteria and/or inadequate sterilization or sterile technique. Due to low domestic incidence of these infections, diagnosis may be difficult and/or delayed. Consulting physicians should have a low threshold to consider atypical etiologies in such scenarios.


METHODS
5 Therapeutic.
From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Mansher
M
Singh
From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Caitlin M
CM
Dugdale
From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Isaac H
IH
Solomon
From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Anne
A
Huang
From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Mary W
MW
Montgomery
From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Bohdan
B
Pomahac
From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Sigal
S
Yawetz
From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
James H
JH
Maguire
From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Simon G
SG
Talbot
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003906:Developing Countries; D004322:Drainage; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D057193:Medical Tourism; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000628:therapy*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy*; D013518:Surgery, Plastic / Q000009:adverse effects*
D000900:Anti-Bacterial Agents