Dear Health Alert Network (HAN) Subscriber:
2013 ALERT # 38
Outbreak on East Coast of Rapidly-growing Mycobacterium Infections following Cosmetic Surgery Performed in the Dominican Republic
One Case Reported in New York City
- An outbreak of Mycobacterium abscessus and chelonae infections associated with cosmetic surgery performed in the Dominican Republic has been identified, including one case in New York City and seven in other states.
- Please report to the Health Department any suspect cases of nontuberculous Mycobacterium skin and soft tissue infections in patients who report recent cosmetic procedures in the Dominican Republic.
Please Share this Alert with All Primary Care, Family Medicine, Emergency Medicine, Internal Medicine, Infectious Disease, General and Plastic Surgery, Dermatology, Laboratory Medicine (including Mycobacteriology Laboratory staff) and Infection Control Staff in Your Facility
December 5, 2013
The New York City Department of Health and Mental Hygiene (DOHMH) has been notified of a cluster of nontuberculous Mycobacterium (NTM) infections following cosmetic surgery procedures performed in the Dominican Republic. The initial cases were reported by the Maryland Department of Health and Mental Hygiene. Additional cases have been identified in Connecticut, Massachusetts, and New York City.
All patients are women with ages ranging from 28 to 57 years. All report having undergone elective cosmetic surgery procedures, including liposuction, abdominoplasty, and breast lifts or reduction, in the Dominican Republic in July or August 2013. Symptoms have included abdominal abscesses, pain, wound discharge, and fever. No deaths have occurred. Five wound cultures have been positive for Mycobacterium abscessus or chelonae. Treatment has included hospitalization, surgical debridement, and intravenous antibiotics. Available isolates are being sent to the Centers for Disease Control and Prevention for molecular typing.
Outbreaks of NTM infections associated with cosmetic surgery in the Dominican Republic have occurred in the past:
1). Centers for Disease Control and Prevention (CDC). (2004, June 18). Brief report: nontuberculous mycobacterial infections after cosmetic surgery — Santo Domingo, Dominican Republic, 2003–2004. Morbidity and Mortality Weekly Reports. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5323a4.htm.
2) Furuya EY, et al. Outbreak of Mycobacterium abscessus wound infections among “lipotourists” from the United States who underwent abdominoplasty in the Dominican Republic. Clin Infect Dis 46:1181-8 (2008).
A proven link to a single clinic in the Dominican Republic has not yet been established. To assist the investigation, we request that providers review their clinical and laboratory records and report any cases of either:
1) Cellulitis, soft tissue infection, or cutaneous abscess in which NTM (including M. abscessus, M. chelonae, and M. fortuitum) has been identified since July 1, 2013. Physicians should inquire about previous surgical procedures in these patients;
2) Cellulitis, soft tissue infection, or cutaneous abscess post cosmetic injection which have not responded to standard antibiotic treatment regardless of the culture results since July 1, 2013. In such patients, we recommend that specimens have mycobacterial culture performed.
Please report all cases meeting the above criteria to the Health Department at 1-866-692-3641.
As always, we appreciate your assistance in helping us identify and respond to communicable disease concerns in New York City.
Marcelle Layton, MD
Bureau of Communicable Disease