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Iatrogenic outbreak of M. chelonae skin abscesses

  • D. Camargo (a1), C. Saad (a1), F. Ruiz (a2), M. E. Ramirez (a2), M. Lineros (a2), G. Rodriguez (a3), E. Navarro (a2), B. Pulido (a2) and L. C. Orozco (a1)...


We describe an outbreak of skin lesions due to Mycobacterium chelonae subsp. abscessus associated with injections of lidocaine (lignocaine) given by a ‘bioenergetic’ (a practitioner of alternative medicine) in Colombia. The lidocaine carpules and the lesions of the patients yielded mycobacteria with identical biochemical characteristics.

Using the methodology of Sartwell and a case control design we examined the incubation period and assessed risk factors. Of 667 potentially exposed individuals, a total of 298 patients were interviewed, of whom 232 had skin lesions. The median incubation period was 30·5 days (range 15–59 days). Male sex (OR 2·85, 95% CI 1·26–6·51), increasing age (OR 1·25, 95% CI 1·03–1·53), subcutaneous injection route (OR 3·72, 95% CI 1·09–12·7) and number of injections (OR 1·01, 95% CI 1·00–1·03) were risk factors for disease.

To our knowledge, this is the largest reported outbreak of M. chelonae infection, the first in which the organism has been isolated from the putative vehicle of infection, and the first in which the incubation period could be determined.

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1.Grange, JM.Infection and disease due to the environmental mycobacteria. Trans Roy Soc Trop Med Hyg 1987; 81: 179–82.
2.Hanson, PJV, Thomas, JM, Collins, JV.Mycobacterium chelonei and abscess formation in soft tissues. Tubercle 1987; 68: 297–9.
3.Collins, CH, Grange, JM, Yates, MD.Mycobacteria in water. J Appl Bacteriol 1984; 57: 193211.
4.Kusunoki, S, Ezaki, T.Proposal of Mycobacterium peregrinum sp. nov., nom. rev., and elevation of Mycobacterium chelonae subsp. abscessus (Kubica et al.) to species status: Mycobacterium abscessus comb. nov. Int J Syst Bacteriol 1992; 42: 240–5.
5.Wallace, RJ, Swenson, JM, Silcox, VA, Good, RC, Tschen, JA, Stone, MS.Spectrum of disease due to rapidly growing mycobacteria. Rev Infect Dis 1983; 5: 657–79.
6.Wallace, RJ, Brown, BA, Onyi, GO.Skin, soft tissue, and bone infections due to Mycobacterium chelonae chelonae: importance of prior corticosteroid therapy, frequency of disseminated infections, and resistance to oral antimicrobials other than clarithromycin. J Infect Dis 1992; 166: 405–12.
7.Khooshabeh, R, Grange, JM, Yates, MD, McCartney, ACE, Casey, TA.A case report of Mycobacterium chelonae keratitis and a review of mycobacterial infections of the eye and orbit. Tubercle 1994; 75: 377–82.
8.Pottage, JC, Harris, AA, Trenholme, GM, Levin, S, Kaplan, RL, Feczko, JM.Disseminated Mycobacterium chelonei infection: A report of two cases. Am Rev Respir Dis 1982; 126: 720–2.
9.Greer, KE, Gross, GP, Martensen, SH.Sporotrichoid cutaneous infection due to Mycobacterium chelonei. Arch Dermatol 1979; 115: 738–9.
10.Kackson, PG, Keen, H, Noble, CJ, Simmons, NA.Injection abscesses in a diabetic due to Mycobacterium chelonei var abscessus. BMJ 1980; 281: 1105–6.
11.Fenske, NA, Millns, JL.Resistant cutaneous infection caused by Mycobacterium chelonei. Arch Dermatol 1981; 117: 151–3.
12.Yip, SY, Wu, PC, Chan, WC, Teoh-Chan, CH.Tuberculoid cutaneous infection due to a niacin-positive Mycobacterium chelonei. Br J Dermatol 1979; 101: 6378.
13.Zina, AM, Depaoli, M, Bossano, AF.Cutaneous-mucous infection with lymphadenopathy caused by Mycobacterium chelonei. Dermatológica 1980; 160: 376–9.
14.Restrepo, A, Jiménez, B, Cano, L, et al. Lesiones de los tejidos blandos causadas por Mycobacterium fortuitumchelonei. Act Med Colombiana 1981; 6: 235–40.
15.Borghans, JGA, Stanford, JL.Mycobacterium chelonei in abscesses after injection of diphtheria-pertussitetanus-polio vaccine. Am Rev Respir Dis 1973; 107: 18.
16.Laskowski, LF, Marr, JJ, Spernoga, JF, et al. Fastidious mycobacteria grown from porcine prosthetic-heart-valve cultures. N Engl J Med 1977; 297: 101–2.
17.Safranek, TJ, Jarvis, WR, Carson, LA, et al. Mycobacterium chelonae wound infections after plastic surgery employing contaminated gentian violet skinmarking solution. N Engl J Med 1987; 317: 197201.
18.Wenger, JD, Spika, JS, Smithwick, RW, et al. Outbreak of Mycobacterium chelonae infection associated with use of jet injectors. JAMA 1990; 264: 373–6.
19.Levy, C, Curtin, JA, Watkins, A, et al. Mycobacterium chelonei infection of porcine heart valves. N Engl J Med 1977; 297: 667–8.
20.Band, JD, Ward, JI, Fraser, DW, et al. Peritonitis due to a Mycobacterium chelonei-like organism associated with intermittent chronic peritoneal dialysis. J Infect Dis 1982; 145: 917.
21.Lowry, PW, Beck-Sague, CM, Bland, LA, et al. Mycobacterium chelonae infection among patients receiving high-flux dialysis in a hemodialysis clinic in California. J Infect Dis 1990; 161: 8590.
22.Bolan, G, Reingold, AL, Carson, LA, et al. Infections with Mycobacterium chelonei in patients receiving dialysis and using processed hemodialyzers. J Infect Dis 1985; 152: 1013–19.
23.Cooper, JF, Lichtenstein, MJ, Graham, BS, Schaffner, W.Mycobacterium chelonae: A cause of nodular skin lesions with a proclivity for renal transplant recipients. Am J Med 1989; 86: 173–7.
24.Hoffman, PC, Fraser, DW, Robicsek, F, O'Bar, PR, Mauney, CU.Two outbreaks of sternal wound infections due to organisms of the Mycobacterium fortuitum complex. J Infect Dis 1981; 143: 533–42.
25.Szabo, I, Sarkozi, K.Mycobacterium chelonei endemy after heart surgery with fatal consequences. Am Rev Respir Dis 1980; 121: 607.
26.Jauregui, L, Arbulu, A, Wilson, F.Osteomyelitis, pericarditis, mediastinitis, and vasculitis due to Mycobacterium chelonei. Am Rev Respir Dis 1977; 115: 699703.
27.Orozco, LC, León, CI, Giraldo, E, et al. El cultivo de esputo para el diagnóstico de la tuberculosis pulmonar: Comparación del método de Petroff en Lowenstein-Jensen y la técnica de escobillón en medio de Ogawa, modificado por Kudoh. Biomédica 1985; 5: 24–5.
28.Orozco, LC, Giraldo, E, León, CI, et al. Disminución del costo del cultivo de M. tuberculosis a partir de esputo. Biomédica 1988; 8: 71–2.
29.Saito, H, Gordon, RE, Juhlin, I, et al. Cooperative numerical analysis of rapidly growing mycobacteria. The second report. Int J Syst Bacteriol 1977; 27: 7585.
30.Bergey, DH.Bergey's manual of systematic bacteriology: Based on Bergey's manual of determinative bacteriology. Vol. 2. Sneath, PHA, Mair, NS, Sharpe, ME, Hott, JG, eds. Section 16. Baltimore: Williams & Wilkins, 1989. Naranjo, PJ, Rodriguez, G, Rodriguez, J, Caldas, ML.La coloración de Ziehl-Neelsen en histopatologia. Biomédica 1988; 8: 8493.
32.Armenian, HK, Lilienfeld, AM.Incubation period of disease. Epidemiol Rev 1983; 5: 115.
33.Sartwell, PE.The distribution of incubation periods of infectious disease. Am J Hyg 1950; 51: 310–18.
34.Hosmer, DW, Lemeshow, S.Applied logistic regression. New York: Wiley & Sons, 1989.
35.Hosmer, DW, Taber, S, Lemeshow, S.The importance of assessing the fit of logistic regression models: a case study. Am J Public Health 1991; 81: 1630–5.
36.Lemeshow, S, Hosmer, DW.A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 1982; 115: 92106.
37.Wolinsky, E.Nontuberculous mycobacteria and associated diseases. Am Rev Respir Dis 1979; 119: 107–56.
38.Wallace, RJ, Musser, JM, Hull, SI, et al. Diversity and sources of rapidly growing mycobacteria associated with infections following cardiac surgery. J Infect Dis 1989; 159: 708–16.
39.Estrada, S, Diaz, J, Jaramillo, E, et al. Un brote por Mycobacterium chelonae, subspecie abscessus asociado a hiposensibilización en pacientes alérgicos. Act Med Colombiana 1992; 17: 7280.
40.Merlin, TL, Tzamaloukas, AH.Mycobacterium chelonae peritonitis associated with continuous ambulatory peritoneal dialysis. Am J Clin Pathol 1989; 91: 717–20.
41.Clegg, HW, Foster, MT, Sanders, WE, Baine, WB.Infection due to organisms of the Mycobacterium fortuitum complex after augmentation mammoplasty: clinical and epidemiologic features. J Infect Dis 1983; 147: 427–33.
42.Kuristky, JN, Bullen, MG, Broome, CV, et al. Sternal wound infections and endocarditis due to organisms of the Mycobacterium fortuitum complex. Ann Intern Med 1983; 98: 938–9.
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