ABSTRACT
During 2013, the Maryland Department of Health and Mental Hygiene in Baltimore, MD, USA, received report of 2 Maryland residents whose surgical sites were infected with rapidly growing mycobacteria after cosmetic procedures at a clinic (clinic A) in the Dominican Republic. A multistate investigation was initiated; a probable case was defined as a surgical site infection unresponsive to therapy in a patient who had undergone cosmetic surgery in the Dominican Republic. We identified 21 case-patients in 6 states who had surgery in 1 of 5 Dominican Republic clinics; 13 (62%) had surgery at clinic A. Isolates from 12 (92%) of those patients were culture-positive for Mycobacterium abscessus complex. Of 9 clinic A case-patients with available data, all required therapeutic surgical intervention, 8 (92%) were hospitalized, and 7 (78%) required ≥3 months of antibacterial drug therapy. Healthcare providers should consider infection with rapidly growing mycobacteria in patients who have surgical site infections unresponsive to standard treatment.
Subject(s)
Medical Tourism , Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium abscessus , Adolescent , Adult , Disease Outbreaks , Dominican Republic/epidemiology , Female , Humans , Middle Aged , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/economics , Surgery, Plastic/adverse effects , Surgical Wound Infection , United States/epidemiology , Young AdultABSTRACT
In August 2013, the Maryland Department of Health and Mental Hygiene (MDHMH) was notified of two persons with rapidly growing nontuberculous mycobacterial (RG-NTM) surgical-site infections. Both patients had undergone surgical procedures as medical tourists at the same private surgical clinic (clinic A) in the Dominican Republic the previous month. Within 7 days of returning to the United States, both sought care for symptoms that included surgical wound abscesses, clear fluid drainage, pain, and fever. Initial antibiotic therapy was ineffective. Material collected from both patients' wounds grew Mycobacterium abscessus exhibiting a high degree of antibiotic resistance characteristic of this organism.
Subject(s)
Disease Outbreaks , Medical Tourism , Mycobacterium Infections/epidemiology , Mycobacterium/classification , Plastic Surgery Procedures/adverse effects , Surgical Wound Infection/epidemiology , Adolescent , Adult , Centers for Disease Control and Prevention, U.S. , Dominican Republic , Female , Humans , Middle Aged , Mycobacterium/isolation & purification , Mycobacterium Infections/etiology , Surgical Wound Infection/etiology , United States/epidemiology , Young AdultABSTRACT
We identified 27 cases of hepatitis A among international adoptees (5 persons), their direct or indirect contacts (20 persons), and unvaccinated travelers to the adoptees' countries (2 persons). Most cases occurred among nontraveling contacts of adoptees, suggesting the need to extend prevention guidelines to include hepatitis A vaccination for at-risk nontravelers.