High Morbidity of Mycobacterial Infections Following Cosmetic Surgery Tourism

Abstract

Background Medical tourism is an increasingly popular practice among cosmetic surgery patients. These procedures place patients at risk of infection by rapidly growing Mycobacterium. Rapidly growing Mycobacterium (RGM) is a relatively rare infection within developed nations. Management options vary, although all pose significant morbidity to patients. We present 2 cases treated at our institution and a comprehensive literature review of RGM infection in patients who have undergone cosmetic surgery in developing nations, analyzing its associated morbidity. Methods This is a review of institutional records for patients with RGM infections after cosmetic surgery tourism was performed. A comprehensive literature search was conducted to identify reports of similar cases. Individual treatment courses were reviewed and descriptive statistics performed for management and associated morbidities. Results Two patients underwent abdominoplasty in a developing nation and later presented to our institution with mycobacterial infection. They underwent a combined 7 procedures, received a combined 3 years of antibiotic therapy, and accounted for 1 line-associated deep venous thrombosis and line-associated bacteremia. Thirty-five similar cases were identified by literature review. Patients underwent an average of 2.4 surgical procedures and received antibiotics for an average of 8.7 months. At least half of the patients (51%) required medication adjustment due to adverse effects or expense. Further morbidities encountered were financial hardship, psychological distress, and scar hypersensitivity. Conclusion Patients who undergo cosmetic surgery as medical tourists are placed at risk of infection by rapidly growing mycobacterial species. Management is highly morbid, and they are often left with extensive surgical scarring and unanticipated additional out-of-pocket expense.