Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated with Medical Tourism to the Dominican Republic, 2013-2014(1).

David Schnabel,Joseph F Perz,Alison Ridpath,Leah Posivak-Khouly,Douglas H Esposito,Joanna Gaines,P Scott Pritchard,Nisha Jani,David Blythe,Duc B Nguyen,Ying Lin,Katherine A Feldman,Gary W Brunette,Nina Ahmad,J Thomas Mullins ,R H G Burns ,Bette Jensen ,Adena Greenbaum ,Susan Rhee ,Oliver Morgan ,Michèle Barry ,Edith Nyangoma ,Heather Moulton-Meissner ,Mark J Sotir

doi:10.3201/eid2208.151938

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.

Highlights

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 in the Dominican Republic
After identification of the first 2 patients, measures were taken by the rapidly growing mycobacteria (RGM) Outbreak Investigation team, which consisted of state and local health departments and the Centers for Disease Control and Prevention (CDC), to locate additional patients who had RGM infections that were associated with cosmetic surgery undergone in the Dominican Republic
Median age of the 21 patients was 40 years; all were female (Table 1). Of those for whom data were available (n = 20), all reported US residency for a median of 25 years; 15 (75%) patients were born in the Dominican Republic, 2 in the United States, and 1 each in Brazil, Puerto Rico, and Jamaica

Summary

Introduction

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. On August 23, 2013, a physician in Maryland, USA, reported to the Maryland Department of Health and Mental Hygiene M. abscessus complex–positive surgical site infections in 2 women who had undergone cosmetic surgery the previous month at a private surgical clinic in the Dominican Republic. These women disclosed that they had an acquaintance in Massachusetts with “similar problems” after a procedure at the same clinic. Investigation objectives were to determine outbreak scope of RGM surgical site infections among medical tourists who traveled to the Dominican Republic for procedures, identify epidemiologic links among patients, and mitigate outbreak effect

Methods

Results

Conclusion