An outbreak of aggressive mycobacterial infections in U.S. residents has been linked linked to cosmetic surgery procedures done in the Dominican Republic, public health officials reported.
David Schnabel, MD, of the Maryland Department of Public Health and Hygiene in Baltimore, and colleagues found that 21 patients (18 confirmed; three probable) from six different states had travelled to the Dominican Republic as medical tourists, and subsequently acquired a rapidly growing mycobacterial infection.
Out of the 18 confirmed cases of rapidly growing mycobacterial infections, 16 (89%) were considered to be from the Mycobacterium abscessus complex, they wrote in Emerging Infectious Diseases.
The investigation began after a Maryland physician reported to the state's department of health that two women, who had recently undergone cosmetic surgery at a clinic in the Dominican Republic, tested positive for M. abscessus complex. Most (62%) of the other case-patients had undergone surgery at the same clinic, according to the authors.
Mycobacterial infections are most commonly spread due to nonsterile water and/or surgical conditions, and are known to be very resistant to antibiotics. Cutaneous symptoms include painful nodules that develop into persistent, discharging abscesses. However, systemic symptoms, such as fever, may not be present, the authors warned.
Patients who become infected are likely to experience decreases in functionality and quality of life, while also facing financial burdens, such as the insurance company refusing to cover the cost of care.
Despite the lure of low-cost medical procedures performed abroad, patients are likely to face more negative consequences later on, the researchers warned. However, due to increasing ease of travel, ubiquitous marketing techniques, and high anticipated financial savings, medical tourism is not expected to slow down in the near future.
Medical tourists are recommended to visit internationally accredited facilities when undergoing surgery, while clinicians are recommended to perform relevant testing on patients who have returned from receiving procedures abroad, they advised.
Rapidly growing mycobacteria "infection is not a nationally notifiable disease in the United States or Dominican Republic," they explained. "Therefore, cases described here might represent a limited proportion of those that actually occurred."
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