Journal Article

Report on an Outbreak of Postinjection Abscesses Due to <i>Mycobacterium abscessus</i>, Including Management with Surgery and Clarithromycin Therapy and Comparison of Strains by Random Amplified Polymorphic DNA Polymerase Chain Reaction

Alvaro Villanueva, Raul Villanueva Calderon, Braxedi Acosta Vargas, Fernando Ruiz, Sonia Aguero, Yansheng Zhang, Barbara A. Brown and Richard J. Wallace

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 24, issue 6, pages 1147-1153
Published in print June 1997 | ISSN: 1058-4838
Published online June 1997 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/513656
Report on an Outbreak of Postinjection Abscesses Due to Mycobacterium abscessus, Including Management with Surgery and Clarithromycin Therapy and Comparison of Strains by Random Amplified Polymorphic DNA Polymerase Chain Reaction

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An outbreak of postinjection abscesses occurred in Barranquilla, Colombia, and was associated with local injections of lidocaine given in a single physician's office. Over a 5-month period, 350 (18%) of ∼2,000 injected patients developed localized cutaneous abscesses or cellulitis; of 210 abscess specimens that were cultured, 205 were positive for rapidly growing mycobacteria, subsequently identified as Mycobacterium abscessus. The source of the outbreak was not identified. M. abscessus could not be characterized by pulsed-field gel electrophoresis, but all isolates were identical in terms of drug and heavy metal resistance patterns and random amplified polymorphic DNA PCR profiles. We believe this is the first report of the use of this latter technique for investigation of an outbreak due to M. abscessus. Therapy with a combination of surgical excision and 3–6 months' administration of clarithromycin was successful for 95% of 148 patients treated in this manner; in contrast, therapy was successful for less than one-third of patients treated with surgery alone or clarithromycin alone. This is the largest of the nine known outbreaks of postinjection abscesses that have occurred due to rapidly growing mycobacteria and is the first in which an effective method of therapy was demonstrated.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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