China - 18 Mothers Infected with "Stubborn Bacteria" after Caesarian sections in Guangdong Province

[sharon sanders]

<table width="100%"><tbody><tr><td bgcolor="#f2f2f2" width="590"><center>Shantou 18 mothers infected with the stubborn bacteria Caesarean
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2010年01月27日3:02:00​

January 27, 2010 3:02:00 </center></td></tr><tr><td bgcolor="#f2f2f2" width="590"><center>
<table style="table-layout: fixed;" align="center" border="0" cellpadding="0" width="90%"><tbody><tr><td width="100%">

记者昨日从广东省卫生厅医政处获悉，汕头市谷饶镇华侨医院18名孕妇剖腹产后，因感染非结核性分枝杆菌久治不愈，但当地卫生部门只上报了11例，有7例被瞒报。​

Reporter yesterday from the Guangdong provincial health department was informed that Yizheng Chu, Rao Valley town of Shantou Overseas Chinese Hospital, 18 pregnant women after cesarean section due to non-tuberculous mycobacterial infection long treatment, but local health departments had reported only 11 cases, 7 cases were concealed .

感染原因正在调查当中。​

http://translate.googleusercontent....le.com&usg=ALkJrhi0Mx9Bi3PAkityWoMJ6-sAeq4Uxw

</td></tr></tbody></table></center></td></tr></tbody></table>

 

[sharon sanders]

Re: China - 18 Mothers Infected with "Stubborn Bacteria" after Cesarian sections in Guangdong Province

Re: China - 18 Mothers Infected with "Stubborn Bacteria" after Cesarian sections in Guangdong Province

Nontuberculous mycobacteria (NTM) are all the other mycobacteria which can cause pulmonary disease resembling tuberculosis, lymphadenitis, skin disease, or disseminated disease.


http://en.wikipedia.org/wiki/Nontuberculous_mycobacteria

 

[alert]

Re: China - 18 Mothers Infected with "Stubborn Bacteria" after Cesarian sections in Guangdong Province

Re: China - 18 Mothers Infected with "Stubborn Bacteria" after Cesarian sections in Guangdong Province

Lots more information here in this ProMED post - apparently these are wound infections.

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,81093

Archive Number 20100127.0296
Published Date 27-JAN-2010
Subject PRO/EDR> Non-tuberculous mycobacterium, nosocomial - China: (GD) RFI


NON-TUBERCULOUS MYCOBACTERIUM, NOSOCOMIAL - CHINA: (GUANGDONG)
REQUEST FOR INFORMATION
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 26 Jan 2010
Source: Xinhua [edited]
<http://english.cri.cn/6909/2010/01/26/1781s545433.htm>


A hospital in south China's Guangdong Province is under investigation
over the bacterial infection of 18 women who had Caesarean sections
there last year [2009]. The women gave birth at the Huaqiao Hospital,
the largest hospital in Gurao Town of Shantou City, from August to
November [2009], an official with the provincial health department
said on condition of anonymity.

"We received reports of several bacterial infection cases in October
[2009] and ordered the local health authority to launch an overhaul
of the hospital," he said. But the public knew little of the scandal
until the Southern Daily, a Guangzhou-based newspaper, carried a
lengthy report on Monday [24 Jan 2010]. The report said at least 7 of
the cases had been covered up, which the provincial health department
official confirmed with Xinhua Tuesday [25 Jan 2010]. "We were aware
of only 11 cases," he said. "We sent an investigation team to Shantou
on Monday and will keep the public informed of the result." The
hospital had been told to suspend Caesarean sections, he added.

Laboratory tests found patients were all infected with nontuberculous
mycobacteria, or NTM, the same cause of a massive post-surgery
infection in 1998 that affected 166 patients at a maternity and
child-care hospital in Shenzhen.

One of the 7 patients whose conditions were concealed was a woman
whose wound has been purulent since she had a Caesarean section at
Huaqiao Hospital on 31 Aug 2009. "I was told it was an immunity
problem and received antibiotic treatment for months," she was quoted
as saying in the newspaper. Until Monday [24 Jan 2010], she and 6
other patients were being treated at the hospital for up to 7 hours daily.

Several other patients were told that their wounds had not healed
either because they were too skinny or too fat, the newspaper
reported. Huaqiao Hospital was founded in 1995 with donations from
overseas Chinese. It provides medical services to more than 300 000
people in town.

[Byline: Liu Donghui]

--
Communicated by:
ProMED-mail Rapporteur Dan Silver

[The species of non-tuberculous mycobacteria involved in the
nosocomial outbreak in China is not specified in the news release
above. The non-tuberculous mycobacteria (NTM) (a grouping outside of
the _M. tuberculosis_ complex) are usually classified on the basis of
in vitro growth rate, colonial pigmentation and rapid molecular
diagnostics. Non-pigmented, rapidly growing mycobacteria species
(RGM) produce mature growth on agar plates within 7 days of
incubation and include the _M. fortuitum_ complex and the _M.
chelonae-abscessus_ group. Pigmented, intermediately growing NTM
require 7-10 days to produce mature growth on agar plates and include
_M. marinum_ and _M. gordonae_. Slowly growing NTM, which require
more than 7-10 days to produce mature growth on agar plates, include
_M. kansasii_ and the _M. avium/intracellulare_ complex. RGM commonly
cause skin and subcutaneous infections, which can be either
community-acquired or nosocomial.

_M. fortuitum_ causes community-acquired skin and soft tissue
infection, usually following trauma in previously healthy individuals
and has followed exposure to contaminated footbaths in nail salons
(see Sniezek PJ, et al. Arch Dermatol 2003; 139: 629-34; available at
<http://archderm.ama-assn.org/cgi/content/full/139/5/629>). _M.
fortuitum_ is found in natural and processed water, as well as in
sewage and dirt, worldwide.

Nosocomial outbreaks of infections due to RGM are generally related
to subcutaneous injection or wound contamination with non-sterile
water or implanted devices (for example, see Padoveze MC, Fortaleza
CM, Freire MP, et al. Outbreak of surgical infection caused by
non-tuberculous mycobacteria in breast implants in Brazil. J Hosp
Infect 2007; 67: 161-7; abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/17881086?dopt=AbstractPlus>).
Also, nosocomial RGM infection has followed use of contaminated skin
markers in cosmetic plastic surgery (Safranek TJ, et al.
_Mycobacterium chelonae_ wound infections after plastic surgery
employing contaminated gentian violet skin-marking solution. N Engl J
Med 1987; 317: 197-201; abstract available at
<http://content.nejm.org/cgi/content/abstract/317/4/197>).

Shantou is a city of almost 5 million people in coastal Eastern
Guangdong Province, China. A map showing the provinces of China can
be seen at <http://www.sacu.org/provmap.html>. The
HealthMap/ProMED-mail interactive map of China is available at
<http://healthmap.org/promed/en?name=China,%20China&g=1814991&v=35,105,5>.
- Mod.ML]

[see also:
Mycobacterium immunogenum, hypersens. pneumonitis - USA: (OH) 20090614.2206
Mycobacterium fortuitum, breast implant - Brazil: (SP) 20090112.0121
2004
----
Mycobacterium abscessus - USA ex Dominican Republic (03) 20040621.1650
Mycobacterium abscessus - USA ex Dominican Republic (02) 20040504.1225
Mycobacterium abscessus - USA ex Dominican Republic 20040501.1200
2003
----
Mycobacterium abscessus - USA (New York) 20030116.0137
2002
----
Mycobacterium abscessus - Canada (Ontario) 20021228.6139]
.......................................................ml/msp/dk

 

[alert]

Re: China - 18 Mothers Infected with "Stubborn Bacteria" after Cesarian sections in Guangdong Province

Re: China - 18 Mothers Infected with "Stubborn Bacteria" after Cesarian sections in Guangdong Province

Courtesy of ProMED, a global history of such events:

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,81106

Archive Number 20100128.0308
Published Date 28-JAN-2010
Subject PRO> Non-tuberculous mycobacterium, nosocomial - China (02): background


NON-TUBERCULOUS MYCOBACTERIUM, NOSOCOMIAL - CHINA (02): BACKGROUND
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Thu 28 Jan 2010
Source: GIDEON (Global Infectious Disease & Epidemiology Network) [edited]
<http://www.gideononline.com/blog/2010/01/27/non-tuberculous-mycobacterial-infections/>


[Re: ProMED-mail Non-tuberculous mycobacterium, nosocomial - China:
(GD) RFI 20100127.0296]
------------------------------------------------
[Prof Steve Berger sent in the following item from Gideon that helps
to place outbreaks of non-tuberculous mycobacteria (NTM) infections
in perspective. - Mod.ML]

Argentina
---------
2007 to 2007: an outbreak (28 cases) of _Mycobacterium immunogenum_
infection in Buenos Aires was associated with mesotherapy
[non-surgical cosmetic medicine treatment].

Brazil
------
2002 to 2004: an outbreak (14 cases) of mycobacterial wound infection
associated with silicone breast implant surgery was reported in
Campinas, Sao Paulo. 2003: an outbreak (5 cases) in Sao Paulo of
keratitis due to _M. immunogenum_ was associated with myopia surgery.
2004 to 2005: an outbreak (311 cases) of _Mycobacterium abscessus_
infections in Belem was associated with invasive procedures.
_Mycobacterium massiliense_ and _Mycobacterium bolletii_ were also
identified in some cases. 2006 to 2007: an outbreak (1051 clinical
cases) of _M. massiliense_ infections involving 63 hospitals in Rio
de Janeiro state was related to contaminated instruments used in
video-assisted surgery. 2008: an outbreak (13 cases) of
_Mycobacterium fortuitum_ infections in Sao Paulo was associated with
breast implant surgery.

Canada
------
2002: an outbreak (32 cases) of _M. abscessus_ infection in Toronto
was reported from 2 acupuncture clinics.

Colombia
--------
1996 (publication year): an outbreak (232 cases) of _Mycobacterium
chelonae_ subsp. _abscessus_ infection in Barranquilla was caused by
contaminated lidocaine used in a single physician's office.

Dominican Republic
------------------
2003: an outbreak (6 cases) of abdominal wall infections caused by
_M. abscessus_ occurred among patients who had undergone liposuction
at a single clinic in Santo Domingo. 2004: an outbreak (12 cases) of
_M. abscessus_ infection was diagnosed among Americans who had
visited various clinics in Santo Domingo for cosmetic surgery.

France
------
1989 to 1993: an outbreak (58 cases) of discitis [infection in the
intervertebral disc space] due to _Mycobacterium xenopi_ was reported
in a hospital. 2006 to 2007: an outbreak (16 cases) of subcutaneous
_M. chelonae_ infections was associated with mesotherapy injections.
2008 (publication year): an outbreak (8 cases) of mycobacteriosis was
associated with a tattoo parlor.

Hong Kong
---------
1993 (publication year): an outbreak of sternotomy infections due to
_M. fortuitum_ was reported in cardiothoracic hospital.

India
-----
1995: an outbreak (45 cases) of post-operative wound infections due
to _M. abscessus_ was ascribed to contaminated water. 2006
(publication year): an outbreak (145 cases) of _M. chelonae_ port
site infections in Bangalore was associated with contaminated
laparoscopic equipment.

Israel
------
2003: an outbreak (15 cases) of _Mycobacterium jacuzzii_ infection
was associated with breast implant surgery. 2008 (publication year):
an outbreak (5 cases) of _Mycobacterium mucogenicum_ bacteremia in a
paediatric haematology-oncology ward was related to a contaminated faucet.

Mexico
------
1991 (publication year): an outbreak of post-rhinoplasty nasal
cellulitis due to _M. chelonae_ was reported in Mexico City.

Peru
----
2004 to 2005: an outbreak (35 cases) in Lima of persistent cutaneous
abscesses due to _M. chelonae_ was associated with mesotherapy sessions.

Republic of Korea
-----------------
2001: an outbreak (40 cases) of _M. abscessus_ infection was
associated with an acupuncture clinic. 2007 (publication year): an
outbreak (12 cases) of _M. massiliense_ infections was associated
with intramuscular injection of an antimicrobial agent
(ribostamycin). 2008: an outbreak (109 cases) of _M. abscessus_
infection was ascribed to contaminated glutaraldehyde disinfectant
used in acupuncture.

Spain
-----
2009 (publication year): an outbreak (39 cases) of _M. fortuitum_
infection in Rioja was associated with mesotherapy administered by a
beauty salon.

United States
-------------
1987: an outbreak (17 cases) of _M. chelonae_ otitis media was caused
by contaminated water used by an ENT [ear, nose, throat] practice in
Louisiana. 1988: an outbreak (8 cases) of foot infections due to _M.
chelonae_ subspecies _abscessus_ infections were associated with a
jet injector used in a podiatric office. 1989 to 1990: an outbreak
(16 cases) of sputum colonization by _M. fortuitum_ was reported
among patients on an alcoholism rehabilitation ward in Washington,
DC. 1991 (publication year): an outbreak (6 cases) of _M. fortuitum_
infection in Washington was associated with contaminated
electromyography needles. 1995 to 1996: an outbreak (87 cases) of
post injection abscesses due to _M. abscessus_ in several states was
ascribed to an adrenal cortex extract. 1999: an outbreak (10 cases)
of intra- and periarticular _M. abscessus_ infection in Texas was
caused by contaminated benzalkonium chloride used for injection. 2000
to 2001: an outbreak (110 cases) of skin infections !
due to _M. fortuitum_ was caused by contaminated footbaths in
California nail salons. 2002: an outbreak (14 confirmed and 11
suspected cases) of soft tissue infections due to _M. abscessus_
followed injections of cosmetic substances administered by unlicensed
practitioners in New York City. 2002: an outbreak (115 cases or more)
of cutaneous infection by _M. fortuitum_ was associated with a
contaminated footbath in a nail salon in California. 2002
(publication year): an outbreak (34 cases) of _M. chelonae_ soft
tissue infection in California was associated with liposuction. 2002
to 2003: an outbreak (4 cases) of _M. chelonae_ infection among
patients undergoing rhytidectomies [facelift] in New Jersey was
caused by a contaminated methylene blue solution. 2003: an outbreak
(3 cases) of _Mycobacterium goodii_ infection was associated with
surgical implants in a Colorado hospital. 2004: an outbreak (12
cases) among Americans of soft tissue infections caused by _M.
abscessus_ follow!
ing cosmetic surgery performed at various clinics in the Dominican
mycobacterial skin and soft tissue infection (presumed _M.
fortuitum_) was reported among persons attending nail salons in
California. 2009 (publication year): an outbreak (6 cases) of _M.
chelonae_ infection was associated with a tattoo establishment.

Venezuela
---------
2005: an outbreak (70 cases) of _Mycobacterium cosmeticum_ infection
was related to mesotherapy injections for fat removal.

(Primary references are available on request.)

--
Communicated by:
Dr Steve Berger
Geographic Medicine
Tel Aviv Medical Center
Israel
<mberger@post.tau.ac.il>

[ProMED-mail once again thanks Dr Berger for his background reports. - Mod.ML]

******
[2]
Date: Thu 28 Jan 2010
From: Karel Hruska <hruska@vri.cz> [edited]


Re: Non-tuberculous mycobacterium, nosocomial - China: (GD) RFI 20100127.0296

The risk of mycobacterial [infection], [modes of] transmission of
mycobacteria from the environment to susceptible hosts, and cases of
infections in hospitals [can be found in] the references in Chapter 7
of the recently published book "The Ecology of Mycobacteria: Impact
on Animal's and Human's Health" (Eds. J. Kazda, I. Pavlik, J. O.
Falkinham III, K. Hruska)
<http://www.springer.com/public+health/book/978-1-4020-9412-5>. For
the contents, see <http://centaur.vri.cz/news/prilohy/pril1219.pdf>.

--
Professor Karel Hruska
Veterinary Research Institute
Czech Republic
<hruska@vri.cz>

[ProMED-mail thanks Dr Hruska for the references. - Mod.ML]

[see also:
Non-tuberculous mycobacterium, nosocomial - China: (GD) RFI 20100127.0296
2009
----
Mycobacterium immunogenum, hypersens. pneumonitis - USA: (OH) 20090614.2206
Mycobacterium fortuitum, breast implant - Brazil: (SP) 20090112.0121
2004
----
Mycobacterium abscessus - USA ex Dominican Republic (03) 20040621.1650
Mycobacterium abscessus - USA ex Dominican Republic (02) 20040504.1225
Mycobacterium abscessus - USA ex Dominican Republic 20040501.1200
2003
----
Mycobacterium abscessus - USA (New York) 20030116.0137
2002
----
Mycobacterium abscessus - Canada (Ontario) 20021228.6139]
........................................................ml/mj/msp/dk

 

[Farmer]

Re: China - 18 Mothers Infected with "Stubborn Bacteria" after Caesarian sections in Guangdong Province

Nontuberculous mycobacteria are found in nature in water, in biofilms and soil.

Nosocomial outbreaks can occur when hospital water systems are contaminated, or when solutions or instruments become contaminated from water or soil.

A cluster in one clinical specialty (obstetrics) such as this is consistent with the use of a contaminated solution (abdominal prep solution) or the use of contaminated water to wash the fresh wound soon after surgery.

These infections can be quite serious and very hard to treat.