Unfolding Mycobacterium abscessus outbreak: a case study of mesotherapy-associated Mycobacterium abscessus infection

Abstract

This article explores the clinical manifestations, diagnostic processes, and management strategies for Mycobacterium abscessus infections following mesotherapy and includes a literature review on M. abscessus incidence, diagnostic challenges, and therapeutic difficulties. A woman who presented to our clinic with redness and swelling across multiple sites 3 months following mesotherapy in a beauty shop was ultimately diagnosed with M. abscessus-induced skin and soft tissue infection (SSTI). Concurrently, Hong Kong’s Department of Health reported 19 similar cases, all linked to mesotherapy sessions at a particular beauty center from June to August 2023. Diagnosis involved analyzing pus samples, including acid-fast bacilli smear and culture. A literature review was conducted on M. abscessus infections, causality, treatment strategies, antibiotic susceptibility tests, advanced diagnostics such as polymerase chain reaction and matrix-assisted laser desorption ionization time-of-flight mass spectrometry, and newer treatment modalities. Nineteen patients exhibited SSTIs that manifested as rashes and abscesses at the injection sites. Diagnosis is hindered by the slow growth of M. abscessus, which necessitates advanced testing. Our patient underwent 2 to 3 months of intravenous antibiotics (combination therapy) as an inpatient at a public hospital, together with repeated surgical curettage and drainage of the infected areas. This report highlights the surge in M. abscessus infections related to cosmetic procedures and the immediate requirement for stringent infection control measures in aesthetic practices. The M. abscessus outbreak emphasizes its emergence as a significant pathogen, the intricacies of managing its antibiotic resistance and biofilm production, and the need for a comprehensive treatment approach that incorporates personalized medicine, innovative therapeutics, and surgical interventions. The literature review underscores the importance of continuous research on strain-specific treatments, development of advanced diagnostic and therapeutic techniques to effectively tackle this antibiotic-resistant pathogen, and infection control.

Keywords

• abscess
• mesotherapy
• mycobacterium abscessus
• nontuberculous mycobacteria