Mycobacterium abscessus infections following injection of botulinum toxin

Cutaneous Nontuberculous Mycobacteria Infections Following Cosmetic Procedures: A Retrospective Study

Background

Reports of skin infections associated with nontuberculous mycobacteria (NTM) following cosmetic procedures are increasing. The diagnosis and treatment of these infections remain a significant challenge for clinicians.

Objective

We examined the clinical characteristics, microbiology, histopathology, and treatment strategies of NTM infections following cosmetic procedures, including botulinum toxin injection, lipolysis injection, hyaluronic acid injection, mesotherapy, autologous fat grafting, and other related procedures.

Methods

This retrospective study of cosmetology-related cutaneous NTM infections diagnosed based on culture or molecular identification was conducted at a tertiary dermatology hospital in China. Demographic, clinical, microbiological, pathological biopsy, management, and outcome data were also collected.

Results

The series enrolled 28 patients, four diagnosed by molecular identification and histology, and 24 by positive culture. All 24 NTM cultures were rapid-growing mycobacteria, mainly Mycobacterium abscessus complex (75%), with a mean time to positive culture of 11.8 days. The mean incubation period for the lesions was three weeks, while the mean time to diagnosis was 9.8 weeks. Treatment typically requires long-term, multi-drug therapy. Surgical intervention may shorten the disease course.

Conclusion

Cosmetology-related cutaneous NTM infections are frequently underrecognized and challenging to diagnose, leading to delayed treatment. We aimed to enhance clinician awareness of NTM infections to facilitate early detection and prompt treatment. Empirical therapy with clarithromycin and moxifloxacin may be considered in the absence of susceptibility results, but treatment decisions should be carefully guided by susceptibility testing results. Surgical intervention may be beneficial, and tigecycline is a viable option when resistant to clarithromycin.

Skin and Soft Tissue Nontuberculous Mycobacteria Infection: A Retrospective Case Series of 49 Patients

BACKGROUND

The incidence of skin and soft tissue nontuberculous mycobacteria infection (SSTNI) is increasing. But it may be challenging to diagnose and treat SSTNI.

OBJECTIVE

To summarize course, clinical features, diagnosis and treatment of SSTNI and discuss the association between SSTNI and procedures.

METHODS

A retrospective case series study was conducted among patients diagnosed with SSTNI after surgical procedures. Medical history was collected, disease course and characteristics were analyzed.

RESULTS

49 patients were collected. Among them, 39 (80%) patients were infected with Mycobacterium abscesses. 40 (82%) patients had a history of fat-related procedures. The median and interquartile range of onset time were 15 and 43 days (1-100). Time from first visit to diagnosis was 82±57 days (23-308). Wound healing time was 161±92 days (30-545). The most common symptom were redness (96%), followed by swelling (96%), abscess (84%), pain (80%) and induration (76%). The most common infected site were head and neck (56%), followed by breasts (20%). 6 (12.5%) patients were diagnosed clearly before admission to our department. 10 (28%) patients showed positive acid-fast bacilli (AFB) smears among 36 patients. Treatment included debridement surgeries, drainage and antibiotics.

CONCLUSION

Patient with the above symptoms should be considered as SSTNI. Results of AFB smears are frequently negative after empirical antibiotic treatment so that molecular diagnostic techniques are required for rapid and accurate identification. Debridement surgeries, drainage and sensitive antibiotics are effective. Drug safety and psychological status should be paid attention.

LEVEL OF EVIDENCE IV

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Adverse effects of the aesthetic use of botulinum toxin and dermal fillers on the face: a narrative review

OBJECTIVE

To evaluate the adverse effects of facial aesthetic treatments using botulinum toxin and biomaterial implants.

METHODS

The bibliographic research for this narrative review considered articles published in journals from the Medline, Pubmed, Embase and Lilacs databases with the following terms: "dermal fillers AND complications, vascular complications AND dermal fillers, adverse reaction, AND toxin botulinum and adverse reaction AND dermal fillers". Inclusion criteria were articles available in English on adverse events with the aesthetic use of botulinum toxin and dermal fillers/biostimulators.

RESULTS

The demonstration of complications increases simultaneously with the progressive performance of facial aesthetic procedures. Quantitative statistics of the procedures and the countries that use them are skillfully classified, as well as the prosperity trends of these procedures. Complications do not receive the same relevance. There is a deficiency in dissemination of the information by the scientific community, or in other words, there is a publication bias in favor of successful results as opposed to adverse events.

CONCLUSION

The lack of knowledge about complications arising from so widely publicized and performed procedures prevents the development of evidence-based guidelines. Complications in aesthetic procedures have become a public health problem, an epidemic that occurs under the supervision of health authorities. Mandatory reporting of adverse events occurring in aesthetic procedures that require medical care aims to fill this gap. With reliable and technical data, it will be possible to identify the causes and perform interventions capable of minimizing irreversible sequelae and deaths. Complications should be promptly recognized by the dermatologist so that, when possible, they can be reversed or adequately managed.

The Price of Beauty: A Literature Review on Non-Tuberculous Mycobacteria Infection After Cosmetic Procedures

Non-tuberculous mycobacteria (NTM) infection of the skin and soft tissues is a complication of cosmetic procedures. The incidence of cutaneous NTM infections has increased significantly as aesthetic operations have become more commonplace. With the rise of cosmetic tourism, the geographic expansion of NTM infections is a major concern. Due to the unique pathogenesis of NTM infections, diagnosis and treatment remain significant challenges for clinicians. Clinical management relies on a combination of antibiotic therapy with drug susceptibility testing and appropriate surgical debridement. Some new drugs, photodynamic therapy, and bacteriophage therapy have been developed in recent years, and may improve the aesthetic outcomes. This review summarizes the cosmetic procedures prone to NTM infections in recent years and their clinical features. We propose a 2-stage treatment procedure, including a hospitalization phase and a follow-up phase. We aim to increase the alertness of clinicians to NTM infections for timely detection and treatment.

LEVEL OF EVIDENCE: 3

Subcutaneous infection caused by Mycobacterium abscessus following botulinum toxin injections: A case report and literature review

BACKGROUND

The rapid development of cosmetic injections has led to an increased incidence of nontuberculous mycobacterial (NTM) infection.

PATIENTS AND METHODS

Here, we presented a case of cutaneous Mycobacterium abscessus infection subsequent to botulinum toxin injection for treating masseter hypertrophy, and reviewed the literature on skin and soft tissue infections caused by NTM after cosmetic injections.

RESULTS AND CONCLUSIONS

The patient underwent surgical excision and regular antibiotic therapy and has had nearly 2 months of follow-up without any signs of infection. The diagnosis and treatment of NTM infection have always been challenging, and further research is needed to standardize and guide the treatment.

Scalp Infection Caused by Mycobacterium abscessus Manifested as Patchy Alopecia in an Immunocompetent Female

Mycobacterium abscessus (M. abscessus) is a fast-growing, non-tuberculous mycobacterium (NTM) that can cause human infections varying from superficial infection to pulmonary or even systemic infections. The latter is more commonly appeared in immunocompromised patients. The skin infection caused by M. abscessus often appears after trauma or surgical procedure. It is often manifested by subcutaneous nodules, papules, erythema, tender erythematous or violaceous plaques, cellulitis, abscesses, ulcerations, and draining sinuses. Herein, we present a non-typical cutaneous manifestation of M. abscessus infection in a 46-year-old woman who presented with alopecia on the scalp with no itching or pain. The pathogen was isolated and identified as M. abscessus by morphology and DNA sequencing. To our best knowledge, there was no report that this organism could cause skin lesions mimicking patchy alopecia. After 3 months of antibacterial treatment, the cutaneous lesion disappeared, and new growth of hair occurred in this patient.

Surgical Treatment for Cutaneous Mycobacterium abscessus Infection Caused by Injections of Hyaluronic Acid

Background

Facial injection has become popular in aesthetic dermatology. Although injections of these tissue fillers are considered a low-risk procedure, they are not without potentially significant drawbacks.

Case Presentation

We would like to report a case about cutaneous Mycobacterium abscessus infection after facial injection of hyaluronic acid in China, which obtained satisfactory clinical efficacy by drainage and surgical excision.

Conclusion

Biological techniques are useful in the diagnosis of cutaneous M. abscessus infection. Surgical excision of skin lesion is effective for cutaneous M. abscessus infection.

Subcutaneous infection caused by Mycobacterium abscessus following cosmetic injections of botulinum toxin: A case report

BACKGROUND

In recent years, the cosmetic intervention related infections caused by nontuberculous mycobacteria (NTM) are increasing as the informal cosmetic treatments are performed. However, many dermatologists are inexperienced in the diagnosis and management of similar cases. Here we report a case of subcutaneous infection caused by Mycobacterium abscessus (M. abscessus) following cosmetic injections of botulinum toxin.

CASE SUMMARY

A 53-year-old woman presented with multiple abscesses and nodules on her forehead and both temporal sites for half a month after cosmetic injections of botulinum toxin. Her lesions did not show any alleviation after 2-wk prescription of antibiotics. Laboratory examinations indicated that she had no sign of immunodeficiency and the whole body of computed tomography did not find any systemic infection or diseases. The pathology of skin tissue showed inflammatory cell infiltration with the negative results of Periodic acid Schiff (PAS) and Acid-fast staining and the culture yielded no microbiome. Afterwards, the puncture on abscess was performed and M. abscessus was successfully isolated. The pathogen was identified by acid-fast staining and DNA sequencing. The patient was treated with the strategy of clarithromycin, ofloxacin, and amikacin according to the result of drug sensitivity test and got complete remission of the lesions.

CONCLUSION

The case presents the whole process of diagnosis and management of NTM infection after cosmetic intervention and highlights the diagnostic thoughts. In a word, the mycobacterium infection should be aware in patients after cosmetic performance.

Mycobacterium abscessus infection after facial injection of argireline: A case report

BACKGROUND

The incidence of infection with Mycobacterium abscessus (M. abscessus) has increased in recent years. This increase is partly associated with invasive cosmetic procedures.

CASE SUMMARY

The purpose of this case summary is to increase clinicians' awareness of M. abscessus infection and reduce mycobacterial infection caused by cosmetic procedures. We report the case of a 45-year-old woman who received acetyl hexapeptide-8 (argireline) injections in the forehead and temples, and erythema, nodules, and abscesses appeared at the injection sites after one week. The pus specimens were examined by microbiological culture and confirmed to be positive for M. abscessus. Clarithromycin 500 mg twice daily and moxifloxacin 400 mg once daily were administered for 5 mo and the lesions gradually subsided.

CONCLUSION

We report here for the first time a case of infection with M. abscessus after argireline injection. This condition is easily misdiagnosed as a common bacterial infection. Microbiological examinations are helpful for diagnosis and standardized cosmetic procedures can prevent infection with M. abscessus.