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Acupuncture-Associated Mycobacterium massiliense and Scedosporium Infections Superimposed by Tetanus

BACKGROUND: Tetanus has rarely been reported in Thailand since 1982 due to 100% tetanus vaccination coverage during the neonatal period of life. However, the reemergence of tetanus has been observed in our country during the past decade, mainly due to the increasing number of migrants traveling from...

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Autor principal: Prasoppokakorn, Thaninee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283024/
https://www.ncbi.nlm.nih.gov/pubmed/35847601
http://dx.doi.org/10.1155/2022/8918020
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author Prasoppokakorn, Thaninee
author_facet Prasoppokakorn, Thaninee
author_sort Prasoppokakorn, Thaninee
collection PubMed
description BACKGROUND: Tetanus has rarely been reported in Thailand since 1982 due to 100% tetanus vaccination coverage during the neonatal period of life. However, the reemergence of tetanus has been observed in our country during the past decade, mainly due to the increasing number of migrants traveling from neighboring countries in search of work. Acupuncture has become an essential part of alternative and complementary medicine. To our knowledge, acupuncture-associated Mycobacterium abscessus and Scedosporium infections superimposed by tetanus have never been reported. Case Presentation. A 55-year-old Thai female with schizophrenia was hospitalized due to a 4-day course of trismus, dysphagia, and back muscle spasms. Upon admission, a clinical diagnosis of tetanus was made, which included muscle rigidity and reflex muscle spasms, despite a recent history of diphtheria-tetanus (dT) vaccination for tetanus prophylaxis after 2 episodes of falling complicated by two lacerations on the left shoulder and head. Endotracheal intubation for airway protection was given, in addition to tetanus immunoglobulin, metronidazole, and diazepam which were prescribed to the patient. Incision and drainage of the wound on the left shoulder yielded 40 mL of pus, which subsequently grew Clostridium species, Mycobacterium massiliense, and Scedosporium on anaerobic bacterial, mycobacterial, and fungal cultures, respectively. An incision of an acupuncture wound on the abdominal wall yielded 1 mL of pus, which exhibited positive acid-fast bacilli (AFB) on AFB stain. Mycobacterial culture finally grew M. massiliense. The organism was susceptible to amikacin and clarithromycin. Amikacin, clarithromycin, ciprofloxacin, and voriconazole were then added. The patient gradually improved and was discharged after one month of hospitalization. The patient was reported to be doing well, with no neurological sequelae, when last seen one month after discharge. CONCLUSIONS: To our knowledge, this is the first case of acupuncture-associated M. massiliense and Scedosporium infections superimposed by tetanus. In Thailand, the occurrence of acupuncture by nonqualified individuals and the reemergence of tetanus remain prevalent. Hence, it is not uncommon to see tetanus in association with acupuncture-related nontuberculous mycobacterial/fungal infection.
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spelling pubmed-92830242022-07-15 Acupuncture-Associated Mycobacterium massiliense and Scedosporium Infections Superimposed by Tetanus Prasoppokakorn, Thaninee Case Rep Infect Dis Case Report BACKGROUND: Tetanus has rarely been reported in Thailand since 1982 due to 100% tetanus vaccination coverage during the neonatal period of life. However, the reemergence of tetanus has been observed in our country during the past decade, mainly due to the increasing number of migrants traveling from neighboring countries in search of work. Acupuncture has become an essential part of alternative and complementary medicine. To our knowledge, acupuncture-associated Mycobacterium abscessus and Scedosporium infections superimposed by tetanus have never been reported. Case Presentation. A 55-year-old Thai female with schizophrenia was hospitalized due to a 4-day course of trismus, dysphagia, and back muscle spasms. Upon admission, a clinical diagnosis of tetanus was made, which included muscle rigidity and reflex muscle spasms, despite a recent history of diphtheria-tetanus (dT) vaccination for tetanus prophylaxis after 2 episodes of falling complicated by two lacerations on the left shoulder and head. Endotracheal intubation for airway protection was given, in addition to tetanus immunoglobulin, metronidazole, and diazepam which were prescribed to the patient. Incision and drainage of the wound on the left shoulder yielded 40 mL of pus, which subsequently grew Clostridium species, Mycobacterium massiliense, and Scedosporium on anaerobic bacterial, mycobacterial, and fungal cultures, respectively. An incision of an acupuncture wound on the abdominal wall yielded 1 mL of pus, which exhibited positive acid-fast bacilli (AFB) on AFB stain. Mycobacterial culture finally grew M. massiliense. The organism was susceptible to amikacin and clarithromycin. Amikacin, clarithromycin, ciprofloxacin, and voriconazole were then added. The patient gradually improved and was discharged after one month of hospitalization. The patient was reported to be doing well, with no neurological sequelae, when last seen one month after discharge. CONCLUSIONS: To our knowledge, this is the first case of acupuncture-associated M. massiliense and Scedosporium infections superimposed by tetanus. In Thailand, the occurrence of acupuncture by nonqualified individuals and the reemergence of tetanus remain prevalent. Hence, it is not uncommon to see tetanus in association with acupuncture-related nontuberculous mycobacterial/fungal infection. Hindawi 2022-07-07 /pmc/articles/PMC9283024/ /pubmed/35847601 http://dx.doi.org/10.1155/2022/8918020 Text en Copyright © 2022 Thaninee Prasoppokakorn. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Prasoppokakorn, Thaninee
Acupuncture-Associated Mycobacterium massiliense and Scedosporium Infections Superimposed by Tetanus
title Acupuncture-Associated Mycobacterium massiliense and Scedosporium Infections Superimposed by Tetanus
title_full Acupuncture-Associated Mycobacterium massiliense and Scedosporium Infections Superimposed by Tetanus
title_fullStr Acupuncture-Associated Mycobacterium massiliense and Scedosporium Infections Superimposed by Tetanus
title_full_unstemmed Acupuncture-Associated Mycobacterium massiliense and Scedosporium Infections Superimposed by Tetanus
title_short Acupuncture-Associated Mycobacterium massiliense and Scedosporium Infections Superimposed by Tetanus
title_sort acupuncture-associated mycobacterium massiliense and scedosporium infections superimposed by tetanus
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283024/
https://www.ncbi.nlm.nih.gov/pubmed/35847601
http://dx.doi.org/10.1155/2022/8918020
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