With the increased popularity of and access to elective cosmetic procedures, there has been a rise in skin and soft tissue infections caused by nontuberculous mycobacteria due to nonsterile equipment and conditions. Though these conditions can occur anywhere and, in any facility, with the proliferation of medical tourism (where a patient travels for less expensive cosmetic procedures), the number of infection cases has sharply increased.
In everything from injections and fat transfers to face lifts, butt lifts and breast reduction or augmentation surgery, some patients end up with severe NTM infections in their skin and tissue which often leave them with permanent disfigurement.
Because so many surgical and injection procedures involve the use of water, which is known to harbor nontuberculous mycobacteria, healthcare providers here and in other countries are seeing more extrapulmonary NTM infections, particularly involving rapid-growing species such as M. abscessus, M. chelonae, and M. fortuitum. Many outbreaks have been traced to inadequate sterilization procedures.
The U.S. Centers for Disease Control (CDC) previously investigated and identified a large outbreak of NTM infection linked to a cosmetic surgery facility in the Dominican Republic.
More recently, the CDC reported on a cluster of 15 cases involving patients from all over the United States who traveled to Florida for cosmetic procedures at a clinic later identified to be the source of the infection.
As a patient, if you are considering any kind of cosmetic procedure, you should be fully aware beforehand of all the risks and ensure any facility or practitioner you use takes every precaution to maintain a sterile field, sterile equipment, and sterile implants or injectables. If you start to see swelling, redness, pain, or discharge from the site(s) of the procedure, seek medical attention immediately and let the treating physician know that you recently had a cosmetic procedure.
As a provider, if you have a patient who has undergone a cosmetic procedure and begins exhibiting symptoms of infection, you should have a high index of suspicion for NTM infection and order the appropriate AFB smear and culture testing. You should also familiarize yourself with the threshold for reporting these cases to public health officials.
These infections can take weeks or even months to develop and become symptomatic, so do not rule out the possibility of NTM infection based solely on the time from procedure to onset of symptoms.
