Abscesses due to mycobacterium abscessus linked to injection of unapproved alternative medication

Area of Science:

• Infectious Diseases
• Public Health
• Microbiology

Background:

• An unlicensed injectable medicine, adrenal cortex extract (ACE), distributed within alternative medicine circles, has been linked to a significant outbreak of Mycobacterium abscessus infections in the US.
• This outbreak represents the largest reported incidence of Mycobacterium abscessus infections associated with a single product.

Purpose of the Study:

• To identify the source and extent of the Mycobacterium abscessus outbreak linked to adrenal cortex extract (ACE).
• To investigate the contamination of ACE with Mycobacterium abscessus and its role in causing post-injection abscesses.

Main Methods:

• Utilized distributor records (January 1995–August 1996) to identify ACE purchasers.
• Conducted interviews with purchasers and patients, and reviewed medical records.
• Performed mycobacterial cultures on ACE vials and patient samples, with identification confirmed by enzymatic and molecular typing.

Main Results:

• Adrenal cortex extract (ACE) was distributed to 148 purchasers across 30 states.
• Identified 87 individuals with post-injection abscesses directly attributable to the contaminated ACE product.
• Mycobacterium abscessus strains from patients and ACE vials were found to be identical, confirming the product as the source.

Conclusions:

• Unlicensed injectable products, such as adrenal cortex extract (ACE), can harbor and disseminate dangerous pathogens like Mycobacterium abscessus.
• Healthcare providers should consider unusual infectious agents and alternative health practices when diagnosing infections that do not respond to standard treatments.
• The findings underscore the importance of regulatory oversight for alternative medicine products to prevent public health crises.