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Invasive Mycobacterium abscessus Outbreak at a Pediatric Dental Clinic
Jasjit Singh1, Kathleen O'Donnell2, Delma J Nieves1
1Department of Pediatric Infectious Diseases, Children's Hospital of Orange County, Orange, California, USA.
Open Forum Infectious Diseases
|June 11, 2021
Summary
This study details a large outbreak of Mycobacterium abscessus and Mycobacterium chelonae (MABs) infections in children following dental procedures. The infections led to significant health issues and treatment complications, highlighting the need for improved dental water quality standards.
Area of Science:
- Infectious Diseases
- Public Health
- Dental Medicine
Background:
- Mycobacterium abscessus and Mycobacterium chelonae (MABs) are waterborne pathogens that can cause serious healthcare-associated infections.
- MAB infections are uncommon but can lead to significant morbidity and complex treatment challenges.
Purpose of the Study:
- To investigate an outbreak of odontogenic MAB infections in pediatric patients following pulpotomy procedures.
- To identify the scope, clinical characteristics, and outcomes of MAB infections linked to a dental practice.
Main Methods:
- Retrospective case identification using culture data, imaging, and pathology from January to September 2016.
- Extraction of epidemiologic and clinical data, including demographics, symptoms, treatments, and outcomes.
- Analysis of 71 confirmed and probable MAB infection cases among 1082 at-risk patients.
Main Results:
- 71 pediatric patients developed MAB infections with a median symptom onset of 85 days post-pulpotomy.
- Infections manifested as pain, swelling, and imaging abnormalities (mandible/maxilla, lymphadenopathy, pulmonary nodules).
- Treatment involved prolonged intravenous antibiotics and clofazimine, associated with adverse effects; however, patients showed signs of healing at 1-year follow-up.
Conclusions:
- This represents the largest MAB infection outbreak linked to a pediatric dental practice, causing significant medical and surgical consequences, including tooth loss.
- The outbreak prompted changes in California's dental water standards.
- Enhanced national dental water quality standards are crucial to prevent future MAB outbreaks in dental settings.
