Editor’s Be aware: This story was up to date at 3:50pm
An investigation by clinicians and public well being officers from Colorado and Arizona has linked a cluster of antibiotic-resistant infections in three US residents to embryonic stem-cell injections at clinics in Mexico.
In a report revealed as we speak in Morbidity and Mortality Weekly Report (MMWR), the investigators stated the infections had been attributable to Mycobacterium abscessus, an intrinsically drug-resistant species of nontuberculosis mycobacterium that has beforehand been related to medical tourism. The primary affected person, a Colorado girl (affected person A) with a number of sclerosis, was handled for M abscessus meningitis at two Colorado hospitals (hospitals A and B) in November-December 2022 following an intrathecal donor stem-cell injection in Baja California, Mexico, in October 2022.
Two further sufferers had been recognized at hospital B—Nationwide Jewish Well being in Denver—within the spring of 2023. The primary (affected person B) was a person from Arizona who developed a proper elbow osteoarticular an infection following a donor stem-cell injection for psoriatic arthritis at a special clinic in Baja in April 2022. The second was a Colorado man (affected person C) who developed infections in each knees after receiving stem-cell injections in his knees at a clinic in Guadalajara in October 2022.
“As a world-renowned referral heart for sufferers with mycobacterial illnesses, we see sufferers from all around the nation, and we seen a development of sufferers getting this explicit an infection after stem cell injections had been carried out exterior the U.S.,” Charles Daley, MD, an writer of the report and head of the division of mycobacterial and respiratory infections at Nationwide Jewish Well being, stated in a hospital press launch.
All three sufferers had been nonetheless present process remedy as of March. No further instances have been recognized.
Widespread supply is suspected
Daly and his colleagues subsequently carried out whole-gene sequencing (WGS) and phylogenetic evaluation of isolates from sufferers A and B and located that each had been clonal M abscessus subspecies massiliense, practically an identical (with just one single nucleotide polymorphism between the core genomes), and distinct from dominant circulating clones, regardless that the clinics had been 167 miles aside. That is after they notified state public well being officers and the Facilities for Illness Management and Prevention (CDC).
The authors of the report suspect the infections in affected person A and B may have been attributable to a typical contaminated supply (such because the product, reagents, or gear used within the procedures). Makes an attempt by the Colorado Division of Public Well being and Surroundings to establish the product and collect extra details about its administration have been unsuccessful, they stated. The subsequent steps shall be to carry out WGS on isolates from affected person C and conduct potential case discovering.
“Suppliers and public well being businesses want to concentrate on the chance for M. abscessus infections from stem cell remedies for indications not permitted by the Meals and Drug Administration and keep vigilance for comparable instances,” the authors wrote. “Additionally they are suggested to supply steering for individuals contemplating medical tourism.”
Infections are among the many many issues skilled by US residents who journey overseas for medical care. In a 2016 investigation reported in MMWR, CDC investigators described a multistate outbreak of M abscessus infections in 21 individuals who had undergone beauty surgical procedure within the Dominican Republic. The CDC urges anybody who’s contemplating medical tourism to seek the advice of their physician first.
Suppliers and public well being businesses want to concentrate on the chance for M. abscessus infections from stem cell remedies for indications not permitted by the Meals and Drug Administration and keep vigilance for comparable instances.
