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Physician Advisory: Infections Reported Following Cosmetic Surgeries

The New Jersey Department of Health and Senior Services (NJDHSS) has become aware of four cases of cellulitis/subcutaneous abscess formation in patients who received injections of unknown substances into the buttocks for cosmetic purposes. All of the cases are young females residing in Essex and Union Counties. Although NJDHSS and the local health officials are actively investigating the four reported cases, the information provided to date suggests that the injections may have been performed by unlicensed individuals. Similar cases in the past have been reported in other states and countries: several transgender individuals have developed infections after receiving cosmetic injections.

Preliminary microbiologic data suggests Nocardia spp. as the causative organism in two of the four New Jersey cases. Although health care providers evaluating individuals with infections following such injections should consider typical organisms such as Streptococcus and Staphylococcus, atypical organisms such as Nocardia spp. and Mycobacterium spp. should also be included in the differential. These atypical organisms can often present with more indolent skin lesions and do not respond to the usual empiric antimicrobial regimens.

Mycobacteria inadvertently injected during various cosmetic procedures are well documented. An outbreak of Mycobacterium abscessus was reported in New York City in 2002. The cases had received injections in residential settings using non-FDA-approved substances by unlicensed practitioners. Other cases have involved Mycobacterium chelonae.

NJDHSS considers it likely that there are other unreported cases in New Jersey. To identify additional cases and to ensure appropriate management, we are asking health care providers to:

  • Report any cases of cellulitis, soft tissue infection or subcutaneous abscess that may be due to injection of foreign substances by unlicensed practitioners regardless of culture results since August 1, 2009.
  • Report any cases of cellulitis, soft tissue infection or subcutaneous abscess in which typical organisms or atypical organisms (including Nocardia, M. abscessus, M. chelonae and M. fortuitum) have been isolated since August 1, 2009:
  • Ensure that specimens are sent to the laboratory and appropriate testing done to identify typical as well as atypical organisms such as Nocardia spp. and Mycobacterium spp.: and
  • Ensure that patients are placed on appropriate antimicrobial regimens.

Cases should be immediately reported to the local health department responsible for the jurisdiction in which the case resides or directly to the NJDHSS Communicable Disease Service at 609-826-5964. Updates regarding this investigation will be provided as details become available.


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