◇◇新语丝(www.xys.org)(xys4.dxiong.com)(www.xinyusi.info)(xys2.dropin.org)◇◇ 港大教授发表医学文章指针灸可传播肝炎、艾滋病 香港大学微生物学系教授胡钊逸发表医学文章，指针灸可以传播乙型及丙型 肝炎，甚至是艾滋病。 胡钊逸在《英国医学杂志》表示，全球至今有50宗因为针灸感染细菌的病例 纪录，还有过5宗由于针灸导致乙型肝炎感染80多名患者的纪录。但相信只是冰 山一角。他指出，这些病例大多数涉及受污染的扎针，传播源头是另一位受感染 的病人。但也有一宗个案，传播源头是针灸师。 大部分被细菌感染的病人自动痊愈，但有5%至10%的患者出现严重问题，包 括关节受损、多个器官衰竭、肌肉腐烂，甚至瘫痪。 胡钊逸警告，针灸有可能还会传播丙型肝炎和艾滋病，建议针灸时使用一次 性的针，以及在施针前加强消毒皮肤，减低传播机会，有关单位应加强规管。 原始文献如下： Published 18 March 2010, doi:10.1136/bmj.c1268 Cite this as: BMJ 2010;340:c1268 Editorials Acupuncture transmitted infections Are underdiagnosed, so clinicians should have a high index of suspicion Acupuncture, which is based on the theory that inserting and manipulating fine needles at specific acupuncture points located in a network of meridians will promote the harmonious flow of "Qi," is one of the most widely practised modalities of alternative medicine. Because needles are inserted up to several centimetres beneath the skin, acupuncture may pose risks to patients. One of the most important complications is transmission of pathogenic micro-organisms, from environment to patient or from one patient to another. In the 1970s and 1980s most infections associated with acupuncture were sporadic cases involving pyogenic bacteria.1 So far, more than 50 cases have been described globally. In most cases, pyogenic bacteria were transmitted from the patient’s skin flora or the environment because of inadequate skin disinfection before acupuncture. In localised infections, meridian specific and acupuncture point specific lesions were typical. About 70% of patients had musculoskeletal or skin infections, usually in the form of abscesses or septic arthritis, corresponding to the site of insertion of the acupuncture needles.1 2 A minority had infective endocarditis, meningitis, endophthalmitis, cervical spondylitis, retroperitoneal abscess, intra-abdominal abscess, or thoracic empyema.3 4 As in other musculoskeletal or skin infections, Staphylococcus aureus was the most common bacterium responsible, accounting for more than half of the reported cases.1 2 Although most patients recovered, 5-10% died of the infections and at least another 10% had serious consequences such as joint destruction, paraplegia, necrotising fasciitis, and multiorgan failure.1 2 Apart from pyogenic bacterial infections, five outbreaks of hepatitis B virus infection associated with acupuncture, which affected more than 80 patients, have been described globally since the 1970s.5 6 In most outbreaks the sources were infected patients, and the virus was transmitted from one patient to another through improperly sterilised or unsterilised reusable acupuncture needles, but in one outbreak an acupuncturist who was positive for hepatitis B surface antigen and hepatitis B e antigen was thought to be the source.5 6 The other two major bloodborne viruses, hepatitis C virus and HIV, could hypothetically be transmitted by acupuncture. Most evidence for the association of hepatitis C virus infection with acupuncture came from epidemiological and case-control studies, where acupuncture was found to be an independent risk factor for hepatitis C virus infections.7 Although no clear evidence exists to support a link between acupuncture and HIV infection, there are reports of patients with HIV who had no risk factors other than acupuncture.8 A new clinical syndrome has emerged in the 21st century—acupuncture mycobacteriosis—which is mainly caused by rapidly growing mycobacteria.9 These mycobacteria are thought to be transmitted from the environment to patients via contaminated equipment used in acupuncture, such as cottonwool swabs, towels, hot pack covers, and boiling tanks. All mycobacterial infections associated with acupuncture so far have been characterised by localised meridian specific and acupuncture point specific lesions without dissemination.9 10 The lesions usually first appear as erythematous papules and nodules that subsequently develop into large pustules, abscesses, and ulcerative lesions after several weeks to months. Patients tended to delay seeking medical advice because of the slowly developing and relatively mild symptoms. Owing to the relatively hardy nature of mycobacteria,10 the long incubation period of the infection, and the difficulty in making a diagnosis, mycobacteria have caused two large outbreaks associated with acupuncture, which affected more than 70 patients.11 12 The case reports and outbreaks of acupuncture transmitted infections may be the tip of the iceberg. The first reports of meticillin resistant S aureus (MRSA) transmitted by acupuncture appeared in 2009.2 The emergence of community associated MRSA infections may aggravate the problem. To prevent infections transmitted by acupuncture, infection control measures should be implemented, such as use of disposable needles, skin disinfection procedures, and aseptic techniques. Stricter regulation and accreditation requirements are also needed. Clinicians should also have a high index of suspicion, particularly for viral and mycobacterial infections transmitted by acupuncture because of their prolonged incubation periods, and they should alert health authorities about clusters of cases. Cite this as: BMJ 2010;340:c1268 Patrick C Y Woo, professor, Ada W C Lin, specialist, Susanna K P Lau, associate professor, Kwok-Yung Yuen, chair of infectious diseases 1 Department of Microbiology, University of Hong Kong, Hong Kong pcywoo@hkucc.hku.hk Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that all authors had: (1) No financial support for the submitted work from anyone other than their employer; (2) No financial relationships with commercial entities that might have an interest in the submitted work; (3) No spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; (4) No non-financial interests that may be relevant to the submitted work. Provenance and peer review: Not commissioned; externally peer reviewed. References 1. Izatt E, Fairman M. Staphylococcal septicaemia with disseminated intravascular coagulation associated with acupuncture. Postgrad Med J 1977;53:285-6.[Abstract/Free Full Text] 2. Woo PC, Lau SK, Yuen KY. First report of methicillin-resistant Staphylococcus aureus septic arthritis complicating acupuncture: simple procedure resulting in most devastating outcome. Diagn Microbiol Infect Dis 2009;63:92-5.[CrossRef][Web of Science][Medline] 3. Lee RJ, McIlwain JC. Subacute bacterial endocarditis following ear acupuncture. Int J Cardiol 1985;7:62-3.[CrossRef][Web of Science][Medline] 4. Vucicevic Z, Sharma M, Miklic S, Ferencic Z. Multiloculated pleural empyema following acupuncture. N Engl J Med 2004;350:1763.[Free Full Text] 5. Boxall EH. Acupuncture hepatitis in the west Midlands, 1977. J Med Virol 1978;2:377-9.[CrossRef][Web of Science][Medline] 6. Kent GP, Brondum J, Keenlyside RA, LaFazia LM, Scott HD. A large outbreak of acupuncture-associated hepatitis B. Am J Epidemiol 1988;127:591-8.[Abstract/Free Full Text] 7. Kweon SS, Shin MH, Song HJ, Jeon DY, Choi JS. Seroprevalence and risk factors for hepatitis C virus infection among female commercial sex workers in South Korea who are not intravenous drug users. Am J Trop Med Hyg 2006;74:1117-21.[Abstract/Free Full Text] 8. Vittecoq D, Mettetal JF, Rouzioux C, Bach JF, Bouchen JP. Acute HIV infection after acupuncture treatments. N Engl J Med 1989;320:250-1.[Web of Science][Medline] 9. Woo PC, Li JH, Tang W, Yuen K. Acupuncture mycobacteriosis. N Engl J Med 2001;345:842-3.[Free Full Text] 10. Woo PC, Leung KW, Wong SS, Chong KT, Cheung EY, Yuen KY. Relatively alcohol-resistant mycobacteria are emerging pathogens in patients receiving acupuncture treatment. J Clin Microbiol 2002;40:1219-24.[Abstract/Free Full Text] 11. Song JY, Sohn JW, Jeong HW, Cheong HJ, Kim WJ, Kim MJ. An outbreak of post-acupuncture cutaneous infection due to Mycobacterium abscessus. BMC Infect Dis 2006;6:6.[CrossRef][Medline] 12. Tang P, Walsh S, Murray C, Alterman C, Varia M, Broukhanski G, et al. Outbreak of acupuncture-associated cutaneous Mycobacterium abscessus infections. J Cutan Med Surg 2006;10:166-9.[Web of Science][Medline] (XYS20100320) ◇◇新语丝(www.xys.org)(xys4.dxiong.com)(www.xinyusi.info)(xys2.dropin.org)◇◇