Medical tourism raises questions that highlight the need for care and caution

The article by Greenfield and Pawsey highlights the risks associated with medical tourism which is increasingly common among Australians.1 Cosmetic procedures like tattooing also place people at high risk of acquiring such infections.

Within the past year, we treated six patients for skin and soft tissue infection with non-tuberculous mycobacterium (NTM) following their return from South-East Asia, where they underwent extensive tattooing in the same tattoo parlour. NTM were detected by polymerase chain reaction (PCR) in one patient and by culture and PCR in four of the six patients (three were infected with Mycobacterium fortuitum and two with M. mucogenicum). All received induction therapy with antimicrobials for 4 weeks, followed by oral therapy for 6 months.

We treated another case in which a patient had a surgical site infection with M. abscessus, which developed after a liposuction procedure in South-East Asia. In this case, a paradoxical reaction occurred during treatment, which required prolonged corticosteroid use. A local allergic reaction to a “dermal filler” (hydrocolloid) obtained from Asia developed following its cosmetic use in a patient. We also saw a case of fatal extended spectrum beta-lactamase-producing Escherichia coli septicaemia in a renal allograft recipient who had received the transplant in the Middle East.

Lower costs and comparatively high availability have been cited as main reasons for medical tourism.2,3 Preprocedural counselling and infection control standards are not always met overseas, and government regulation of such procedures is often sparse.2,4

Infections acquired in these countries are difficult to treat, as they often involve more atypical and resistant organisms.4 Infections and other complications associated with medical tourism therefore confer a significant financial burden on our local health care system. A prior history of overseas travel for treatment may not be readily volunteered by patients. It is therefore important to maintain a high index of suspicion when faced with atypical infections.