The New Jersey Department of Health and Senior Services (NJDHSS) continues to investigate infections related to cosmetic injections. As of March 23, 2010, NJDHSS had been notified of eight cases of soft tissue infections following buttock injections for cosmetic purposes. Preliminary information suggests that the injections may have been performed by unlicensed medical providers. The NJDHSS, in conjunction with local health officials, is working with the NJ Department of Consumer Affairs and the U.S. Food and Drug Administration, Criminal Investigation Unit to identify the involved unlicensed provider(s) and implicated product.
All cases involve African-American women with a median age of 26 years (range: 22-42 years), residing in Essex, Morris and Union Counties. They reported receiving injections during November 2009–February 2010. The incubation periods range from 2 to 4 weeks. Two patients reported traveling to the Dominican Republic to receive the procedure. One patient reported receiving the injections in New York City (NYC), possibly in Brooklyn. Case-patients reported receiving injections of unknown substances, including “hydrogel” (2),”botox” (1), “gel filler” (2), and “biogel” (1) into the buttocks. They presented at local hospitals with cellulitis and abscesses at the injection sites; all required hospitalization. No deaths have been reported.
Preliminary microbiologic data suggest Nocardia spp. as the etiologic agent in 4 of the 6 patients that were injected in NJ. One patient that got injected in Dominican Republic had Rhodococcus equi identified and the second patient had Nocardia. Culture results are pending for the other cases. Though health-care providers evaluating persons with infections following such injections should consider typical organisms such as Streptococcus and Staphylococcus spp., atypical organisms such as Nocardia, Rhodococcus and Mycobacterium spp. should also be considered. Patients infected with these atypical organisms can often present with more indolent skin lesions and do not respond to the usual empiric antimicrobial regimens.
NJDHSS considers it likely that there are other unreported cases. To identify additional cases and to ensure appropriate management, health-care providers are asked to:
Report any cases of cellulitis, soft tissue infection, or subcutaneous abscess that may be caused by injection of foreign substances, regardless of culture results, since August 1, 2009. This especially applies if atypical organisms (including Nocardia, Rhodococcus, M. abscessus, M. chelonae, and M. fortuitum) have been isolated or suspected.
Ensure that specimens are sent to the laboratory and appropriate testing is done to identify typical as well as atypical organisms such as Nocardia, Rhodococcus and Mycobacterium spp.
Ensure that patients are placed on appropriate antimicrobial regimens.
Providers identifying cases that meet the above clinical and epidemiologic features are asked to report to the local health department responsible for the jurisdiction in which the case-patient resides or directly to the NJDHSS Communicable Disease Service at 609-826-5964. A directory of the Local Health Departments in NJ can be found by clicking on the following link: http://www.state.nj.us/health/lh/directory/lhdselectcounty.shtml.