Infections by acupuncture are underdiagnosed worldwide – as the microbiologist Patrick Woo at the Hong Kong University and colleagues warn in an editorial of the British Medical Journal. They describe infection cases since the seventies as well as infection types and –sources.
Infections: From skin to HIV
Accordingly acupuncture needles do not only serve harmonization of the “Qi” when they are stung up to one centimeter into the skin. Needles and accessories, cotton swabs or towels can be contaminated with pathogenic micro-organisms thus transmitting infectious pathogens from tool to patient.
Most frequent infections described are those with pyogenic bacteria. In the seventies and eighties worldwide 50 cases were counted. Most of the infections with pyogenic organisms came from the skin flora of the acupunctured patient. Obviously the skin was not disinfected properly prior to treatment. In local infections, the typical meridian- and acupuncture-specific lesions appear. After acupuncture, abscesses and septic arthritides develop, more rarely associated diseases like endocarditis, meningitis, endophtalmitis and others.
In more than half of the cases the bad guy is: Staphylococcus aureus.
They describe more than 80 hepatitis B-infections. Patients were infected by not at all or not efficiently sterilized re-usable needles. In those cases of an outbreak, the acupuncturist was obviously the source of infection. Even hepatitis C and HIV can – hypothetically – be transmitted by acupuncture according to Woo. Epidemiological studies and case control studies discovered a correlation between acupuncture and hepatitis C. According to reports about cases of HIV they did not find any other risk factor than acupuncture. But on the other hand a few reports certainly are not enough evidence.
Acupuncture-mycobacteriosis as a new clinical syndrome
Acupuncture-mycobacteriosis is considered a new syndrome of this century, an infection of the skin with mycobacteria, transmitted by contaminated cotton swabs, towels or other material getting in touch with the puncture. Even weeks or months after the acupuncture, abscesses and ulcerative lesions can develop. The subtle start of the illness causes patients to visit their doctor rather later than sooner. Due to the delayed occurrence not every physicians comes to the conclusion that there might be a connection with an earlier acupuncture. During the period of examination two larger outbreaks of infection in relation to acupuncture occurred. Joon Young Song described one outbreak of cutaneous wound infection caused by mycobacteria of patients treated by a physician in Seoul in 2010 in the professional journal BMC Infectious Diseases.
The infections mentioned might be only the tip of the iceberg though, as Woo assumes. He demands better infection control. In 2009, the first report on the transmission of the Methicillin-resistant staphylococcus aureus (MRSA) was published. A septic arthritis with destruction of joint cartilage and an osteomyelitis were caused by acupuncture.
Quality standards without control
The expert Mike Cummings of the British Association of Medical Acupuncturists estimates the risk for severe side effects at 1:200,000. Overall acupuncture is supposed to be very safe. Nonetheless there is no control in many countries, also in Great Britain. Everybody can work as an acupuncturist there. Here in Germany there is at least a qualification necessary. The question remains though: Should every acupuncturist just use disposable sterile needles which would exclude risk for infection? And does he or she feel obligated and bound to the existing quality criteria even beyond this or her training and qualification?