Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated with Medical Tourism to the Dominican Republic, 2013–20141
David Schnabel
, Douglas H. Esposito, Joanna Gaines, Alison Ridpath, M. Anita Barry, Katherine A. Feldman, Jocelyn Mullins, Rachel Burns, Nina Ahmad, Edith N. Nyangoma, Duc T. Nguyen, Joseph F. Perz, Heather Moulton-Meissner, Bette J. Jensen, Ying Lin, Leah Posivak-Khouly, Nisha Jani, Oliver Morgan, Gary W. Brunette, P. Scott Pritchard, Adena H. Greenbaum, Susan M. Rhee, David Blythe, Mark Sotir, and the RGM Outbreak Investigation Team
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (D. Schnabel, D.H. Esposito, J. Gaines, A. Ridpath, J. Mullins, N. Ahmad, E.N. Nyangoma, D.B. Nguyen, J.F. Perz, H.A. Moulton-Meissner, B.J. Jensen, O.W. Morgan, G.W. Brunette, M. Sotir); Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA (D. Schnabel, K.A. Feldman, D. Blythe); New York City Department of Health and Mental Hygiene, New York, New York, USA (A. Ridpath, Y. Lin); Boston Public Health Commission, Boston, Massachusetts, USA (M.A. Barry); Connecticut Department of Public Health, Hartford, Connecticut, USA (J. Mullins); Massachusetts Department of Public Health, Boston (R. Burns); New York State Department of Health, Albany, New York (N. Ahmad); Montgomery County Health Department, Norristown, Pennsylvania, USA (L. Posivak-Khouly); Newark Department of Child and Family Well-Being, Newark, New Jersey, USA (N. Jani); Florida Department of Health, Tallahassee, Florida, USA (P.S. Pritchard); Johns Hopkins Hospital, Baltimore (A.H. Greenbaum); Johns Hopkins Bayview Medical Center, Baltimore (S.M. Rhee)
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Figure 1
Figure 1. Dendrogram of rapidly growing mycobacteria in surgical site infections among patients in the US associated with medical tourism to the Dominican Republic, 2013–2014. Patients were exposed in 5 known clinics and 1 unknown clinic (data not shown). Pulsed-field gel electrophoresis band patterns for available Mycobacterium abscessus complex isolates were restricted with the Asel enzyme and run at 3 and 20 seconds for 20 hours. Isolates with indistinguishable band patterns are labelled cluster A. Case ID indicates US location and patient case number. ID, identification; NYC, New York City; NYS, state of New York.
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