港大教授發表醫學文章指針灸可傳播肝炎、艾滋病

　　香港大學微生物學系教授胡釗逸發表醫學文章，指針灸可以傳播乙型及丙型
肝炎，甚至是艾滋病。

　　胡釗逸在《英國醫學雜誌》表示，全球至今有50宗因為針灸感染細菌的病例
紀錄，還有過5宗由於針灸導致乙型肝炎感染80多名患者的紀錄。但相信只是冰
山一角。他指出，這些病例大多數涉及受污染的扎針，傳播源頭是另一位受感染
的病人。但也有一宗個案，傳播源頭是針灸師。

　　大部分被細菌感染的病人自動痊癒，但有5%至10%的患者出現嚴重問題，包
括關節受損、多個器官衰竭、肌肉腐爛，甚至癱瘓。

　　胡釗逸警告，針灸有可能還會傳播丙型肝炎和艾滋病，建議針灸時使用一次
性的針，以及在施針前加強消毒皮膚，減低傳播機會，有關單位應加強規管。

原始文獻如下：

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. 
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