港大教授发表医学文章指针灸可传播肝炎、艾滋病

　　香港大学微生物学系教授胡钊逸发表医学文章，指针灸可以传播乙型及丙型
肝炎，甚至是艾滋病。

　　胡钊逸在《英国医学杂志》表示，全球至今有50宗因为针灸感染细菌的病例
纪录，还有过5宗由于针灸导致乙型肝炎感染80多名患者的纪录。但相信只是冰
山一角。他指出，这些病例大多数涉及受污染的扎针，传播源头是另一位受感染
的病人。但也有一宗个案，传播源头是针灸师。

　　大部分被细菌感染的病人自动痊愈，但有5%至10%的患者出现严重问题，包
括关节受损、多个器官衰竭、肌肉腐烂，甚至瘫痪。

　　胡钊逸警告，针灸有可能还会传播丙型肝炎和艾滋病，建议针灸时使用一次
性的针，以及在施针前加强消毒皮肤，减低传播机会，有关单位应加强规管。

原始文献如下：

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. 
References
1. Izatt E, Fairman M. Staphylococcal septicaemia with 
disseminated intravascular coagulation associated with acupuncture. 
Postgrad Med J 1977;53:285-6.[Abstract/Free Full Text] 
2. Woo PC, Lau SK, Yuen KY. First report of methicillin-resistant 
Staphylococcus aureus septic arthritis complicating acupuncture: 
simple procedure resulting in most devastating outcome. Diagn 
Microbiol Infect Dis 2009;63:92-5.[CrossRef][Web of Science][Medline] 
3. Lee RJ, McIlwain JC. Subacute bacterial endocarditis following 
ear acupuncture. Int J Cardiol 1985;7:62-3.[CrossRef][Web of 
Science][Medline] 
4. Vucicevic Z, Sharma M, Miklic S, Ferencic Z. Multiloculated 
pleural empyema following acupuncture. N Engl J Med 
2004;350:1763.[Free Full Text] 
5. Boxall EH. Acupuncture hepatitis in the west Midlands, 1977. J 
Med Virol 1978;2:377-9.[CrossRef][Web of Science][Medline] 
6. Kent GP, Brondum J, Keenlyside RA, LaFazia LM, Scott HD. A 
large outbreak of acupuncture-associated hepatitis B. Am J Epidemiol 
1988;127:591-8.[Abstract/Free Full Text] 
7. Kweon SS, Shin MH, Song HJ, Jeon DY, Choi JS. Seroprevalence 
and risk factors for hepatitis C virus infection among female 
commercial sex workers in South Korea who are not intravenous drug 
users. Am J Trop Med Hyg 2006;74:1117-21.[Abstract/Free Full Text] 
8. Vittecoq D, Mettetal JF, Rouzioux C, Bach JF, Bouchen JP. 
Acute HIV infection after acupuncture treatments. N Engl J Med 
1989;320:250-1.[Web of Science][Medline] 
9. Woo PC, Li JH, Tang W, Yuen K. Acupuncture mycobacteriosis. N 
Engl J Med 2001;345:842-3.[Free Full Text] 
10. Woo PC, Leung KW, Wong SS, Chong KT, Cheung EY, Yuen KY. 
Relatively alcohol-resistant mycobacteria are emerging pathogens in 
patients receiving acupuncture treatment. J Clin Microbiol 
2002;40:1219-24.[Abstract/Free Full Text] 
11. Song JY, Sohn JW, Jeong HW, Cheong HJ, Kim WJ, Kim MJ. An 
outbreak of post-acupuncture cutaneous infection due to Mycobacterium 
abscessus. BMC Infect Dis 2006;6:6.[CrossRef][Medline] 
12. Tang P, Walsh S, Murray C, Alterman C, Varia M, Broukhanski G, 
et al. Outbreak of acupuncture-associated cutaneous Mycobacterium 
abscessus infections. J Cutan Med Surg 2006;10:166-9.[Web of 
Science][Medline]