By Stan Deresinski, MD, FACP, FIDSA

Clinical Professor of Medicine, Stanford University

Dr. Deresinski reports no financial relationships relevant to this field of study.

SYNOPSIS: Infections are a potential complication associated with medical tourism — something that both patients and clinicians must consider.

SOURCE: Pavli A, Maltezou HC. Infectious complications related to medical tourism. J Travel Med 2020; Nov 7:taaa210. doi: 10.1093/jtm/taaa210. [Online ahead of print].

Pavli and Maltezou have summarized the literature describing infectious complications in medical tourists individuals who travel to another country to receive medical or surgical care.

A frequent reason for medical tourism in those reported to have experienced a resultant infectious complication was cosmetic surgery, with breast augmentation accounting for 70.4% of these. Other cosmetic procedures included gluteal augmentation, abdominoplasty, liposuction, blepharoplasty, and rhinoplasty. Infection involved the surgical wound in 89% of cases and non-tuberculous mycobacteria, including Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium senegalese, Mycobacterium fortuitum, often were identified in these published case series. Countries where the surgery was been performed included the Dominican Republic, Brazil, Venezuela, Ecuador, and Mexico, as well as countries in Southeast Asia.

Solid organ transplantation, most often renal transplantation, was another reason for medical tourism, with most performed in the Indian subcontinent, followed by China and Southeast Asia. In addition to the almost expected infections with, e.g., cytomegalovirus, acquired infections included those caused by hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV), in addition to various bacterial and fungal infections.

COMMENTARY

Medical tourism is increasingly popular, driven primarily by financial considerations, possibly particularly in citizens of the United States. In addition to cosmetic and transplant surgery, other reasons for medical tourism include dental services, bariatric surgery, and management of infertility. Although some such tourism entails travel to European countries and the United States, destinations also include middle- and even low-income countries.

Overall, two-thirds of infections involved surgical wounds, while the remainder were caused by bloodborne pathogens. Infection with multidrug resistant (MDR) organisms, including non-tuberculous mycobacteria as well as resistant Gram-negative bacteria, frequently were reported. The latter included carbapenemase-producing Enterobacteriales, such as those carrying New Delhi metallo-beta-lactamase.

Since many of these infections present after patients return home, clinicians must be aware of the risk — especially of the presence of multidrug-resistant pathogens. Recognition of the risk of the presence of such pathogens is critically important for both therapeutic and infection control reasons. Patients traveling for medical tourism should be aware of the potential hazards and take precautions, including undergoing pre-travel consultation.