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Ren H, Xiao Y, Tang B, Shi Y, Zeng Z, Qiu X, Ding Y, Xiao R. The Price of Beauty: A Literature Review on Non-Tuberculous Mycobacteria Infection After Cosmetic Procedures. Aesthet Surg J 2024; 44:NP574-NP584. [PMID: 38591553 DOI: 10.1093/asj/sjae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
Non-tuberculous mycobacteria (NTM) infection of the skin and soft tissues is a complication of cosmetic procedures. The incidence of cutaneous NTM infections has increased significantly as aesthetic operations have become more commonplace. With the rise of cosmetic tourism, the geographic expansion of NTM infections is a major concern. Due to the unique pathogenesis of NTM infections, diagnosis and treatment remain significant challenges for clinicians. Clinical management relies on a combination of antibiotic therapy with drug susceptibility testing and appropriate surgical debridement. Some new drugs, photodynamic therapy, and bacteriophage therapy have been developed in recent years, and may improve the aesthetic outcomes. This review summarizes the cosmetic procedures prone to NTM infections in recent years and their clinical features. We propose a 2-stage treatment procedure, including a hospitalization phase and a follow-up phase. We aim to increase the alertness of clinicians to NTM infections for timely detection and treatment. LEVEL OF EVIDENCE: 3
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Ou Y, Liu D, Feng J, Xu X, Lin T, Zhang Y, Luo L, Wu M, Cui Y. Subcutaneous infection caused by Mycobacterium abscessus following botulinum toxin injections: A case report and literature review. J Cosmet Dermatol 2024; 23:1527-1532. [PMID: 38178368 DOI: 10.1111/jocd.16170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/30/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The rapid development of cosmetic injections has led to an increased incidence of nontuberculous mycobacterial (NTM) infection. PATIENTS AND METHODS Here, we presented a case of cutaneous Mycobacterium abscessus infection subsequent to botulinum toxin injection for treating masseter hypertrophy, and reviewed the literature on skin and soft tissue infections caused by NTM after cosmetic injections. RESULTS AND CONCLUSIONS The patient underwent surgical excision and regular antibiotic therapy and has had nearly 2 months of follow-up without any signs of infection. The diagnosis and treatment of NTM infection have always been challenging, and further research is needed to standardize and guide the treatment.
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MESH Headings
- Adult
- Female
- Humans
- Anti-Bacterial Agents/administration & dosage
- Anti-Bacterial Agents/adverse effects
- Anti-Bacterial Agents/therapeutic use
- Botulinum Toxins, Type A/adverse effects
- Botulinum Toxins, Type A/administration & dosage
- Cosmetic Techniques/adverse effects
- Hypertrophy
- Masseter Muscle/abnormalities
- Mycobacterium abscessus/isolation & purification
- Mycobacterium Infections, Nontuberculous/drug therapy
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium Infections, Nontuberculous/etiology
- Mycobacterium Infections, Nontuberculous/microbiology
- Skin Diseases, Bacterial/diagnosis
- Skin Diseases, Bacterial/microbiology
- Skin Diseases, Bacterial/drug therapy
- Skin Diseases, Bacterial/etiology
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Affiliation(s)
- Yanting Ou
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- Medical College, Shantou University, Shantou, China
| | - Dandan Liu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun Feng
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiangwen Xu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Tingyin Lin
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- Medical College, Shantou University, Shantou, China
| | - Yihan Zhang
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- Medical College, Shantou University, Shantou, China
| | - Lin Luo
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Mengfan Wu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yongyan Cui
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
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Shen H, Zhang Q, Peng L, Ma W, Guo J. Cutaneous Mycobacterium Abscessus Infection Following Plastic Surgery: Three Case Reports. Clin Cosmet Investig Dermatol 2024; 17:637-647. [PMID: 38505806 PMCID: PMC10949168 DOI: 10.2147/ccid.s445175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
Aim Mycobacterium abscessus is ubiquitous in the environment and seldom causes infections in immunocompetent individuals. However, skin and soft tissue infections caused by M. abscessus have been reported in recent years. Additionally, the cutaneous infections or outbreaks post cosmetic surgery caused by M. abscessus have been increasing due to the popularity of plastic surgery. The main modes of transmission are through contaminated saline, disinfectants, or surgery equipment, as well as close contact between patients. This article describes three patients who were admitted to our hospital between November 2019 and October 2020. They presented with long-term non-healing wounds caused by M. abscessus infection after undergoing plastic surgery. Symptoms presented by the three patients included swelling, ulceration, secretion, and pain. After identification of M. abscessus with Ziehl-Neelsen staining and MALDI-TOF MS system, the patients were treated with surgical debridement and clarithromycin. Conclusion It is important to note that a long-term wound that does not heal, especially after plastic surgery, should raise suspicion for M. abscessus infection. The infection mechanism in these three patients may have been due to exposure to surgical equipment that was not properly sterilized or due to poor sterile technique by the plastic surgeon. To prevent such infections, it is important to ensure proper sterilization of surgical equipment and saline.
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Affiliation(s)
- Hongwei Shen
- Clinical Laboratory, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, People’s Republic of China
| | - Qiaomin Zhang
- Clinical Laboratory, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, People’s Republic of China
| | - Liang Peng
- Department of Burns and Plastic Surgery, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, People’s Republic of China
| | - Wen Ma
- Clinical Laboratory, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, People’s Republic of China
| | - Jingdong Guo
- Department of Burns and Plastic Surgery, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, People’s Republic of China
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Zhang X, Feng Y, Li D, Han J, Shi D. Scalp Infection Caused by Mycobacterium abscessus Manifested as Patchy Alopecia in an Immunocompetent Female. Infect Drug Resist 2023; 16:5413-5419. [PMID: 37614680 PMCID: PMC10443697 DOI: 10.2147/idr.s416974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
Mycobacterium abscessus (M. abscessus) is a fast-growing, non-tuberculous mycobacterium (NTM) that can cause human infections varying from superficial infection to pulmonary or even systemic infections. The latter is more commonly appeared in immunocompromised patients. The skin infection caused by M. abscessus often appears after trauma or surgical procedure. It is often manifested by subcutaneous nodules, papules, erythema, tender erythematous or violaceous plaques, cellulitis, abscesses, ulcerations, and draining sinuses. Herein, we present a non-typical cutaneous manifestation of M. abscessus infection in a 46-year-old woman who presented with alopecia on the scalp with no itching or pain. The pathogen was isolated and identified as M. abscessus by morphology and DNA sequencing. To our best knowledge, there was no report that this organism could cause skin lesions mimicking patchy alopecia. After 3 months of antibacterial treatment, the cutaneous lesion disappeared, and new growth of hair occurred in this patient.
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Affiliation(s)
- Xiaoyu Zhang
- School of Clinical Medicine, Weifang Medical University, Weifang, People’s Republic of China
| | - Yahui Feng
- Laboratory of Medical Mycology, Jining No. 1 People’s Hospital, Jining, People’s Republic of China
| | - Dongmei Li
- Department of Microbiology & Immunology, Georgetown University Medical Center, Washington, DC, USA
| | - Jingjian Han
- Department of Medical Cosmetology, Jining No. 1 People’s Hospital, Jining, People’s Republic of China
| | - Dongmei Shi
- Laboratory of Medical Mycology, Jining No. 1 People’s Hospital, Jining, People’s Republic of China
- Department of Dermatology, Jining No. 1 People’s Hospital, Jining, People’s Republic of China
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Yu Q, Wang Y, Gao Z, Yang H, Liu S, Tan J, Yang L. DNA microarray chip assay in new use: early diagnostic value in cutaneous mycobacterial infection. Front Cell Infect Microbiol 2023; 13:1183078. [PMID: 37457951 PMCID: PMC10349391 DOI: 10.3389/fcimb.2023.1183078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction The clinical practicability of DNA microarray chip in detecting the presence of mycobacterial species/isolates directly in the skin tissues has not been evaluated, nor the efficacy of DNA microarray chip as a novel diagnostic tool for the early diagnosis of cutaneous mycobacterial infections is known. Methods The present study analyzed the incidence of cutaneous mycobacterial infections in Shanghai and explored the efficacy of a novel DNA microarray chip assay for the clinical diagnosis of the disease from skin tissue specimens compared to traditional detection methods. A total of 60 participants fulfilling the defined diagnostic criteria and confirmed positive for cutaneous mycobacterial infections from 2019 to 2021 were enrolled in the study. Subsequent to recording the participants' medical history and clinical characteristics, the skin tissue specimens were collected for analyses. The specimens underwent histopathological analyses, skin tissue culture, and DNA microarray chip assay. Results Increased incidence of cutaneous mycobacterial infection was detected from 2019 to 2021. The most common infecting pathogen was M. marinum followed by M. abscessus. The sensitivity, specificity and accuracy of the skin tissue culture method were 70%, 100% and 76.62%, respectively, while that of the DNA microarray chip assay were 91.67%, 100% and 93.51%, respectively. The sensitivity and accuracy of the DNA microarray chip assay were significantly higher than those of the skin tissue culture method. The positive likelihood and diagnostic odds ratio were >10 and >1, respectively for both the methods. The negative likelihood ratio was significantly higher (30% vs 8.33%) and the Youden's index was significantly lower (70.00% vs 91.67%) in the skin culture method compared to that of the DNA microarray chip assay. There was a significant association of false negative results with a history of antibiotic use in the skin tissue culture method. Discussion Given the increasing incidence of cutaneous mycobacterial infections, early diagnosis remains a prime clinical focus. The DNA microarray chip assay provides a simple, rapid, high-throughput, and reliable method for the diagnosis of cutaneous mycobacterial infections with potential for clinical application.
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Guidance on the treatment of rare deep subcutaneous mycobacterium abscess following cosmetic procedures: a case series and systematic review of the literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.1007/s00238-023-02053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Liu Y, Chen Y. Surgical Treatment for Cutaneous Mycobacterium abscessus Infection Caused by Injections of Hyaluronic Acid. Clin Cosmet Investig Dermatol 2023; 16:687-692. [PMID: 36969385 PMCID: PMC10038003 DOI: 10.2147/ccid.s394594] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
Background Facial injection has become popular in aesthetic dermatology. Although injections of these tissue fillers are considered a low-risk procedure, they are not without potentially significant drawbacks. Case Presentation We would like to report a case about cutaneous Mycobacterium abscessus infection after facial injection of hyaluronic acid in China, which obtained satisfactory clinical efficacy by drainage and surgical excision. Conclusion Biological techniques are useful in the diagnosis of cutaneous M. abscessus infection. Surgical excision of skin lesion is effective for cutaneous M. abscessus infection.
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Affiliation(s)
- Yuanzhi Liu
- Department of Medical Cosmetology, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Yongjun Chen
- Department of Medical Cosmetology, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Yongjun Chen, Department of Medical Cosmetology, Dermatology Hospital, Southern Medical University, 2 Lujing Road, Yuexiu District, Guangzhou, 523326, Guangdong, People’s Republic of China, Tel/Fax +86 20-87257353, Email
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Mohanty M, Mishra B, Sirka CS, Mohapatra PR. Case Report: Multiple Scalp Abscesses due to Mycobacterium abscessus Infection Following Triamcinolone Injection in an Immunocompetent Person. Am J Trop Med Hyg 2022; 107:tpmd220126. [PMID: 35940200 PMCID: PMC9490647 DOI: 10.4269/ajtmh.22-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/03/2022] [Indexed: 11/07/2022] Open
Abstract
Mycobacterium abscessus complex is a group of nontuberculous mycobacteria (NTM). The NTM may involve skin, soft tissue, and other organs like the eye and central nervous system. Clinically may mimic multidrug resistance. Here, we present a case of a 29-year man with a history of multiple scalp swellings with mild symptoms. He had undergone multiple triamcinolone acetonide injections on his scalp to stop hair fall and baldness 2 months prior. As there was a history of injections on the scalp and lesions associated with minimal symptoms, we suspected the possibility of NTM and fungal infections. As a part of treatment and obtaining a sample for investigation, lesions were aspirated with a needle. The swellings contained gelatinous material, which was sent for microscopic examination, and revealed the presence of acid-fast bacilli (AFB). Xpert MTB/RIF assay was negative for mycobacteria (MTB complex), but culture revealed NTM, identified as M. abscessus complex by line probe assay. Based on the diagnosis, the patient was treated with an injection of amikacin, moxifloxacin, and azithromycin. The lesions improved. The patient has completed over a year of follow-up with no recurrence noted. Mycobacterium abscessus, a rapidly growing NTM, has been occasionally reported to cause cutaneous soft tissue infection when injected with nonsterile medicine or needles. Therefore, a high index of suspicion for NTM infection is warranted in patients with cutaneous scalp abscess following scalp injections for hair loss.
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Affiliation(s)
- Monalisa Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chandra Sekhar Sirka
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Deng L, Luo YZ, Liu F, Yu XH. Subcutaneous infection caused by Mycobacterium abscessus following cosmetic injections of botulinum toxin: A case report. World J Clin Cases 2022; 10:6141-6147. [PMID: 35949848 PMCID: PMC9254168 DOI: 10.12998/wjcc.v10.i18.6141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/27/2021] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, the cosmetic intervention related infections caused by nontuberculous mycobacteria (NTM) are increasing as the informal cosmetic treatments are performed. However, many dermatologists are inexperienced in the diagnosis and management of similar cases. Here we report a case of subcutaneous infection caused by Mycobacterium abscessus (M. abscessus) following cosmetic injections of botulinum toxin.
CASE SUMMARY A 53-year-old woman presented with multiple abscesses and nodules on her forehead and both temporal sites for half a month after cosmetic injections of botulinum toxin. Her lesions did not show any alleviation after 2-wk prescription of antibiotics. Laboratory examinations indicated that she had no sign of immunodeficiency and the whole body of computed tomography did not find any systemic infection or diseases. The pathology of skin tissue showed inflammatory cell infiltration with the negative results of Periodic acid Schiff (PAS) and Acid-fast staining and the culture yielded no microbiome. Afterwards, the puncture on abscess was performed and M. abscessus was successfully isolated. The pathogen was identified by acid-fast staining and DNA sequencing. The patient was treated with the strategy of clarithromycin, ofloxacin, and amikacin according to the result of drug sensitivity test and got complete remission of the lesions.
CONCLUSION The case presents the whole process of diagnosis and management of NTM infection after cosmetic intervention and highlights the diagnostic thoughts. In a word, the mycobacterium infection should be aware in patients after cosmetic performance.
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Affiliation(s)
- Lin Deng
- Department of Dermatology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Ying-Zhi Luo
- Department of Dermatology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Fang Liu
- Department of Dermatology, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
| | - Xiao-Hong Yu
- Department of Dermatology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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Chen CF, Liu J, Wang SS, Yao YF, Yu B, Hu XP. Mycobacterium abscessus infection after facial injection of argireline: A case report. World J Clin Cases 2021; 9:1996-2000. [PMID: 33748252 PMCID: PMC7953399 DOI: 10.12998/wjcc.v9.i8.1996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/14/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of infection with Mycobacterium abscessus (M. abscessus) has increased in recent years. This increase is partly associated with invasive cosmetic procedures.
CASE SUMMARY The purpose of this case summary is to increase clinicians' awareness of M. abscessus infection and reduce mycobacterial infection caused by cosmetic procedures. We report the case of a 45-year-old woman who received acetyl hexapeptide-8 (argireline) injections in the forehead and temples, and erythema, nodules, and abscesses appeared at the injection sites after one week. The pus specimens were examined by microbiological culture and confirmed to be positive for M. abscessus. Clarithromycin 500 mg twice daily and moxifloxacin 400 mg once daily were administered for 5 mo and the lesions gradually subsided.
CONCLUSION We report here for the first time a case of infection with M. abscessus after argireline injection. This condition is easily misdiagnosed as a common bacterial infection. Microbiological examinations are helpful for diagnosis and standardized cosmetic procedures can prevent infection with M. abscessus.
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Affiliation(s)
- Chao-Feng Chen
- Department of Dermatology & Venereology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Jie Liu
- Department of Dermatology & Venereology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Shuang-Shuang Wang
- Department of Dermatology & Venereology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Yu-Fang Yao
- Department of Dermatology & Venereology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Bo Yu
- Department of Dermatology & Venereology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Xiao-Ping Hu
- Department of Dermatology & Venereology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
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Chen X, Jin Y, Torres KMT, Li B, Zhuo F, Ding X, Cai L, Zhang J, Zhou C. Mycobacterium abscessus cutaneous infection secondary to botulinum toxin injection: A report of 2 cases. JAAD Case Rep 2019; 5:982-984. [PMID: 31709291 PMCID: PMC6834988 DOI: 10.1016/j.jdcr.2019.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Xi Chen
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Yan Jin
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Kara Melissa T Torres
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Bo Li
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Fenglin Zhuo
- Department of Dermatology, Beijing Friendship Hospital, Beijing, China
| | - Xiaolan Ding
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Lin Cai
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Cheng Zhou
- Department of Dermatology, Peking University People's Hospital, Beijing, China
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Mycobacterium abscessus Complex Cutaneous Infection. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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