The authors of this editorial, from the University of Hong Kong, discuss the risk of infections with acupuncture, noting that they are under-diagnosed and therefore clinicians should have a high index of suspicion.

As needles are inserted up to several centimetres below the skin, acupuncture may pose an infection risk.  So far, over 50 cases of infection with pyogenic bacteria have been described globally; in most cases the bacteria were transmitted from the patient’s skin or environment due to inadequate skin disinfection prior to acupuncture.  The majority of these cases had musculoskeleal or skin infections (corresponding to the site of insertion); a minority had others, including for example endocarditis and meningitis.  5-10% died from the infections and at least another 10% had serious consequences.

In addition to pyogenic bacteria, other infections reported have included hepatitis B (five outbreaks affecting over 80 patients described globally since the 1970s).  These cases involved transmission from an infected person due to improper sterilisation of acupuncture needles. Acupuncture has been found to be an independent risk factor for hepatitis C virus infections; no clear evidence exists for HIV at present.

The authors go on to discuss acupuncturemycobacteriosis - a new clinical syndrome has emerged in the 21st century.  This is thought to be mainly cause by rapid growing mycobacteria, thought to be transmitted via contaminated equipment.  It has been associated with two large outbreaks, as the infection has a long incubation period and the diagnosis is difficult.

The first reports of MRSA transmitted by acupuncture have now started to emerge; the authors say that infection control measures should be implemented and stricter regulation and accreditation requirements are needed.