course of acupuncture.^52 In another case two acquired immune deficiency
syndrome (AIDS) patients were strongly suspected of contracting their
condition as a result of acupuncture.^53 It must be stressed that due to lack of
information a direct causal link in this case could not be established. There
may also be some risk to the acupuncturist from treating a patient who
already has HIV.
Other infections
Other infections reported include those due to Pseudomonas spp. and
Staphylococcus aureus.^54
A recent report describes an outbreak of post-acupuncture cutaneous
infection due to Mycobacterium abcessusin Seoul, South Korea. The report
details a large outbreak of rapidly growing mycobacterial infection among
patients who received acupuncture at a single clinic and concludes that
physicians should suspect mycobacterial infections in patients with
persistent cutaneous infections after acupuncture, and infection control
education should be emphasised for acupuncturepractitioners.^55
Since the adoption of disposable needles and avoidance of touching the
needle shaft before insertion, the incidence of infection during needling is
likely to fall even more. It is no longer considered appropriate to use auto-
claves to sterilise acupuncture needles due to the validation problems asso-
ciated with bench-top autoclaves. The British Acupuncture Council (BAcC)
has a comprehensive code of safe practice that, among other things, gives
direction on clean needle technique.
Trauma
A number of cases of damage due to acupuncture needling, including
pneumothorax, cardiac tamponade and spinal cord damage, have been
reviewed.47,48Five fatalities have been reported, although the evidence that
acupuncture was solely to blame is compelling in only one of these cases,
involving a 40-year-old Norwegian woman whose heart was pierced by a
needle.^56 A case of spinal cord injury from a broken, small needle-knife
(known as Xiaozendao in Chinese) insertion into the spinal cord with
delayed onset of neurological symptoms has also been reported.^57
Local traumatic damage to blood vessels may produce a haematoma.
Other adverse effects
Other possible adverse reactions to acupuncture include cardiac arrhyth-
mias,^58 the triggering of asthma^59 and the exacerbation of symptoms.^59
Allergic reactions caused by the metal of the needles, particularly chrome and
140 | Traditional medicine