In an editorial published in the British Medical Journal, microbiologists at the University of Hong Kong said the number of reported acupuncture-related infections worldwide was the tip of an iceberg and they called for tighter infection control measures.
"To prevent infections transmitted by acupuncture, infection control measures should be implemented, such as use of disposable needles, skin disinfection procedures and aseptic techniques," wrote the researchers, led by Patrick Woo, microbiology professor at the University of Hong Kong.
"Stricter regulation and accreditation requirements are also needed," they added.
Acupuncture is one of the most widely practiced strands of alternative medicine and is based on the theory that inserting and manipulating fine needles at specific points in the body helps to promote the flow of "Qi" or energy.
It has its origins in ancient China and has become widely accepted in the West in recent decades particularly in the treatment of pain. It is also used for conditions like obesity, constipation and arthritis, among others, although documented scientific evidence for these are patchy.
Woo and his colleagues said acupuncture may be risky as needles are inserted up to several centimeters beneath the skin and they warned of a new syndrome — acupuncture mycobacteriosis — in the 21st century.
"This is an infection caused by mycobacteria that rapidly grow around the acupuncture insertion point as a result of contaminated cotton wool swabs, towels and hot-pack covers. There is a long incubation period but the infection usually leads to large abscesses and ulcers," they wrote.
"So far, more than 50 cases have been described globally. In most cases ... bacteria were transmitted from the patient's skin flora or the environment because of inadequate skin disinfection before acupuncture," they wrote.
While most patients recover from these bacterial infections, 5 to 10 percent of the reported bacterial infections end up with serious problems including joint destruction, multi-organ failure, flesh-eating disease and paralysis.
There have been at least five outbreaks of hepatitis B virus infection that are linked to acupuncture.
In most of these cases, the sources were infected patients and the virus was transmitted through dirty needles, although in one case, it was the acupuncturist who was the source, they said.
The paper also laid out the possibility of transmission of hepatitis C and HIV via acupuncture.
"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," it said.