Outbreak of Tattoo-associated Nontuberculous Mycobacterial Skin Infections

Abstract

Background On 29 April 2015, the Florida Department of Health in Miami-Dade County (DOH Miami-Dade) was notified by a local dermatologist of 3 patients with suspected nontuberculous mycobacterial (NTM) infection after receiving tattoos at a local tattoo studio. Methods DOH Miami-Dade conducted interviews and offered testing, described below, to tattoo studio clients reporting rashes. Culture of clinical isolates and identification were performed at the Florida Bureau of Public Health Laboratories. Characterization of NTM was performed by the Centers for Disease Control and Prevention and the US Food and Drug Administration (FDA), respectively. Whole-genome sequencing (WGS) and single-nucleotide polymorphism (SNP) analyses were used to construct a phylogeny among 21 Mycobacterium isolates at the FDA. Results Thirty-eight of 226 interviewed clients were identified as outbreak-associated cases. Multivariate logistic regression revealed that individuals who reported gray tattoo ink in their tattoos were 8.2 times as likely to report a rash (95% confidence interval, 3.1–22.1). Multiple NTM species were identified in clinical and environmental specimens. Phylogenetic results from environmental samples and skin biopsies indicated that 2 Mycobacterium fortuitum isolates (graywash ink and a skin biopsy) and 11 Mycobacterium abscessus isolates (5 from the implicated bottle of graywash tattoo ink, 2 from tap water, and 4 from skin biopsies) were indistinguishable. In addition, Mycobacterium chelonae was isolated from 5 unopened bottles of graywash ink provided by 2 other tattoo studios in Miami-Dade County. Conclusions WGS and SNP analyses identified the tap water and the bottle of graywash tattoo ink as the sources of the NTM infections.

Cluster of Lymphadenitis due to Nontuberculous Mycobacterium in Children and Adolescents 8–15 Years of Age

“…Outbreaks in the community associated with common contaminated sources including swimming pools or ponds have been reported 2. NTM has also been known as an important source of healthcare-associated infection through contaminated medical equipment3 or via cosmetic procedures 45. NTM infection leads to four main clinical syndromes, including pulmonary disease, lymphadenitis, skin and soft tissue infection, and disseminated disease 13…”

Nontuberculous mycobacterial infections of the lower extremities: A 15-year experience

“…In 2000, an outbreak of furunculosis due to M. fortuitum was associated with whirlpool footbaths in nail salons in California [13]. In 2015, the Florida Department of Health in Miami-Dade County reported an outbreak of NTM-associated SSTIs that affected 38 people [14]. Whole-genome sequencing and single-nucleotide polymorphism analysis were used to identify isolates of M fortuitum, M abscessus , and M chelonae in tap water and contaminated greywash tattoo ink, which was identified as the source of infection at a local tattoo studio.…”

Nodules developing within a tattoo

“…Considering tattoo‐associated infections, species within the M. chelonae–M. abscessus complex are most commonly implicated 2 . Here we report a unique case of an atypical mycobacterial infection from a fairly new species discovered in the M. chelonae–M.…”

“…abscessus group, which includes closely related mycobacteria traced in environmental sources such as municipal water supplies 5 . Mycobacterial tattoo infections have also been linked to poor hygiene practices at tattoo parlors, including contaminated grey wash ink used for shading and creating depth 2 . It should be noted that exposure to fresh water shortly after tattoo procedures can lead to poor wound care, increasing the risk of infection over the tattoo site 6 .…”