Outbreak of Tattoo-Associated Nontuberculous Mycobacterial Skin Infections.

Authors:
Isabel Griffin
Isabel Griffin
Florida International University
Pensacola | United States
Ann Schmitz
Ann Schmitz
University of Bonn Medical Center
Germany
Christine Oliver
Christine Oliver
CSIRO Food & Nutrition Flagship
Scott Pritchard
Scott Pritchard
Duke University Medical Center
United States
Guoyan Zhang
Guoyan Zhang
University of Miami Miller School of Medicine
United States
Emily Davenport
Emily Davenport
Iowa State University
United States
Anthoni Llau
Anthoni Llau
Florida International University

Clin Infect Dis 2018 Nov 17. Epub 2018 Nov 17.

Florida Department of Health in Miami-Dade County, Epidemiology, Disease Control, and Immunization Services, Miami, FL, USA.

Background: On April 29, 2015, the Florida Department of Health in Miami-Dade County (DOH-Miami-Dade) was notified by a local dermatologist of three patients with suspect 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 (BPHL). Characterization of NTM was performed by the Centers for Disease Control and Prevention (CDC) and the United States 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 FDA.

Results: Thirty-eight of 226 interviewed clients were identified as outbreak-associated cases. Multivariate logistic regression revealed individuals who reported grey tattoo ink in their tattoos were 8.2 times as likely to report a rash [95% CI: 3.07-22.13]. Multiple NTM species were identified in clinical and environmental specimens. Phylogenetic results from environmental samples and skin biopsies indicated that two M. fortuitum isolates (greywash ink and a skin biopsy) and 11 M. abscessus isolates (five from the implicated bottle of greywash tattoo ink, two from tap water, and four from skin biopsies) were indistinguishable. In addition, M. chelonae was isolated from five unopened bottles of greywash ink provided by two other tattoo studios in Miami-Dade County.

Conclusions: WGS and SNP analyses identified the tap water and the bottle of greywash tattoo ink as the sources of the NTM infections.

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http://dx.doi.org/10.1093/cid/ciy979DOI Listing
November 2018
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References

(Supplied by CrossRef)
Tattoo-associated nontuberculous mycobacterial skin infections—multiple states, 2011–2012
Bedard et al.
MMWR Morb Mortal Wkly Rep 2012
Rapid identification of mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis
Telenti et al.
J Clin Microbiol 1993
DNA large restriction fragment patterns of sporadic and epidemic nosocomial strains of Mycobacterium chelonae and Mycobacterium abscessus
Wallace et al.
J Clin Microbiol 1993

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