Cluster of Nontuberculous Mycobacteria Skin Infections from Tattoos

摘要

In July 2008, the owner of a local tattoo parlor notified the San Antonio Metropolitan Health District (SAMHD) about 11 people who had developed adverse reactions shortly after receiving tattoos. Customers reported a constellation of symptoms of prolonged, erythematous, papular eruptions that were localized only to the gray (shaded) portions of their tattoos. An investigation conducted by SAMHD revealed these eruptions to be nontuberculous mycobacteria (NTM) skin infections caused by contaminated ink. The NTM organisms discovered from tissue cultures were M. abcessus and M. chelonae. NTM skin infections are not only difficult to diagnose, they are difficult to treat. After 6 months, 6 of the 11 patients still had a persistent, papular rash in the gray portion of their tattoo, 2 had complete resolution of their initial dermatologic condition, and 3 could not be contacted for followup. To reduce the incidence of adverse reactions, tattooing may need to be more carefully regulated. Perhaps at the state and/or federal level, tattoo artists could be asked/required to receive annual training (they already receive initial training) in the field of infection control/sterile technique while practicing their art. This would be in similar fashion to physicians being required to earn continuing medical education in their own fields.