Abstract
Sporadic cases and outbreaks of tattoo-associated skin infection with rapidly growing mycobacteria have been reported although they often contain few details of public health investigations and have not previously been systematically collated. We present the details of the public health investigation of a cluster of cases, which occurred in Scotland in 2010. Investigation of the cluster involved case finding, environmental investigation of the tattoo studio and pathological and microbiological investigation of possible cases and tattoo ink. Mycobacterium chelonae was isolated from one case and three probable cases were identified. M. chelonae was grown from an opened bottle of ink sourced from the studio these cases had attended. In addition, in order to identify all published cases, we conducted a systematic review of all reported cases of tattoo-associated skin infection with rapidly growing mycobacteria. A total of 25 reports were identified, describing 71 confirmed and 71 probable cases. Mycobacteria were isolated in 71 cases and M. chelonae was cultured from 48 of these. The most frequently postulated cause of infection was the dilution of black ink with tap water. Reports of tattoo-associated rapidly growing mycobacterial skin infection are increasing in frequency. Interested agencies must work with the tattoo industry to reduce the risk of contamination during tattoo ink manufacture, distribution and application.
Highlights
Growing mycobacteria (RGM) are a non-tuberculous group of mycobacteria commonly found in the environment in water, soil and dust [1]
A recent report described the clinical investigation and treatment of the United Kingdom’s (UK’s) first confirmed case, and three probable cases, of tattoo-associated Rapidly growing mycobacteria (RGM) skin infection, which occurred in Scotland in 2010 [23]
Further cases were sought by reviewing medical photography records for tattoo-associated lesions with similar characteristics between October 2010 and March 2011 and by searching the Scottish Mycobacteria Reference Laboratory records for cases of RGM infection associated with tattoos between January 2009 and March 2011
Summary
Growing mycobacteria (RGM) are a non-tuberculous group of mycobacteria commonly found in the environment in water, soil and dust [1]. Both the peer-reviewed and grey literature contain sporadic reports of cases and outbreaks of RGM skin infection associated with tattooing [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29] Contamination leading to such tattoo-associated infection could theoretically occur at any point, from manufacture of the tattoo ink or equipment to application of the tattoo in the studio or during aftercare of the tattoo by the recipient. Reports of this emerging condition often contain few details of the public health investigations into the potential points of contamination and these reports have not previously been systematically collated
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