Outbreak of Tattoo-Associated Nontuberculous Mycobacterial Skin Infections



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Title: Outbreak of Tattoo-Associated Nontuberculous Mycobacterial Skin Infections
Abstract: 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.

CONCLUSIONS: WGS and SNP analyses identified the tap water and the bottle of greywash tattoo ink as the sources of the NTM infections.
Industry Significance Rating: High - Industry alert, report has major implications related to health and safety.
Publication: Clinical Infectious Diseases. 2018 Nov 17. doi: 10.1093/cid/ciy979.
Authors: Griffin I, Schmitz A, Oliver C, Pritchard S, Zhang G, Rico E, Davenport E, Llau A, Moore E, Fernandez D, Mejia-Echeverry A, Suarez J, Noya-Chaveco P, Elmir S, Jean R, Pettengill JB, Hollinger KA, Chou K, Williams-Hill D, Zaki S, Muehlenbachs A, Keating MK, Bhatnagar J, Rowlinson MC, Chiribau C, Rivera L.
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Discussion:

The authors report an extremely serious cluster of NonTuberculous Mycobacterial infections among clients of a tattoo parlour, after the Florida Dept of Health conducted an investigation it was discovered that "Thirty-eight of 226 interviewed clients were identified as outbreak-associated cases" and the likely sources of the infections were tap water and a bottle of greywash tattoo ink.

Mycobacterium are a member of the genus of Actinobacteria which have over 190 species many of whom are pathogens capable of causing very serious diseases in animals and humans including tuberculosis and leprosy. It would be of particular concern to the tattoo industry that "M. chelonae was isolated from five unopened bottles of greywash ink" as M. chelonae is capable of causing skin infections such as rashes, cellulitis and abscessus.

Purchasing tattoo inks from non-local suppliers can be problematic for health authorities as offshore suppliers are likely to be outside of the regulatory jurisdiction of local health authorities and this may hamper the ability to identify the exact source of infections and or any problems with the manufacturing and supply chain, tattoo technicians who import should also be aware that depending on local laws the act of importation may place the impost of product liability and compliance upon them.

Recommendations:
  • Tap water should never be used to dilute tattoo inks as it is NOT STERILE and is likely to contain a wide range of microorganisms.
     

  • It is advisable to restrict the purchase of tattoo inks to reputable sources that are able to provide all required information about the ingredients, sterility of the product, and the manufacturing processes.
     

  • Legal, insurance and regulatory advice is recommended if tattoo inks are to be purchased from non local suppliers.

Keywords:

Medical Report, Health Department, Infections, nontuberculous mycobacterial, tattoo, tap water.

 

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