Watch out where you get that tattoo!

Mycobacterial rash on a tattooed arm (Credit: AP Photo/Monroe County (N.Y.) Department)

From the ever insightful CDC’s Morbidity and Mortality Weekly Report, a news alert about an outbreak of Mycobacterium infections following receiving a tattoo. In January 2012, the New York Department of Health received reports of 14 cases of Mycobacterium chelonae skin infection among residents at the site of a recent tattoo. M. chelonae is a member of a group of non-tuberculosis mycobacteria (NTM), and has traditionally been associated with relatively non life threatening, superficial infections, typically acquired nosocomially. Disseminated disease can occur and is typically fatal, but generally only occurs in extenuating circumstances where the patient is otherwise immunocompromised as with AIDS. Because the disease is typically not serious, and no human to human cases of transmission have been documented, cases are not generally reported to the CDC and the actual levels of infection are not precisely known. Voluntary reporting indicates level of disease around 3 cases per million population, however underreporting of disease is likely the case.

With the current outbreak, patients were identified by an address list provided by a tattoo artist in New York, after one patient reported a persistent rash 1 week following receiving a tattoo. Culturing of the isolate identified it as M. chelonae. From the address list, 14 additional individuals were identified, and M. chelonae was again isolated. No lapses in infection control were found to be done by the tattoo artist, and the organism was not found in water and environmental samples at the tattoo parlor. The artist reported using prediluted ink provided by a commercial vendor; analysis of one opened and one unopened bottle of prediluted grey ink indicated contamination with the organism. Pulsed field DNA gel electrophoresis (PFGE) analysis indicated greater than 95% genetic identity among all of the recovered isolates, strongly supporting the ink as the source of the outbreak. The CDC then identified other tattoo parlors in other states and found additional instances of infection in Washington, Iowa, and Colorado.

In light of this outbreak, the CDC makes the following “best practices” recommendations for tattoo artists:

  • avoid using products not intended for tattooing (e.g. non-sterile water)
  • avoid ink dilution, and if dilution is necessary, only use sterile water
  • follow aseptic technique practices at all points in the procedure\

and has several recommendations for consumers:

  • use only licensed tattoo parlors
  • request ink specifically manufactured for tattoos
  • ensure that artists use good hygiene
  • be aware of the potential for infection, and follow up with a health practitioner if an adverse reaction occurs.

About ycpmicro

My name is David Singleton, and I am an Associate Professor of Microbiology at York College of Pennsylvania. My main course is BIO230, a course taken by allied-health students at YCP. Views on this site are my own.

Posted on August 27, 2012, in Microbes in the News, The more you know, Wash your hands! and tagged , , . Bookmark the permalink. 2 Comments.

  1. This article was a bit scary to me as a receiver of tattoos. I always go to the same person for my tattoos because he uses, and from what my watchful nursing eye has observed from the other artists, excellent aseptic technique. He is constantly wiping down the area with antibacterial cleaner, we will not get into what that may be creating; I am sure he is taking all the needles he uses from sealed packages; and he always wears gloves of which he is constantly changing. The one thing I never even considered was the fact that they are pouring portions of ink from opened container, however they are pouring them into individual cups so I never gave it a second thought because they were not dipping into the main container, however now this article has given me something else to consider and ask when I go get my next tattoo. Just when you thought you had all your bases covered now you have to worry about the ink! Thank you Dr. S you always find the most informative, fascinating, and useful articles to share!!

    • Right! I too assumed that problems with tattoos and infections were due to someone with poor technique, but it turns out that you even could have had a board certified dermatologist doing it with the same result.

      Fortunately, M. chelonae is not very virulent provided it doesn’t disseminate, and the infections can be readily cleared up with antibiotics.

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