An outbreak of Mycobacterium chelonae skin and soft tissue infections in Rochester, N.Y., was attributed to premixed ink used for tattoos, researchers from the Monroe County Department of Public Health reported.
The outbreak affected 19 people from October to December 2011. Within 3 weeks of receiving a tattoo, they experienced a persistent, raised, erythematous rash in the area where they received tattoos. All patients received their tattoos from a single artist who used premixed gray ink.
The index patient was reported by a dermatologist who treated a man aged 20 years who had previously received several tattoos with no reported problems. A biopsy specimen showed presence of M. chelonae. Upon interviewing the man, investigators from the Monroe County Department of Public Health visited the tattoo parlor and learned that he had been using a new premixed ink.
The investigators obtained a list of patrons from the tattoo artist and contacted the patrons to identify cases of infections. Also, they contacted a regional pathology laboratory to have them report any cases of ink-related granulomatous reactions.
The rate of infection increased from zero in May through August and peaked at 65% in November. The rashes were in areas of the skin that were tattooed with the premixed gray ink. Biopsy specimens were obtained from 17 of the patients, and M. chelonae was confirmed in 14 of the specimens. Eighteen patients received appropriate antibiotics.
In response, the Department of Public Health confiscated the remaining bottles of premixed ink and educated tattoo artists and patrons about the infection at a tattoo trade show in the city. The CDC also issued a nationwide alert about the outbreak.
“Since tattooing has become more popular over time, the incidence of cutaneous mycobacterial infections may be underestimated, given the lack of both routine testing and mandated reporting,” the researchers wrote. “Although contamination in tattoo parlors has been implicated in previous outbreaks, our investigation of this outbreak shows that premixed ink contaminated before distribution poses a risk to public health, which may suggest the need for enhanced oversight of not just tattooing, but also the inks used in tattooing to ensure public safety.”
Disclosure: One researcher reported a financial relationship with Bayer Corp.