November 24, 2018
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Tattoo ink causes outbreak of nontuberculous mycobacteria

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An outbreak of nontuberculous mycobacterial skin infections in Florida was traced to contaminated tattoo ink and tap water, according to findings published in Clinical Infectious Diseases.

Officials launched an investigation after a dermatologist in Miami-Dade County reported three patients with skin infections to the state health department.

“In recent years, a number of nontuberculous mycobacterial outbreaks associated with tattoo studios have been reported in the literature,” Isabel Griffin, MPH, epidemiologist and biological scientist at the Florida Department of Health (DOH) in Miami-Dade County, and colleagues wrote. “These outbreaks have been associated with poor infection control practices at tattoo studios and contamination of graywash ink at the point of manufacture.”

Interviews with the first three patients revealed they all received a tattoo from the same studio and artist in February and March of 2015. The source of the infections was determined to be a bottle of graywash ink — a diluted ink used to create a greater range of gray colors within a tattoo — which had been opened when purchased, Griffin and colleagues reported.

someone getting a tattoo 
An outbreak of nontuberculous mycobacteria was linked to tattoo ink and tap water used for ink dilution.
Source: Adobe Stock

Investigators interviewed a total of 226 clients and identified 38 as outbreak-associated cases. According to Griffin and colleagues, individuals whose tattoos had gray tattoo ink were 8.2 times more likely to report a rash (95% CI, 3.07-22.13). Genetic analysis of environmental samples and skin biopsies uncovered two Mycobacterium fortuitum isolates in the graywash ink and one skin biopsy and 11 M. abscessus isolates, five from the bottle of graywash ink, two from tap water and four from skin biopsies. Griffin and colleagues observed that these isolates were indistinguishable, leading to a national recall of the implicated ink. Investigators also discovered that five unopened bottles of graywash ink obtained from two other Miami-Dade tattoo studios contained M. chelonae isolates.

According to the authors, CDC and FDA sterilization recommendations for tattoo ink manufacturers vary. The CDC advises manufactures to ensure sterilization of tattoo ink and recommends against dilution with nonsterile water, such as tap water.

“Tattoo patrons should be made aware of the infection risks associated with tattooing, not only those that result from bloodborne pathogens, but also bacteria in contaminated inks and nonsterile water,” Griffin and colleagues wrote. “The community would benefit from additional safeguards regarding tattoo ink manufacturing, guidelines for the dilution of tattoo ink, improved consumer information, and education on reporting adverse reactions and tattoo-related outbreaks to FDA and DOH.” – by Marley Ghizzone

Disclosures: The authors report no relevant financials disclosures.