Outbreak of Mycobacterium chelonae Infection Associated with Tattoo Ink
Outbreak of Mycobacterium chelonae Infection Associated with Tattoo Ink
复制标题
DOI：
10.1056/nejmoa1205114
复制
发表时间：
2012-09-13
影响因子：
158.5
通讯作者：
Goldgeier, Mark H.
中科院分区：
文献类型：
--
作者：
Kennedy, Byron S.;Bedard, Brenden;Goldgeier, Mark H.
背景2012年1月，根据皮肤科医生的初步报告，我们开始调查纽约罗切斯特的一起纹身相关龟分枝杆菌皮肤和软组织感染的爆发。的主要目标是确定的程度，原因和形式的传播的爆发，以防止进一步的病例infection.MethodsWe结构化的采访患者，皮肤活检标本，抗酸杆菌涂片的组织病理学检测，微生物培养和抗菌药物敏感性测试的数据进行了分析。我们还进行了DNA测序，脉冲场凝胶电泳（PFGE），墨水和墨水的制备和包装中使用的成分的培养，纹身店的水源和水的评估，以及墨水制造商的调查。19人纹身部位出现皮疹（13名男性和6名女性）在接受使用预混灰色墨水的单一艺术家的纹身后3周内;纹身和皮疹的发病率最高的是在11月（分别占15和12名患者）。患者的平均年龄为35岁（范围，18至48岁）。17例患者的皮肤活检标本均显示异常，其中M。从14例标本中分离到龟类，并经DNA测序证实。PFGE分析显示，在11个临床分离株和三个未开封的预混墨水瓶之一，无法区分的模式。19例患者中有18例接受了适当的抗生素治疗，病情好转。这些发现导致制造商召回。
BackgroundIn January 2012, on the basis of an initial report from a dermatologist, we began to investigate an outbreak of tattoo-associated Mycobacterium chelonae skin and soft-tissue infections in Rochester, New York. The main goals were to identify the extent, cause, and form of transmission of the outbreak and to prevent further cases of infection.MethodsWe analyzed data from structured interviews with the patients, histopathological testing of skin-biopsy specimens, acid-fast bacilli smears, and microbial cultures and antimicrobial susceptibility testing. We also performed DNA sequencing, pulsed-field gel electrophoresis (PFGE), cultures of the ink and ingredients used in the preparation and packaging of the ink, assessment of source water and faucets at tattoo parlors, and investigation of the ink manufacturer.ResultsBetween October and December 2011, a persistent, raised, erythematous rash in the tattoo area developed in 19 persons (13 men and 6 women) within 3 weeks after they received a tattoo from a single artist who used premixed gray ink; the highest occurrence of tattooing and rash onset was in November (accounting for 15 and 12 patients, respectively). The average age of the patients was 35 years (range, 18 to 48). Skin-biopsy specimens, obtained from 17 patients, showed abnormalities in all 17, with M. chelonae isolated from 14 and confirmed by means of DNA sequencing. PFGE analysis showed indistinguishable patterns in 11 clinical isolates and one of three unopened bottles of premixed ink. Eighteen of the 19 patients were treated with appropriate antibiotics, and their condition improved.ConclusionsThe premixed ink was the common source of infection in this outbreak. These findings led to a recall by the manufacturer.