Tattoo rashes linked to ink

Tainted supplies caused stubborn bacterial infections

Tattoos are getting some bad ink, literally.

An outbreak of uncommon bacterial skin infections in upstate New York in late 2011 has been traced to a tainted batch of ink used in a tattoo parlor, researchers report August 22 in the New England Journal of Medicine. The infections required potent antibiotics to vanquish the culprit, Mycobacterium chelonae, a bacterium in the same family as those that cause tuberculosis and leprosy.

Around the same time that the patients in New York were being identified and treated, scientists from the CDC and elsewhere began tracing the origins of similar tattoo-based infections. They found eight caused by mycobacteria in Washington, Iowa and Colorado. Ink used in these states came from three separate suppliers, all different from the source of the New York infections.

Some of the microbes varied, too. Two confirmed infections in Iowa, two in Washington, and one in Colorado were caused by M. chelonae. But three in Washington arose from a related bacterium, M. abscessus. Mycobacterial infections can range from skin rashes to severe abscesses that require surgery, CDC researchers and their colleagues report August 22 in Morbidity and Mortality Weekly Report.

Mycobacteria can show up in tap water, sewage, dust and soil. It’s unclear how the bacteria got into the ink from four different suppliers. Ink used in the New York tattoo parlor, which came from a company called Catfish Carl, was subsequently recalled.

The New York study began when a dermatologist examining an infected tattoo couldn’t discern its cause from a standard test. The doctor contacted health authorities, says Byron Kennedy, a physician and deputy director of the Monroe County Health Department. Kennedy and his colleagues contacted people in the county treated by the tattoo artist and uncovered 19 infections. Biopsies by dermatologists and lab tests at the University of Rochester confirmed M. chelonae infection in 14 of the patients, with probable infection in four others.

“This is a very complete, fair study that looked at the artist and the patients,” says Myrna Armstrong, a nurse and researcher at Texas Tech University in Lubbock.

The microbe had previously appeared in a similar outbreak in France. The New York analysis is the first to nail down the microbial cause using DNA-level sleuthing and by examining an unopened ink bottle that turned out to contain the microbe, says Kennedy, who coauthored both new reports.

The antibiotics azithromycin and doxycycline proved effective in the New York patients, but lab tests showed the microbe might be resistant to cefoxitin and ciprofloxacin, potent antibiotics prescribed for a variety of infections. The CDC report notes that mycobacterial infections can require four months and two or more antibiotics to cure.

Despite these and other reports linking tattooing to an increased risk of hepatitis and other diseases, tattoos are as popular as ever. A Harris poll released in February found that 21 percent of U.S. adults have at least one tattoo, up from 14 percent in 2008.

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