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Yoon S, Kondakala S, Foley SL, Moon MS, Huang MCJ, Periz G, Zang J, Katz LM, Kim SJ, Kweon O. Detection of anaerobic and aerobic bacteria from commercial tattoo and permanent makeup inks. Appl Environ Microbiol 2024; 90:e0027624. [PMID: 38953654 PMCID: PMC11267919 DOI: 10.1128/aem.00276-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024] Open
Abstract
Tattooing and use of permanent makeup (PMU) have dramatically increased over the last decade, with a concomitant increase in ink-related infections. Studies have shown evidence that commercial tattoo and PMU inks are frequently contaminated with pathogenic microorganisms. Considering that tattoo inks are placed into the dermal layer of the skin where anaerobic bacteria can thrive and cause infections in low-oxygen environments, the prevalence of anaerobic and aerobic bacteria should be assessed in tattoo and PMU inks. In this study, we tested 75 tattoo and PMU inks using the analytical methods described in the FDA Bacteriological Analytical Manual Chapter 23 for the detection of both aerobic and anaerobic bacterial contamination, followed by 16S rRNA gene sequencing for microbial identification. Of 75 ink samples, we found 26 contaminated samples with 34 bacterial isolates taxonomically classified into 14 genera and 22 species. Among the 34 bacterial isolates, 19 were identified as possibly pathogenic bacterial strains. Two species, namely Cutibacterium acnes (four strains) and Staphylococcus epidermidis (two strains) were isolated under anaerobic conditions. Two possibly pathogenic bacterial strains, Staphylococcus saprophyticus and C. acnes, were isolated together from the same ink samples (n = 2), indicating that tattoo and PMU inks can contain both aerobic (S. saprophyticus) and anaerobic bacteria (C. acnes). No significant association was found between sterility claims on the ink label and the absence of bacterial contamination. The results indicate that tattoo and PMU inks can also contain anaerobic bacteria. IMPORTANCE The rising popularity of tattooing and permanent makeup (PMU) has led to increased reports of ink-related infections. This study is the first to investigate the presence of both aerobic and anaerobic bacteria in commercial tattoo and PMU inks under aerobic and anaerobic conditions. Our findings reveal that unopened and sealed tattoo inks can harbor anaerobic bacteria, known to thrive in low-oxygen environments, such as the dermal layer of the skin, alongside aerobic bacteria. This suggests that contaminated tattoo inks could be a source of infection from both types of bacteria. The results emphasize the importance of monitoring these products for both aerobic and anaerobic bacteria, including possibly pathogenic microorganisms.
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Affiliation(s)
- Sunghyun Yoon
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, USA
| | - Sandeep Kondakala
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, USA
| | - Steven L. Foley
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, USA
| | - Mi Sun Moon
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, Maryland, USA
| | - Mei-Chiung Jo Huang
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, Maryland, USA
| | - Goran Periz
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, Maryland, USA
| | - Janet Zang
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, Maryland, USA
| | - Linda M. Katz
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, Maryland, USA
| | - Seong-Jae Kim
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, USA
| | - Ohgew Kweon
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, USA
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Yoon S, Kondakala S, Moon MS, Huang MCJ, Periz G, Foley SL, Kweon O, Kim SJ. Recalls of tattoo and permanent makeup inks in the United States and a follow-up microbiological survey of inks with a previous recall history. Front Public Health 2023; 11:1279884. [PMID: 38026365 PMCID: PMC10668429 DOI: 10.3389/fpubh.2023.1279884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
In this study, we collected voluntary recall records of tattoo and permanent makeup ink from the U.S. Food and Drug Administration (US FDA) Enforcement Report Database. The recall records contain information, such as recall date, manufacturer, ink color, reason for recall, and the microorganisms detected from the ink samples. Between 2003 and 2021, a total of 15 voluntary tattoo ink recalls occurred in the U.S. market, involving over 200 tattoo inks marketed by 13 manufacturers and one distributor. Fourteen recalls were due to microbial contamination, and one recall was due to allergic reaction. As follow-up, a microbiological survey of 28 tattoo inks of new batches from seven manufacturers having products that were previously recalled was conducted. Aerobic plate count (APC) and enrichment culture methods based on the FDA's Bacteriological Analytical Manual (BAM) were used to detect microbial contamination. The results revealed that six out of 28 tattoo inks were contaminated with bacteria and were produced by two manufacturers. The level of microbial contamination was less than 250 CFU/g in three of the tattoo inks and between 1 × 103 and 1 × 105 CFU/g in the other three inks. Eleven bacterial isolates were identified, including spore-forming Bacillus-related species and potentially pathogenic species. Overall, this study shows that some tattoo ink products produced by manufacturers with a recall history continue to be contaminated with microorganisms. This highlights the need for ongoing monitoring and quality control of such products.
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Affiliation(s)
- Sunghyun Yoon
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Sandeep Kondakala
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Mi Sun Moon
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, United States
| | - Mei-Chiung J. Huang
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, United States
| | - Goran Periz
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, United States
| | - Steven L. Foley
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Ohgew Kweon
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Seong-Jae Kim
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
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Microbiological Survey of 47 Permanent Makeup Inks Available in the United States. Microorganisms 2022; 10:microorganisms10040820. [PMID: 35456870 PMCID: PMC9031709 DOI: 10.3390/microorganisms10040820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023] Open
Abstract
In two previous surveys, the U.S. Food and Drug Administration (FDA) identified microbial contamination in 53 of 112 (47%) unopened tattoo inks and tattoo-ink-related products (e.g., diluents) from 15 manufacturers in the U.S. In this study, we primarily focused our microbiological survey on permanent makeup (PMU) inks. We conducted a survey of 47 unopened PMU inks from nine manufacturers and a comparative species-centric co-occurrence network (SCN) analysis using the survey results. Aerobic plate count and enrichment culture methods using the FDA's Bacteriological Analytical Manual (BAM) Chapter 23 revealed that 9 (19%) inks out of 47, from five manufacturers, were contaminated with microorganisms. The level of microbial contamination was less than 250 CFU/g in eight inks and 980 CFU/g in one ink. We identified 26 bacteria that belong to nine genera and 21 species, including some clinically relevant species, such as Alloiococcus otitis, Dermacoccus nishinomiyaensis, Kocuria rosea, and Pasteurella canis. Among the identified microorganisms, the SCN analysis revealed dominance and a strong co-occurrence relation of spore-forming extreme environment survivors, Bacillus spp., with close phylogenetic/phenotypic relationships. These results provide practical insights into the possible microbial contamination factors and positive selection pressure of PMU inks.
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Gębska-Kuczerowska A, Kucharska I, Segiet-Święcicka A, Kuczerowski M, Gajda R. Assessment of Epidemiological Safety in the Cosmetic Service Industry in Poland: A Cross-Sectional Questionnaire Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5661. [PMID: 34070627 PMCID: PMC8199086 DOI: 10.3390/ijerph18115661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 12/22/2022]
Abstract
The variety of current cosmetic procedures has increased the potential risks of adverse events and infections. In a nationwide cross-sectional study (2013-2015), we assessed the aspects of infection risk in cosmetic services. An anonymous voluntary questionnaire survey was conducted among 813 employees of cosmetic establishments in Poland. The establishments were selected from a register of service providers. The survey was conducted by employees of the State Sanitary Inspectorate during an audit, and the results showed that cosmetic providers were not fully prepared for risk assessment in terms of occupational exposure or infection transmission. The majority of the respondents (84%) reportedly washed the salon tools. Some establishments did not perform any decontamination (2%) or sterilization (~13%) procedures. Occupational punctures or lacerations occurred from needles, ampoules-syringes, or razors. Most respondents had attended professional training or studied medical textbooks. Approximately 1.7% of the respondents had not updated their knowledge, and 5% gained knowledge from unauthorized sources.The project's results impacted a variety of innovations and improvements in the field of public health. The results were used to update the national education program (2012-2017); more attention has been directed toward effective education in infection prevention, general hygiene, and post-exposure procedures. Moreover, the study's results were grounds for the introduction of legislative modifications in the field of epidemiological safety standards for cosmetic services in Poland.
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Affiliation(s)
- Anita Gębska-Kuczerowska
- Collegium Medicum, Cardinal Stefan Wyszynski University, KazimierzaWóycickiego 1/3, 01-938 Warsaw, Poland
| | | | - Agnieszka Segiet-Święcicka
- Faculty and Department of Experimental Physiology, Medical University of Warsaw, ŻwirkiiWigury 61, 02-091 Warsaw, Poland;
| | - Marcin Kuczerowski
- Clinical Department of Oncological Gynecology and Obstetrics, prof. Witlold Orłowski Hospital, Czerniakowska, 231, 00-416 Warsaw, Poland;
| | - Robert Gajda
- Gajda-Med Medical Center, ul. PiotraSkargi 23/29, 06-100 Pułtusk, Poland;
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Assessing Infection Risks among Clients and Staff Who Use Tattooing Services in Poland: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186620. [PMID: 32932896 PMCID: PMC7559388 DOI: 10.3390/ijerph17186620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022]
Abstract
Across cultures and generations, people have tattooed their bodies. Although blood-borne infections from tattooing have been reduced, certain service aspects remain improperly managed. We assessed the infection risks associated with tattooing by conducting a cross-sectional study (2013–2014) in Poland using an anonymous questionnaire survey. Scoring procedures for blood-borne infection risks for tattooists and their clients were used. Overall, 255 tattooists were interviewed. A quasi-random selection of tattoo parlors was based on a service register. Knowledge, attitudes, and behavior regarding blood-borne infection risks were assessed using a questionnaire. Simultaneously, tattoo centers were audited. Tattooing had a higher infection risk for tattooists than for clients. Approximately 50% of respondents underwent training on postexposure procedures, which constituted almost one in five of the reported needlestick/cut injuries sustained while working. Furthermore, 25.8% had no knowledge regarding risk from reliable sources, and 2.1% had not broadened their knowledge. Tattooists and their clients are at a risk of infection, and knowledge concerning infection risks remains an underestimated preventative factor. Service quality surveillance and creation of a register for tattoo-related complications may help assess the scale of this public health issue. However, a lack of these records implies the challenges in developing effective organizational and legal protections.
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Nho SW, Kim M, Kweon O, Kim SJ, Moon MS, Periz G, Huang MCJ, Dewan K, Sadrieh NK, Cerniglia CE. Microbial contamination of tattoo and permanent makeup inks marketed in the US: a follow-up study. Lett Appl Microbiol 2020; 71:351-358. [PMID: 32654157 DOI: 10.1111/lam.13353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 11/28/2022]
Abstract
In a 2018 survey, U.S. Food and Drug Administration (FDA) identified microbial contamination in 42 (49%) of 85 unopened tattoo and permanent makeup (PMU) inks purchased from 13 manufacturers in the US between November 2015 and April 2016. To confirm the results of our previous survey, we evaluated the level of microbial contamination in an additional 27 samples from 10 manufacturers from September 2017 to December 2017, including 21 unopened tattoo and PMU inks which were selected based on our previous survey results and 6 ink diluents that were not previously analysed. Aerobic plate count and enrichment culture methods from the FDA's Bacteriological Analytical Manual revealed 11 (52%) out of 21 inks, from six manufacturers, were contaminated with micro-organisms, with contamination levels up to 3·6 × 108 CFU per gram, consistent with our previous survey results. We identified 25 bacterial strains belonging to nine genera and 19 species. Strains of Bacillus sp. (11 strains, 44%) were dominant, followed by Paenibacillus sp. (5 strains, 20%). Clinically relevant strains, such as Kocuria rhizophila and Oligella ureolytica, were also identified, as similar to the findings in our previous survey. No microbial contamination was detected in any of the six ink diluents.
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Affiliation(s)
- S W Nho
- Division of Microbiology, National Center for Toxicological Research, U.S. FDA, Jefferson, AK, USA
| | - M Kim
- Division of Microbiology, National Center for Toxicological Research, U.S. FDA, Jefferson, AK, USA
| | - O Kweon
- Division of Microbiology, National Center for Toxicological Research, U.S. FDA, Jefferson, AK, USA
| | - S-J Kim
- Division of Microbiology, National Center for Toxicological Research, U.S. FDA, Jefferson, AK, USA
| | - M S Moon
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. FDA, College Park, MD, USA
| | - G Periz
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. FDA, College Park, MD, USA
| | - M-C J Huang
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. FDA, College Park, MD, USA
| | - K Dewan
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. FDA, College Park, MD, USA
| | - N K Sadrieh
- Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, U.S. FDA, College Park, MD, USA
| | - C E Cerniglia
- Division of Microbiology, National Center for Toxicological Research, U.S. FDA, Jefferson, AK, USA
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Nho S, Kim S, Kweon O, Howard P, Moon M, Sadrieh N, Cerniglia C. Microbiological survey of commercial tattoo and permanent makeup inks available in the United States. J Appl Microbiol 2018; 124:1294-1302. [DOI: 10.1111/jam.13713] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 12/15/2022]
Affiliation(s)
- S.W. Nho
- Division of Microbiology National Center for Toxicological Research US FDA Jefferson AR USA
| | - S.‐J. Kim
- Division of Microbiology National Center for Toxicological Research US FDA Jefferson AR USA
| | - O. Kweon
- Division of Microbiology National Center for Toxicological Research US FDA Jefferson AR USA
| | - P.C. Howard
- Office of Scientific Coordination National Center for Toxicological Research US FDA Jefferson AR USA
| | - M.S. Moon
- Office of Cosmetics and Colors Center for Food Safety and Applied Nutrition US FDA College Park MD USA
| | - N.K. Sadrieh
- Office of Cosmetics and Colors Center for Food Safety and Applied Nutrition US FDA College Park MD USA
| | - C.E. Cerniglia
- Division of Microbiology National Center for Toxicological Research US FDA Jefferson AR USA
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Dieckmann R, Boone I, Brockmann SO, Hammerl JA, Kolb-Mäurer A, Goebeler M, Luch A, Al Dahouk S. The Risk of Bacterial Infection After Tattooing. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:665-671. [PMID: 27788747 DOI: 10.3238/arztebl.2016.0665] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 12/02/2015] [Accepted: 06/08/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Tattooing is a globally growing trend. Overall prevalence among adults in industrialized countries is around 10-20%. Given the high and increasing numbers of tattooed people worldwide, medical and public health implications emerging from tattooing trends require greater attention not only by the public, but also by medical professionals and health policy makers. METHODS We performed a systematic review of the literature on tattooassociated bacterial infections and bacterial contamination of tattoo inks. Furthermore, we surveyed tattoo inks sampled during an international tattoo convention in Germany to study their microbial status. RESULTS Our systematic review identified 67 cases published between 1984 and 2015, mainly documenting serious bacterial infectious complications after intradermal deposition of tattoo inks. Both local skin infections (e.g. abscesses, necrotizing fasciitis) and systemic infections (e.g. endocarditis, septic shock) were reported. Published bacteriological surveys showed that opened as well as unopened tattoo ink bottles frequently contained clinically relevant levels of bacteria indicating that the manufactured tattoo product itself may be a source of infection. In our bacteriological survey, two of 39 colorants were contaminated with aerobic mesophilic bacteria. CONCLUSION Inappropriate hygiene measures in tattoo parlors and non-medical wound care are major risk factors for tattoo-related infections. In addition, facultative pathogenic bacterial species can be isolated from tattoo inks in use, which may pose a serious health risk.
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Affiliation(s)
- Ralf Dieckmann
- German Federal Institute for Risk Assessment (BfR), Department of Biological Safety, Berlin, Regional Public Health Office, Department for Infection Control, Reutlingen, University Hospital Würzburg, Department of Dermatology, Venereology and Allergology, Würzburg, German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Berlin, RWTH Aachen University Hospital, Clinic for Gastroenterology, Metabolic Disorders and Internal Intensive Medicine (Medical Clinic III), Aachen
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Laux P, Tralau T, Tentschert J, Blume A, Dahouk SA, Bäumler W, Bernstein E, Bocca B, Alimonti A, Colebrook H, de Cuyper C, Dähne L, Hauri U, Howard PC, Janssen P, Katz L, Klitzman B, Kluger N, Krutak L, Platzek T, Scott-Lang V, Serup J, Teubner W, Schreiver I, Wilkniß E, Luch A. A medical-toxicological view of tattooing. Lancet 2016. [PMID: 26211826 DOI: 10.1016/s0140-6736(15)60215-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Long perceived as a form of exotic self-expression in some social fringe groups, tattoos have left their maverick image behind and become mainstream, particularly for young people. Historically, tattoo-related health and safety regulations have focused on rules of hygiene and prevention of infections. Meanwhile, the increasing popularity of tattooing has led to the development of many new colours, allowing tattoos to be more spectacular than ever before. However, little is known about the toxicological risks of the ingredients used. For risk assessment, safe intradermal application of these pigments needs data for toxicity and biokinetics and increased knowledge about the removal of tattoos. Other concerns are the potential for phototoxicity, substance migration, and the possible metabolic conversion of tattoo ink ingredients into toxic substances. Similar considerations apply to cleavage products that are formed during laser-assisted tattoo removal. In this Review, we summarise the issues of concern, putting them into context, and provide perspectives for the assessment of the acute and chronic health effects associated with tattooing.
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Affiliation(s)
- Peter Laux
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Tewes Tralau
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Jutta Tentschert
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Annegret Blume
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Sascha Al Dahouk
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Wolfgang Bäumler
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Regensburg, Germany
| | | | | | | | | | | | | | - Urs Hauri
- Kantonales Laboratorium Basel-Stadt, Basel, Switzerland
| | - Paul C Howard
- US Food and Drug Administration, National Center for Toxicological Research, Jefferson, AR, USA
| | - Paul Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Linda Katz
- US Food and Drug Administration, College Park, MD, USA
| | - Bruce Klitzman
- Duke University Medical Center, Research Park, Durham, NC, USA
| | - Nicolas Kluger
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lars Krutak
- Smithsonian Institution, Washington, DC, USA
| | - Thomas Platzek
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | | | - Jørgen Serup
- Bispebjerg University Hospital, Department of Dermatology, The Tattoo Clinic, Copenhagen, Denmark
| | | | - Ines Schreiver
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Elena Wilkniß
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany
| | - Andreas Luch
- German Federal Institute for Risk Assessment (BfR), Department of Product Safety, Berlin, Germany.
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Conaglen PD, Laurenson IF, Sergeant A, Thorn SN, Rayner A, Stevenson J. Systematic review of tattoo-associated skin infection with rapidly growing mycobacteria and public health investigation of a cluster in Scotland, 2010. Euro Surveill 2013; 18:20553. [DOI: 10.2807/1560-7917.es2013.18.32.20553] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sporadic cases and outbreaks of tattoo-associated skin infection with rapidly growing mycobacteria have been reported although they often contain few details of public health investigations and have not previously been systematically collated. We present the details of the public health investigation of a cluster of cases, which occurred in Scotland in 2010. Investigation of the cluster involved case finding, environmental investigation of the tattoo studio and pathological and microbiological investigation of possible cases and tattoo ink. Mycobacterium chelonae was isolated from one case and three probable cases were identified. M. chelonae was grown from an opened bottle of ink sourced from the studio these cases had attended. In addition, in order to identify all published cases, we conducted a systematic review of all reported cases of tattoo-associated skin infection with rapidly growing mycobacteria. A total of 25 reports were identified, describing 71 confirmed and 71 probable cases. Mycobacteria were isolated in 71 cases and M. chelonae was cultured from 48 of these. The most frequently postulated cause of infection was the dilution of black ink with tap water. Reports of tattoo-associated rapidly growing mycobacterial skin infection are increasing in frequency. Interested agencies must work with the tattoo industry to reduce the risk of contamination during tattoo ink manufacture, distribution and application.
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Affiliation(s)
- P D Conaglen
- NHS Fife, Department of Public Health, Cameron House, Leven, United Kingdom
| | - I F Laurenson
- NHS Lothian, Scottish Mycobacteria Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - A Sergeant
- NHS Lothian, Department of Dermatology, Lauriston Building, Edinburgh, United Kingdom
| | - S N Thorn
- NHS Lothian, Department of Public Health, Waverley Gate, Edinburgh, United Kingdom
| | - A Rayner
- NHS Lothian, Scottish Mycobacteria Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - J Stevenson
- NHS Lothian, Department of Public Health, Waverley Gate, Edinburgh, United Kingdom
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