title: An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon.
abstract: BACKGROUND
  In September 2000, a physician in northern California described four patients with persistent, culture-negative boils on the lower extremities. The patients had received pedicures at the same nail salon. We identified and investigated an outbreak of Mycobacterium fortuitum furunculosis among customers of this nail salon.
  
  
  METHODS
  Patients were defined as salon customers with persistent skin infections below the knee. A case-control study was conducted that included the first 48 patients identified, and 56 unaffected friends and family members who had had a pedicure at the same salon served as controls. Selected M. fortuitum isolates, cultured from patients and the salon environment, were compared by pulsed-field gel electrophoresis.
  
  
  RESULTS
  We identified 110 customers of the nail salon who had furunculosis. Cultures from 34 were positive for rapidly growing mycobacteria (32 M. fortuitum and 2 unidentified). Most of the affected patients had more than 1 boil (median, 2; range, 1 to 37). All patients and controls had had whirlpool footbaths. Shaving the legs with a razor before pedicure was a risk factor for infection (70 percent of patients vs. 31 percent of controls; adjusted odds ratio, 4.8; 95 percent confidence interval, 2.1 to 11.1). Cultures from all 10 footbaths at the salon yielded M. fortuitum. The M. fortuitum isolates from three footbaths and 14 patients were indistinguishable by electrophoresis.
  
  
  CONCLUSIONS
  We identified a large outbreak of rapidly growing mycobacterial infections among persons who had had footbaths and pedicures at one nail salon. Physicians should suspect this cause in patients with persistent furunculosis after exposure to whirlpool footbaths.
authors: Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, USA. kwinthro@dhs.ca.gov
authors: Kevin L
authors: KL
authors: Winthrop
authors: Marcy
authors: M
authors: Abrams
authors: Mitchell
authors: M
authors: Yakrus
authors: Ira
authors: I
authors: Schwartz
authors: Janet
authors: J
authors: Ely
authors: Duncan
authors: D
authors: Gillies
authors: Duc J
authors: DJ
authors: Vugia
mesh_terms: D001505:Beauty Culture; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D003357:Cosmetic Techniques; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D006875:Hydrotherapy / Q000009:adverse effects*; D009161:Mycobacterium / Q000235:genetics / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D012307:Risk Factors; D014871:Water Microbiology