title: Rapidly growing mycobacterial infections after pedicures.
abstract: BACKGROUND
  Rapidly growing mycobacteria (RGM) can cause a variety of cutaneous and systemic diseases. The causative organisms are typically Mycobacterium fortuitum or Mycobacterium chelonae (also known as Mycobacterium abscessus). Primary cutaneous lesions may develop after a variable latent period, from weeks to several months, and usually result from direct inoculation after trauma, from injections, or during surgery via contaminated medical instruments. Recently, investigators from the Centers for Disease Control and Prevention, Atlanta, Ga, and the California Department of Health Services, Berkeley, documented a large, unprecedented outbreak of community-acquired RGM infection, during which more than 100 patrons of a northern California nail salon contracted furunculosis in their legs as a result of exposure to whirlpool footbaths that were contaminated with M fortuitum.
  
  
  METHODS
  We report the clinical and epidemiological findings in 3 cases of lower extremity RGM infections that occurred after similar whirlpool footbath exposure at several different nail salons in southern California. These infections typically presented as recurrent furunculosis, causing considerable morbidity as a result of scarring, delayed diagnosis, and the need for long-term polymicrobial therapy.
  
  
  CONCLUSIONS
  Rapidly growing mycobacterial infections related to pedicures may continue to occur in a sporadic fashion. Clinicians should consider the possibility of RGM infection and inquire about recent pedicures in a patient with recurrent lower extremity furunculosis and abscesses that are unresponsive to conventional antibiotic therapy.
authors.affiliation: Department of Flight Surgery, Naval Air Station Pensacola, Pensacola, FL, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Sniezek
authors.forename: Brad S
authors.initials: BS
authors.lastname: Graham
authors.forename: Heidi Byers
authors.initials: HB
authors.lastname: Busch
authors.forename: Edith R
authors.initials: ER
authors.lastname: Lederman
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Lim
authors.forename: Kimberly
authors.initials: K
authors.lastname: Poggemyer
authors.forename: Annie
authors.initials: A
authors.lastname: Kao
authors.forename: Moise
authors.initials: M
authors.lastname: Mizrahi
authors.forename: Gerry
authors.initials: G
authors.lastname: Washabaugh
authors.forename: Mitch
authors.initials: M
authors.lastname: Yakrus
authors.forename: Kevin
authors.initials: K
authors.lastname: Winthrop
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D005667:Furunculosis / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D006801:Humans; D006875:Hydrotherapy / Q000009:adverse effects*; D009165:Mycobacterium Infections, Nontuberculous / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D016926:Mycobacterium chelonae / Q000254:growth & development* / Q000302:isolation & purification; D019907:Mycobacterium fortuitum / Q000254:growth & development* / Q000302:isolation & purification; D013997:Time Factors