title: Pedicure-associated rapidly growing mycobacterial infection: an endemic disease.
abstract: BACKGROUND
  Pedicure-associated nontuberculous mycobacterial furunculosis has been reported in the setting of either outbreaks or sporadic case reports. The epidemiology of these infections is not well understood.
  
  
  METHODS
  Systematic surveillance for pedicure-associated nontuberculous mycobacterial furunculosis was conducted in 2 North Carolina counties from 1 January 2005 through 31 December 2008. A subset of implicated nail salons and control salons was inspected and sampled for nontuberculous mycobacteria.
  
  
  RESULTS
  Forty cases of suspected or confirmed pedicure-associated nontuberculous mycobacterial furunculosis were reported during the 4-year study period. Furunculosis incidence in the surveillance region was 1.00, 0.96, 0.83, and 0.89 cases per 100,000 population in 2005, 2006, 2007, and 2008, respectively. The responsible organisms primarily belonged to the Mycobacterium chelonae/abscessus group (30 [91%] of 33 isolates). Thirteen implicated salons and 11 control salons were visited and environmentally sampled. An assortment of nontuberculous mycobacteria was cultured from footbaths, but there was no association between the species distribution of the environmental isolates and implication of the salon in human infection. Evidence of suboptimal cleaning (visible debris or surface biofilms) was observed in at least 1 footbath for 11 of 13 implicated salons and 4 of 11 control salons (P = .032).
  
  
  CONCLUSIONS
  Pedicure-associated mycobacterial furunculosis was endemic in these 2 North Carolina counties during 2005-2008. Suboptimal footbath cleaning may have contributed to these infections, which suggests straightforward means of potential prevention. The relative rarity of this type of infection in the setting of nearly ubiquitous exposure to these pathogens suggests that as yet undefined host-specific or procedure-related factors may be involved in susceptibility to these infections.
authors.affiliation: Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA. stout002@mc.duke.edu
authors.forename: Jason E
authors.initials: JE
authors.lastname: Stout
authors.forename: L Beth
authors.initials: LB
authors.lastname: Gadkowski
authors.forename: Shadia
authors.initials: S
authors.lastname: Rath
authors.forename: James A
authors.initials: JA
authors.lastname: Alspaugh
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Miller
authors.forename: Gary M
authors.initials: GM
authors.lastname: Cox
mesh_terms: D000293:Adolescent; D000328:Adult; D001505:Beauty Culture; D019353:Endemic Diseases; D005260:Female; D005667:Furunculosis / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D006801:Humans; D006875:Hydrotherapy / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D016926:Mycobacterium chelonae / Q000302:isolation & purification; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D009657:North Carolina / Q000453:epidemiology; D011159:Population Surveillance; D012307:Risk Factors; D055815:Young Adult