title: Cutaneous inoculation of nontuberculous mycobacteria during professional tattooing: a case series and epidemiologic study.
abstract: BACKGROUND
  The increase in popularity of tattoos has coincided with an increase in reports of cutaneous inoculation of nontuberculous (atypical) mycobacteria (NTM) during the tattooing process. We report 3 NTM infections in otherwise healthy persons who received tattoos, which prompted a multiagency epidemiologic investigation.
  
  
  METHODS
  Tattoo artists involved were contacted and interviewed regarding practices, ink procurement and use, and other symptomatic clients. Additional patients were identified from their client lists with an Internet survey.
  
  
  RESULTS
  Thirty-one cases of suspected or confirmed NTM inoculation from professional tattooing were uncovered, including 5 confirmed and 26 suspected cases. Clinical biopsy specimens from 3 confirmed infections grew Mycobacterium abscessus strains that were indistinguishable by pulsed-field gel electrophoresis testing. Another 2 skin specimens grew Mycobacterium chelonae, which also grew from a bottle of graywash ink obtained from the tattoo artist.
  
  
  CONCLUSIONS
  The pathogenicity and antibiotic resistance patterns of certain NTM isolates highlight the importance of correct diagnosis and potential difficulty in treating infections. Enforcement of new standards for the regulation and use of tattoo inks should be considered.
authors.affiliation: Division of Dermatology, University of Washington, 1959 NE Pacific St, WA 98195-6524, USA. rfalsey@gmail.com
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Falsey
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kinzer
authors.forename: Stanley
authors.initials: S
authors.lastname: Hurst
authors.forename: Andrea
authors.initials: A
authors.lastname: Kalus
authors.forename: Paul S
authors.initials: PS
authors.lastname: Pottinger
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Duchin
authors.forename: Jiong
authors.initials: J
authors.lastname: Zhang
authors.forename: Judith
authors.initials: J
authors.lastname: Noble-Wang
authors.forename: Michi M
authors.initials: MM
authors.lastname: Shinohara
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D006801:Humans; D007281:Ink; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000635:transmission*; D009170:Nontuberculous Mycobacteria / Q000187:drug effects / Q000302:isolation & purification*; D017192:Skin Diseases, Bacterial / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D013653:Tattooing / Q000009:adverse effects*; D014861:Washington / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents
keywords: antibiotic resistance; nontuberculous mycobacteria (NTM); tattoo