Monroe County Department of Public Health, Rochester, New York 14620, USA.
N Engl J Med. 2012 Sep 13;367(11):1020-4. doi: 10.1056/NEJMoa1205114. Epub 2012 Aug 22.
In January 2012, on the basis of an initial report from a dermatologist, we began to investigate an outbreak of tattoo-associated Mycobacterium chelonae skin and soft-tissue infections in Rochester, New York. The main goals were to identify the extent, cause, and form of transmission of the outbreak and to prevent further cases of infection.
We analyzed data from structured interviews with the patients, histopathological testing of skin-biopsy specimens, acid-fast bacilli smears, and microbial cultures and antimicrobial susceptibility testing. We also performed DNA sequencing, pulsed-field gel electrophoresis (PFGE), cultures of the ink and ingredients used in the preparation and packaging of the ink, assessment of source water and faucets at tattoo parlors, and investigation of the ink manufacturer.
Between October and December 2011, a persistent, raised, erythematous rash in the tattoo area developed in 19 persons (13 men and 6 women) within 3 weeks after they received a tattoo from a single artist who used premixed gray ink; the highest occurrence of tattooing and rash onset was in November (accounting for 15 and 12 patients, respectively). The average age of the patients was 35 years (range, 18 to 48). Skin-biopsy specimens, obtained from 17 patients, showed abnormalities in all 17, with M. chelonae isolated from 14 and confirmed by means of DNA sequencing. PFGE analysis showed indistinguishable patterns in 11 clinical isolates and one of three unopened bottles of premixed ink. Eighteen of the 19 patients were treated with appropriate antibiotics, and their condition improved.
The premixed ink was the common source of infection in this outbreak. These findings led to a recall by the manufacturer.
2012 年 1 月，基于一位皮肤科医生的初步报告，我们开始调查在纽约罗彻斯特市暴发的与纹身相关的脓肿分枝杆菌皮肤和软组织感染。主要目标是确定暴发的范围、原因和传播方式，并防止进一步感染病例的发生。
我们分析了对患者进行的结构化访谈、皮肤活检标本的组织病理学检测、抗酸杆菌涂片和微生物培养及药敏试验的数据。我们还进行了 DNA 测序、脉冲场凝胶电泳（PFGE）、墨水中的成分和用于制备和包装墨水的成分的培养、纹身店的水源和龙头的评估，以及对墨水瓶制造商的调查。
2011 年 10 月至 12 月期间，在接受一名使用预混灰色墨水的单一纹身师的纹身 3 周内，19 名（13 名男性和 6 名女性）患者的纹身部位出现了持续、隆起、红斑皮疹；纹身和皮疹发作的最高发生率分别是在 11 月（分别为 15 例和 12 例）。患者的平均年龄为 35 岁（范围 18 至 48 岁）。从 17 名患者中获取的皮肤活检标本均显示所有 17 名患者均存在异常，从 14 名患者中分离出并通过 DNA 测序证实了脓肿分枝杆菌。PFGE 分析显示 11 例临床分离株和 3 瓶未开封预混墨水中的 1 瓶具有相同的模式。19 名患者中有 18 名接受了适当的抗生素治疗，病情得到改善。
这种混合墨水中的成分是此次暴发的共同感染源。这些发现导致制造商召回了相关产品。
