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During a site visit, investigators interviewed the tattoo artist and learned that since May 2011, he had been using a new, hand-blended, diluted black ink (gray wash) that contained pigment, distilled water, witch hazel, and glycerin. Epidemiologic InvestigationĪfter the interview with the index patient, investigators at the Monroe County Department of Public Health learned that similar reactions had developed in other persons who had obtained tattoos from the same artist at the same tattoo parlor. Histopathological examination and culture of a biopsy specimen confirmed the presence of M. He was treated unsuccessfully with glucocorticoids by his primary care provider before being referred to a dermatologist. This index patient was a previously healthy 20-year-old man who had a history of multiple tattoos without any health problems. On January 4, 2012, we and colleagues at the Monroe County Department of Public Health began investigating an outbreak on the basis of a report from a dermatologist of the development of a persistent granulomatous rash on the arm of a person who had received a tattoo on that area in October 2011. These findings led to a recall by the manufacturer. The premixed ink was the common source of infection in this outbreak.
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Eighteen of the 19 patients were treated with appropriate antibiotics, and their condition improved. PFGE analysis showed indistinguishable patterns in 11 clinical isolates and one of three unopened bottles of premixed ink. chelonae isolated from 14 and confirmed by means of DNA sequencing. Skin-biopsy specimens, obtained from 17 patients, showed abnormalities in all 17, with M. The average age of the patients was 35 years (range, 18 to 48). Resultsīetween 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). 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. 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. The main goals were to identify the extent, cause, and form of transmission of the outbreak and to prevent further cases of infection. 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 most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident.
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