September’s Emerging Infectious Diseases journal reports that two individuals’ tattoos were infected by a bacteria normally seen only in people with poor immune systems. In August 2009, an otherwise healthy adult sought medical care for pustules at the site of his new tattoo. When the infection did not respond well to antibiotics, the case was referred to the local public health department and an investigation by CDC and Washington State public health officials was launched.
Medical tests isolated Mycobacterium haemophilum,which can be difficult to treat, just like its Tuberculosis-causing relative. The lesions did not fully heal until March 2010. M. haemophilum does not normally cause the pustules seen in this case. They may have been due to the mode of infection, via tattooing needle. The authors report a second individual had identical symptoms and had been tattooed at the same shop, but tests failed to identify the organism.
An outbreak of M. haemophilum was earlier reported among 12 Swiss women who had their eyebrows tattooed as permanent makeup. In addition to lengthy antibiotic treatment, 10 of them needed surgery.
Tattoo regulations vary widely in the United States. The tattoo establishment was operating within state safety and sanitation standards. Investigators believe the use of tap water to dilute the tattoo ink may have contributed to the infections. While this practice is permitted, the authors recommended the tattoo establishment use sterile water in the future. M. haemophilum was not found in samples of tap water or on any surfaces in the business, but previous studies have suggested water can be a vehicle for it. It is important to note that this study does not suggest the tap water was dangerous, simply that at some point the water used to dilute the ink could have picked up M. haemophilum which was then injected into the skin to cause the infection. Since M. haemophilum does not normally cause disease in healthy people, injecting it may be a necessary step in causing illness in people with health immune systems.
Traditionally, health officials have been concerned about the risk of blood-borne diseases during tattooing. The widespread adoption of single-use needles has helped reduce this risk. The difference in the story reported here is that M. haemophilum is common in the environment. These infections were not due to transmission between clients. For more information on tattoos and health, you can visit the CDC’s webpage on the topic.