• Isabel Griffin, Ann Schmitz, Christine Oliver, Scott Pritchard, Guoyan Zhang, Edhelene Rico, Emily Davenport, Anthoni Llau, Emily Moore, Danielle Fernandez, Alvaro Mejia-Echeverry, Juan Suarez, Pedro Noya-Chaveco, Samir Elmir, Reynald Jean, James B Pettengill, Katherine A Hollinger, Kyson Chou, Donna Williams-Hill, Sherif Zaki, Atis Muehlenbachs, M Kelly Keating, Julu Bhatnagar, Marie-Claire Rowlinson, Calin Chiribau, and Lillian Rivera.
• Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Tallahassee.
• Clin. Infect. Dis. 2019 Aug 30; 69 (6): 949-955.

BackgroundOn 29 April 2015, the Florida Department of Health in Miami-Dade County (DOH Miami-Dade) was notified by a local dermatologist of 3 patients with suspected nontuberculous mycobacterial (NTM) infection after receiving tattoos at a local tattoo studio.MethodsDOH Miami-Dade conducted interviews and offered testing, described below, to tattoo studio clients reporting rashes. Culture of clinical isolates and identification were performed at the Florida Bureau of Public Health Laboratories. Characterization of NTM was performed by the Centers for Disease Control and Prevention and the US Food and Drug Administration (FDA), respectively. Whole-genome sequencing (WGS) and single-nucleotide polymorphism (SNP) analyses were used to construct a phylogeny among 21 Mycobacterium isolates at the FDA.ResultsThirty-eight of 226 interviewed clients were identified as outbreak-associated cases. Multivariate logistic regression revealed that individuals who reported gray tattoo ink in their tattoos were 8.2 times as likely to report a rash (95% confidence interval, 3.1-22.1). Multiple NTM species were identified in clinical and environmental specimens. Phylogenetic results from environmental samples and skin biopsies indicated that 2 Mycobacterium fortuitum isolates (graywash ink and a skin biopsy) and 11 Mycobacterium abscessus isolates (5 from the implicated bottle of graywash tattoo ink, 2 from tap water, and 4 from skin biopsies) were indistinguishable. In addition, Mycobacterium chelonae was isolated from 5 unopened bottles of graywash ink provided by 2 other tattoo studios in Miami-Dade County.ConclusionsWGS and SNP analyses identified the tap water and the bottle of graywash tattoo ink as the sources of the NTM infections.Published by Oxford University Press for the Infectious Diseases Society of America 2019.

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