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Infected tattoos linked to distilled water in ink

The New England Journal of Medicine

The owner of this dragonfly tattoo was among dozens who developed hard-to-treat rashes associated with an infection spread by contaminated distilled water.

Who would have thought that distilled water could carry an infection? Disease sleuths said on Wednesday they traced infected tattoos in four states to ink diluted using distilled water.

More than 40 men and women got hard-to-treat rashes from the ink -- even though they went to licensed tattoo artists who followed every sterile procedure, public health officials said. They issued warnings so that people who get new tattoos and their doctors can be on the alert. With 21 percent of the U.S. public now sporting tattoos, a lot of people could be affected.

The investigation started when a 20-year-old man in upstate New York got a rash that wouldn’t go away after he got a new tattoo. Tests showed the rash was caused by a rare bacteria called Mycobacterium chelonae. It’s a distant relative of the tuberculosis bug, and lives in soil and water. While the rashes are not life-threatening, it can take weeks of antibiotic therapy to get rid of them.

County and state health officials tracked down a total of 19 people who got tattoos from the same artists, and it turned out they all got the same fashionable artistic treatment -- a gray wash that makes a tattoo resemble a photograph. But the artist who did the work had done it by the book, following sterile procedures all the way, according to the report in this week’s issue of the New England Journal of Medicine.

"We went there several times," said Dr. Byron Kennedy of the Monroe County, N.Y., department of public health. "And we interviewed all 19 patients. they all confirmed they observed the artist using disposable gloves ... using clean needles, and the like."

The artist bought the ink from one manufacturer at a large trade show in Arizona, so health officials called in the Food and Drug Administration, which got ink samples and sent them to the Centers for Disease Control and Prevention for testing. The ink, it turned out, was contaminated with M. chelonae.

Tara MacCannell, a CDC epidemiologist, said the agency sent out a wider alert. “As a result of putting out a more general health alert, we found several brands of inks that were linked to this particular type of infection,” she said in a telephone interview.

In all, 32 more people in Washington, Iowa and Colorado had possible or confirmed infections from inks made by three other companies, CDC reported.

The New England Journal of Medicine

The infections were not the fault of tattoo artists, who followed proper procedures, but were caused by the tainted ink.

The needles used to give tattoos can pass along serious infections, from hepatitis to HIV.  People have also caught nasty methicillin-resistant Staphylococcus aureus -- MRSA -- infections from dirty needles. Tattoo artists must follow strict hygiene procedures, including using sterile materials and wearing protective gloves. They must attend regular educational classes and they must be inspected.

“They can do all those things right and get this contaminated tattoo ink and still result in infection,” MacCannell said.  “There are lots of people who are very conscientious about their practices … yet they are not given the tools to ensure the sterility of the product.”

The most likely source of the contamination is distilled water, CDC says. “Tattoo ink manufacturers think distilled water is sterile,” MacCannell said. Sometimes they use alcohol or witch hazel as a preservative, but that doesn’t work on these particular germs.

“Non-tubercular mycoplasmae have no problem living in alcohol. They have no problem living in witch hazel,” MacCannell said. “They are related to tuberculosis and that is a very hard bug to kill, too. They are generally known to be resistant to disinfectants.”

The researchers point out that it can take four months or longer of treatment, often with a cocktail of antibiotics, to get rid of these infections. Some patients may need to have the whole area surgically removed, leaving an ugly scar. So if you get a tattoo and develp a rash, Kennedy advises, it's best to go straight to a doctor. And doctors need to be aware that the rash may be caused by this tricky and hard-to-treat bacteria.


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