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Previous Volume 346:1366-1371 May 2, 2002 Number 18 Next

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ABSTRACT

Background In September 2000, a physician in northern California described four patients with persistent, culture-negative boils on the lower extremities. The patients had received pedicures at the same nail salon. We identified and investigated an outbreak of Mycobacterium fortuitum furunculosis among customers of this nail salon.

Methods Patients were defined as salon customers with persistent skin infections below the knee. A case–control study was conducted that included the first 48 patients identified, and 56 unaffected friends and family members who had had a pedicure at the same salon served as controls. Selected M. fortuitum isolates, cultured from patients and the salon environment, were compared by pulsed-field gel electrophoresis.

Results We identified 110 customers of the nail salon who had furunculosis. Cultures from 34 were positive for rapidly growing mycobacteria (32 M. fortuitum and 2 unidentified). Most of the affected patients had more than 1 boil (median, 2; range, 1 to 37). All patients and controls had had whirlpool footbaths. Shaving the legs with a razor before pedicure was a risk factor for infection (70 percent of patients vs. 31 percent of controls; adjusted odds ratio, 4.8; 95 percent confidence interval, 2.1 to 11.1). Cultures from all 10 footbaths at the salon yielded M. fortuitum. The M. fortuitum isolates from three footbaths and 14 patients were indistinguishable by electrophoresis.

Conclusions We identified a large outbreak of rapidly growing mycobacterial infections among persons who had had footbaths and pedicures at one nail salon. Physicians should suspect this cause in patients with persistent furunculosis after exposure to whirlpool footbaths.

Source Information

From the Epidemic Intelligence Service, Epidemiology Program Office (K.L.W.), and the Division of AIDS, Sexually Transmitted Diseases, and Tuberculosis Laboratory Research, Tuberculosis/Mycobacterial Branch (M.Y.), Centers for Disease Control and Prevention, Atlanta; the Division of Communicable Disease Control, California Department of Health Services, Berkeley (K.L.W., J.E., D.J.V.); and the Santa Cruz County Department of Health, Santa Cruz (M.A., I.S., D.G.).

Address reprint requests to Dr. Winthrop at the California Department of Health Services, Rm. 708, 2151 Berkeley Way, Berkeley, CA 94704, or at kwinthro{at}dhs.ca.gov.

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