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Abstract & Commentary
Synopsis: An outbreak of cutaneous nontuberculous mycobacterial leg infections was encountered among pedicure salon patrons.
Source: Altman LK. Microbe in salon footbath is suspected in boil outbreak. New York Times. April 27, 2001.
The New York Times recently reported news of an outbreak of Mycobacterium fortuitum cutaneous infections among women receiving pedicures. The account cited the results of a Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) investigation that was presented at the 50th annual EIS conference earlier this year in Atlanta, Ga.
At least 110 patrons of a California salon developed furuncles on their legs 10 days to 4 months after receiving pedicures. CDC investigators hypothesized that prepedicure soaking in a footbath exposed the skin of the patrons’ legs to M fortuitum, and found that the footbaths were "teeming" with the microorganism. Infection risk was increased nearly 6-fold in those patrons who shaved their legs shortly before the pedicure; an oil massage during the pedicure increased the risk of infection 3-fold.
The problem may be far more common than the 1 outbreak might suggest. CDC investigators noted that M fortuitum could be isolated from the majority of footbaths in other California nail salons. Indeed, a small outbreak of pedicure-associated M fortuitum skin infections has recently been reported in Arizona.1
Public health officials in California and Arizona are issuing guidelines and regulations to ensure that pedicure footbaths undergo proper disinfection.
Comment by Jerry D. Smilack, MD
Clinicians should be aware of this entity. As always, a careful history is the key in making the diagnosis. Mycobacterial cultures of drainage from a lesion or a punch biopsy are mandatory. Specific recommendations regarding antimicrobial therapy are not possible because of limited outcome data, but most isolates of M fortuitum are susceptible to ciprofloxacin and sulfonamides, and to a lesser extent clarithromycin. Parenteral agents with excellent in vitro activity include amikacin and imipenem. However, antimicrobial susceptibility testing of a patient’s isolate should guide therapy in each case.
1. Arizona Department of Health Services. Mycobacterium fortuitum furunculosis associated with salon foot baths. Prevention Bulletin. 2001;15(4):3.
Jerry Smilack, Infectious Disease Consultant, Mayo Clinic Scottsdale, Scottsdale, Ariz., is Associate Editor of Infectious Disease Alert.