An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon

Kevin Winthrop, Marcy Abrams, Mitchell Yakrus, Ira Schwartz, Janet Ely, Duncan Gillies, Duc J. Vugia

Research output: Contribution to journalArticle

157 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1366-1371
Number of pages6
JournalNew England Journal of Medicine
Volume346
Issue number18
DOIs
StatePublished - May 2 2002
Externally publishedYes

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Furunculosis
Nails
Disease Outbreaks
Mycobacterium fortuitum
Infection
Physicians
Pulsed Field Gel Electrophoresis
Mycobacterium
Electrophoresis
Case-Control Studies
Lower Extremity
Leg
Knee
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Winthrop, K., Abrams, M., Yakrus, M., Schwartz, I., Ely, J., Gillies, D., & Vugia, D. J. (2002). An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. New England Journal of Medicine, 346(18), 1366-1371. https://doi.org/10.1056/NEJMoa012643

An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. / Winthrop, Kevin; Abrams, Marcy; Yakrus, Mitchell; Schwartz, Ira; Ely, Janet; Gillies, Duncan; Vugia, Duc J.

In: New England Journal of Medicine, Vol. 346, No. 18, 02.05.2002, p. 1366-1371.

Research output: Contribution to journalArticle

Winthrop, K, Abrams, M, Yakrus, M, Schwartz, I, Ely, J, Gillies, D & Vugia, DJ 2002, 'An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon', New England Journal of Medicine, vol. 346, no. 18, pp. 1366-1371. https://doi.org/10.1056/NEJMoa012643
Winthrop, Kevin ; Abrams, Marcy ; Yakrus, Mitchell ; Schwartz, Ira ; Ely, Janet ; Gillies, Duncan ; Vugia, Duc J. / An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. In: New England Journal of Medicine. 2002 ; Vol. 346, No. 18. pp. 1366-1371.
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