An Outbreak of Mycobacterial Furunculosis Associated with Footbaths at a Nail Salon

A physician in northern California reported four women who had multiple, culture-negative furunculoses of the lower extremities after pedicures at the same nail salon. Investigation identified an additional 106 customers with similar, persistent skin infections. All had had whirlpool footbaths before pedicures. The same strain of Mycobacterium fortuitum was isolated from 14 patients and three footbaths. Rapidly growing mycobacteria are distributed ubiquitously in soil and water, including chlorinated municipal water systems. 1 – 5 They are known to cause localized cutaneous infections, such as cellulitis and soft-tissue abscesses, as well as rare extracutaneous or disseminated disease. 6 Since the first description of Mycobacterium fortuitum infection, from an abscess resulting from vitamin injection in 1936, 7 nosocomial outbreaks of infection with rapidly growing mycobacteria have been documented. These outbreaks are typically associated with surgical or clinical devices contaminated with water from a hospital or municipal water system. 8 In the community setting, only sporadic infections have been reported, usually resulting from the . . .