Tattoo, Piercing And Breast Implantation Infections

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Tattoo, Piercing And Breast Implantation Infections

This Article Also Appears In Dermatology

Cosmetic Medicine/Plastic Surgery

Article Date: 08 Apr 2006 - 0:00am (UK)

16th European Congress of Clinical Microbiology and

Infectious Diseases

Nice, France - In the USA, Canada, Australia and

Northern Europe, between 8 and 13% of the population

has tattoos and/or piercings, Jean-Baptiste

Guiard-Schmid of the Paris Rothschild Hospital

reported during the 16th European Congress of Clinical

Microbiology and Infectious Disease (ECCMID). The

congress, which is organized by the European Society

of Clinical Microbiology and Infectious Disease

(ESCMID), is currently underway in Nice and ends

today.

In the USA alone, according to figures gathered in

2000, some 7 to 20 million Americans have tattoos,

Guiard-Schmid said. Those with tattoos and piercings

spanned various age and socio-economic groups. While

piercings are more commonly found among teenagers;

tattoos appear to be more popular with adults between

the ages of 18 and 30. Other more extreme body

modifications (scarification, foreign body implants,

branding) are performed by a limited number of

practitioners.

The main health complications associated with piercing

and tattooing include infections, pathologic healing,

allergic reactions, tissue damages, bleeding and

odonto-stomatologic lesions.

Local bacterial infections are rare after tattooing

but develop frequently from piercings, although they

are usually minor. Between 10 to 20% of piercings are

associated with local benign bacterial infection,

according to the results of the few available studies

on the topic. Typical symptoms of a local bacterial

infection are redness, swelling, fever and pain. The

main pathogens causing local infections, e.g.

suppuration or abscesses, are Staphylococcus aureus,

group A streptococcus and Pseudomonas spp. Impetigo

has also been identified and is caused by

Streptococcus pyogenes.

These infections may become chronic and lead to local

pyogenic granuloma (also called botryomycoma).

Bacterial infections occurring as a result of piercing

rarely spread and rarely lead to severe or

life-threatening infections. Erysipelas and cellulitis

have been observed with S. aureus and S. pyogenes

aetiology. Anecdotal case reports of leprosy,

tuberculosis, syphilis, chancroid and tetanus have

also been published in recent years.

The use of unsterilized needles, needle bars and

tubes, forceps, jewelery, scalpels, dermographs and

contaminated pigments can result in blood-borne

infections, such as hepatitis B, C and HIV infection.

HBV and HCV transmission have been well documented in

cases reported about Dutch piercing shops in 1997 and

in London tattooist shops during the late seventies.

Similarly acute hepatitis C apparently originated from

tattooing in an Australian prison population in 2001.

These viral infections may be asymptomatic in their

early phases and therefore rarely diagnosed. Thus,

their relationship to body modifications is not always

realized. Piercing and tattooing are identified as

risk factors for viral hepatitis in more than 20

epidemiological studies currently available. But

debate continues among some authors who think that it

is difficult to distinguish body modifications from

other risk factors (use of intravenous drugs,

incarceration, etc.) in the studied populations. Even

if hepatitis B and C virus transmission rates are very

low, the number of body modifications performed each

year probably accounts for a significant number of

hepatitis cases. Fortunately, the HBV vaccination

should prevent at least half of these cases. HIV

transmission has been documented by a case reported in

1997. The patient had been contaminated in a period of

3 months during which he underwent six piercings in

different parts of his body, performed in different

piercing shops in Europe and the USA. There were no

biomolecular data on HIV strains in this report. The

theoretical risk is probably very low since HIV is a

fragile virus. However, piercing of genitals may be a

risk factor for HIV infection, according to some

authors. Piercers and tattooists generally work

without medical supervision, and techniques are often

passed on from one piercer or tattooist to another

directly. Even though they have become very common,

body modifications still exist within a context of

" epidemiological silence " . However, they have a

significant impact on public health and concern all

health care professionals, ranging from general

practitioners to emergency units. Regulations on body

modifications are heterogeneous, especially in Europe.

People seeking cosmetic breast surgery must be aware

of the risk of infection. In fact, 2.5% of prostheses

result in infection. This should be taken into

consideration by those facing a mastectomy and wanting

to reconstruct their breasts, Didier Pittet of the

University of Geneva reported at the ECCMID.

Breast implants have to be divided into two

categories: augmentation and reconstruction. In all

the cases some adverse effects could occur:

infections, wound dehiscence, capsular contracture,

implant rupture, etc. But infection rates are 10-fold

higher in breast reconstruction than in aesthetic

implants.

Major predisposing and risk factors include

pre-existing scarring, radiation therapy, simultaneous

mastectomy or lymph node dissection. The origin of

infection can be a contaminated implant, contaminated

saline within the implant, contamination of the saline

implant (some implants need to be filled by the

surgeon during the intervention), contaminated

surgical environment, seeding of the implant by remote

infection.

Usually infections occur during the first month after

implantation (on average between 10-12 days) and cause

fever, rapidly evolving pain, marked breast erythema.

The only way to deal with such effects is the surgical

removal of the implants.

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