SLR - August 2011 - Jacqueline Monroe
Reference: Wertman, R., Miller, M., Groben, P., Morrell, D., Culton, D. (2001, April). Mycobacterium bolletii/Mycobacterium massiliense Furunculosis Associated with Pedicure Footbaths. Archives of Dermatology, 147(4), 454-458.
Scientific Literature Review
Reviewed by: Jacqueline Monroe, DPM
Residency Program: University Hospitals Richmond Medical Center/OCPM
Podiatric Relevance:
In the office setting, podiatrists often treat patients for skin and nail pathologies related to visits at nail salons. Patients may also have questions relating to the safety and cleanliness of these salons and spas. It is necessary for podiatrists to be aware of the possible infections and conditions their patients may present with after pedicures. Although it is generally safe to say that most spas and salons are clean and use good sterilization techniques, it is important to educate the patient about the signs and symptoms of possible skin and nail infections that may occur following such visits so that they are able to seek medical attention in a timely manner.
Methods:
This report discusses three separate cases of lower extremity furunculosis caused by M bolletii/M massiliense after footbaths and pedicures were given at the same nail salon in North Carolina. In each case, lesions developed on the lower extremities within one month of the salon visit. These lesions were noted to be erythematous, indurated papules and plaques. Cultures/biopsies were taken from the lesions and sequencing of the 16S ribosomal RNA and hsp65 genes was performed. Once each of these three patients sought treatment, they were placed on antibiotic therapy for 6 months duration and followed until resolution of their lower extremity lesions.
Results:
After each of the three patients sought treatment for the lower extremity lesions, cultures and biopsies were taken. Mycobacterium bolletti and Mycobacterium massiliense were isolated from these lesions. They were identified by sequencing the 16S ribosomal RNA and hsp65 genes. Each patient was then placed on a combination of antiobiotics depending on the determined drug resistance. Resolution of each patient’s lower extremity lesions became apparent between 4-6 months.
Conclusions:
Mycobacterium bolletti and Mycobacterium massiliense are opportunistic in that they often affect those who are immunosuppressed. Initially, one will see the formation of nodules with a protracted course of healing that can result in scarring. The lesions generally appear 1-2 months after introduction of the organism. Skin microtrauma from leg shaving has been associated as a risk factor for infection from footbaths. Patients often wait before seeking treatment, which can delay the accurate identification and differentiation of different species. Since each species is resistant to different antibiotic therapies, gene sequencing becomes instrumental in determining the correct antibiotic therapy combination to ensure proper healing. It is not unusual to treat patients for lower extremity conditions caused from visits to salons for pedicures and footbaths. Therefore, it is important to understand the risks and possible complications resulting from such treatments.