Q: 32 year old female is admitted to ICU with hypotension and possible sepsis. Patient's past medical history is unremarkable except that she started working 6 weeks ago at the spa to do pedicures. Knowing her history, out of the following which one would be your concern? 

A) Mycobacterium kansasii 
B) Mycobacterium marinum 
C) Mycobacterium avium-intra-cellulare (MAI) 
D) Mycobacterium tuberculosis 
E) Mycobacterium fortuitum 


Answer: E

The objective of above question is to address risk factors and knowledge of unusual infectious bugs may encounter in ICU. With the explosion of spas and salons in urban settings, ICU physicians are expected to know about Mycobacterium fortuitum as a risk. Also reported in similar setting is Mycobacterium mageritense.


References: 

1. Sniezek PJ, Graham BS, Busch HB, et al. Rapidly growing mycobacterial infections after pedicures. Arch Dermatol 2003;139:629-34. 

2. Winthrop KL, Albridge K, South D, et al. The clinical management and outcome of nail salon-acquired Mycobacterium fortuitum skin infection. Clin Infect Dis 2004;38:38-44.

3. Winthrop KL, Abrams M, Yakrus M, et al. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med 2002;346:1366-71. 

4. Gira AK, Reisenauer AH, Hammock L, et al. Furunculosis due to Mycobacterium mageritense associated with footbaths at a nail salon. J Clin Microbiol 2004;42:1813-7

5. Vugia DJ, Jang Y, Zizek C, Ely J, Winthrop KL, Desmond E. Mycobacteria in nail salon whirlpool footbaths, California. Emerg Infect Dis 2005;11:616-8.