The scientists searched the PubMed database for articles published between 2009 and 2019. Any studies describing systemic infections in humans associated with tattoos were included in the final analysis. Tattoo-associated systemic infection was defined as penetration of any infection into the skin, with or without spread to other organs.
The analysis included a total of 17 studies. However, none of the selected studies reported the development of systemic tuberculosis, syphilis, or viral infections after tattooing.
Several sporadic cases of Mycobacterium leprae, the bacteria that cause leprosy, have been identified in India. In addition, several cases of enlarged lymph nodes due to non-tuberculous mycobacteria, which do not cause tuberculosis or leprosy, have been identified.
The most commonly identified nontuberculous mycobacteria included Mycobacterium chelonae, Mycobacterium abscessus and Mycobacterium haemophilum. The majority of systemic infections caused by Mycobacterium haemophilum have been identified in women after eyebrow tattooing, 50% of which eventually required partial or complete removal of the parotid gland.
Several studies were identified that reported septic shock associated with cellulitis or necrotizing fasciitis. Septic shock was primarily associated with pyogenic bacteria and occurred within two weeks of tattooing.
Only one study was identified that reported staphylococcal toxic shock syndrome. This infection has been observed after traditional Samoan tattooing or after tattooing in unsanitary conditions.
Infective endocarditis was detected mainly in young men. The condition was accompanied by fever, as well as pulmonary or systemic embolism without local symptoms.
Massive embolism was found in two cases, while leaflet perforation and perivalvular abscess were reported in two cases. Only one case of toxic shock syndrome has been identified.
Current research confirms that systemic infections can develop after a tattoo. However, tattoo-related death is a rare event, with only one death reported in the last ten years.