{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T10:45:01Z","timestamp":1793184301556,"version":"4.5.0"},"reference-count":47,"publisher":"Akademiai Kiado Zrt.","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.akjournals.com"],"crossmark-restriction":true},"short-container-title":["EUJMI"],"published-print":{"date-parts":[[2026,10,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Tattooing is an ancient decorative cosmetic procedure with increasing popularity, but regulations concerning professional including hygienic practice are limited. Although mild inflammatory responses due to infections, for instance, are known complications, severe sequelae are beyond consideration. Here we summarize 40 cases of invasive and systemic infections as collateral damages of decorative tattooing. Reports from 14 countries revealed that most patients were male, with a median age of 28.5 years including a 6-week-old infant. Cases were categorized into deep abscesses and cellulitis, infective endocarditis, necrotizing soft-tissue infection, toxic shock syndrome, sepsis, and others. Overall, Gram-positive bacteria including\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    and streptococci dominated as infectious agents. Thirty out of 40 patients were considered immunocompetent, 23 required surgical interventions alongside antimicrobial therapy, and five cases were fatal. Severe complications occurred due to soft-tissue destruction near the tattoo, hematogenous seeding to distant sites such as the heart valves, and toxin-mediated systemic responses; unregulated inadequate hygienic practices were risk factors for such collateral damages. In conclusion, severe tattoo-associated infections are rare events but can be fatal even in immunocompetent individuals. In cases of otherwise unexplained soft-tissue, systemic, or cardiac valve infections a tattooing history should be considered even if the tattoo site looks uninflamed.\n                  <\/jats:p>","DOI":"10.1556\/1886.2026.00045","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:03:22Z","timestamp":1791889402000},"update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":0,"title":["Severe infections as collateral damage of decorative tattoos \u2013 A literature survey"],"prefix":"10.1556","author":[{"given":"Gevorg","family":"Aramian","sequence":"first","affiliation":[{"name":"Institute of Microbiology, Infectious Diseases and Immunology, Gastrointestinal Microbiology Research Group, Charit\u00e9 - University Medicine Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Bereswill","sequence":"additional","affiliation":[{"name":"Institute of Microbiology, Infectious Diseases and Immunology, Gastrointestinal Microbiology Research Group, Charit\u00e9 - University Medicine Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6399-651X","authenticated-orcid":true,"given":"Markus M.","family":"Heimesaat","sequence":"additional","affiliation":[{"name":"Institute of Microbiology, Infectious Diseases and Immunology, Gastrointestinal Microbiology Research Group, Charit\u00e9 - University Medicine Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"issue":"9","key":"B1","series-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz","first-page":"1077","article-title":"Tattoos in Germany: prevalence, demographics, and health orientation","volume":"62","author":"Borkenhagen A","year":"2019","unstructured":"Borkenhagen A, Mirastschijski U, Petrowski K, Br\u00e4hler E. Tattoos in Germany: prevalence, demographics, and health orientation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019;62(9):1077\u201382."},{"key":"B2","series-title":"Curr Probl Dermatol","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1159\/000369175","article-title":"Epidemiology of tattoos in industrialized countries","volume":"48","author":"Kluger N","year":"2015","unstructured":"Kluger N. Epidemiology of tattoos in industrialized countries. Curr Probl Dermatol. 2015;48:6\u201320."},{"issue":"2","key":"B3","series-title":"Clin Rev Allergy Immunol","first-page":"273","article-title":"Medical complications of tattoos: a comprehensive review","volume":"50","author":"Islam PS","year":"2016","unstructured":"Islam PS, Chang C, Selmi C, Generali E, Huntley A, Teuber SS, et\u00a0al. Medical complications of tattoos: a comprehensive review. Clin Rev Allergy Immunol. 2016;50(2):273\u201386."},{"issue":"40","key":"B4","series-title":"Dtsch Arztebl Int","first-page":"665","article-title":"The risk of bacterial infection after tattooing","volume":"113","author":"Dieckmann R","year":"2016","unstructured":"Dieckmann R, Boone I, Brockmann SO, Hammerl JA, Kolb-M\u00e4urer A, Goebeler M, et\u00a0al. The risk of bacterial infection after tattooing. Dtsch Arztebl Int. 2016;113(40):665\u201371."},{"issue":"1","key":"B5","series-title":"Eur\u00a0J\u00a0Microbiol Immunol (Bp)","first-page":"59","article-title":"Tattoos causing local and even generalized lymphadenopathies including sarcoidosis","volume":"16","author":"Jacobi MM","year":"2026","unstructured":"Jacobi MM, Bereswill S, Heimesaat MM. Tattoos causing local and even generalized lymphadenopathies including sarcoidosis. Eur\u00a0J\u00a0Microbiol Immunol (Bp). 2026;16(1):59\u201366."},{"issue":"4","key":"B6","series-title":"Med Clin (Barc)","first-page":"159","article-title":"Systemic infections associated with tattoos or permanent makeup: a systematic review","volume":"158","author":"Rello J","year":"2022","unstructured":"Rello J, Tejada S, Campogiani L, Adebanjo AG, Tammaro A. Systemic infections associated with tattoos or permanent makeup: a systematic review. Med Clin (Barc). 2022;158(4):159\u201366."},{"key":"B7","series-title":"BMJ","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page MJ","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et\u00a0al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71."},{"issue":"1","key":"B8","series-title":"Clin Infect Dis","first-page":"225","article-title":"Spinal epidural abscess after tattooing","volume":"29","author":"Chowfin A","year":"1999","unstructured":"Chowfin A, Potti A, Paul A, Carson P. Spinal epidural abscess after tattooing. Clin Infect Dis. 1999;29(1):225\u20136."},{"issue":"9","key":"B9","series-title":"World J Clin Cases","first-page":"459","article-title":"Tattooing: a potential novel risk factor for iliopsoas abscess","volume":"2","author":"Gulati S","year":"2014","unstructured":"Gulati S, Jain A, Sattari M. Tattooing: a potential novel risk factor for iliopsoas abscess. World J Clin Cases. 2014;2(9):459\u201362."},{"issue":"1526","key":"B10","series-title":"N Z Med J","first-page":"102","article-title":"Blood brothers: tattoo sepsis in two Samoan men","volume":"133","author":"Lakshman P","year":"2020","unstructured":"Lakshman P, Zhang C, Balm M, Morice Y, Towns C. Blood brothers: tattoo sepsis in two Samoan men. N Z Med J. 2020;133(1526):102\u20134."},{"issue":"3","key":"B11","series-title":"Herz","first-page":"349","article-title":"Tattooing complicated by multivalvular bacterial endocarditis","volume":"39","author":"Akkus NI","year":"2014","unstructured":"Akkus NI, Mina GS, Fereidoon S, Rajpal S. Tattooing complicated by multivalvular bacterial endocarditis. Herz. 2014;39(3):349\u201351."},{"issue":"Supplement_1","key":"B12","series-title":"Am J Respir Crit Care Med","article-title":"B49-22 when the heart gets inked: tattoo-associated infective endocarditis with septic emboli and mitral regurgitation-induced pulmonary congestion in a healthy young male","volume":"212","author":"Akram M","year":"2026","unstructured":"Akram M, Maqsood M, Khan A. B49-22 when the heart gets inked: tattoo-associated infective endocarditis with septic emboli and mitral regurgitation-induced pulmonary congestion in a healthy young male. Am J Respir Crit Care Med. 2026;212(Supplement_1)."},{"issue":"1","key":"B13","series-title":"Clin Microbiol Newsl","first-page":"6","article-title":"Moraxella lacunata infective endocarditis after tattooing as confirmed by 16S rRNA gene sequencing from heart valve tissue","volume":"32","author":"Callejo RM","year":"2010","unstructured":"Callejo RM, Nacinovich F, Prieto MA, Lambert S, Vizzotti C, Villar H, et\u00a0al. Moraxella lacunata infective endocarditis after tattooing as confirmed by 16S rRNA gene sequencing from heart valve tissue. Clin Microbiol Newsl. 2010;32(1):6\u20137."},{"issue":"9","key":"B14","series-title":"Eur Heart J Case Rep","article-title":"Case report on right ventricular mural endocarditis, not diagnosed clinically, but histopathologically after cardiac surgery","volume":"6","author":"Diaz-Navarro RA","year":"2022","unstructured":"Diaz-Navarro RA, Kerkhof PLM. Case report on right ventricular mural endocarditis, not diagnosed clinically, but histopathologically after cardiac surgery. Eur Heart J Case Rep. 2022;6(9):ytac376."},{"key":"B15","series-title":"Am J Emerg Med","first-page":"227.e5","article-title":"Tattoo associated native valve infective endocarditis","volume":"60","author":"Newell CF","year":"2022","unstructured":"Newell CF, Bridwell RE, Inman BL, Long B. Tattoo associated native valve infective endocarditis. Am J Emerg Med. 2022;60:227.e5\u2013.e7."},{"issue":"1","key":"B16","series-title":"Int\u00a0J\u00a0Cardiol","first-page":"e6","article-title":"The danger of wearing your heart on your sleeve","volume":"175","author":"Orton CM","year":"2014","unstructured":"Orton CM, Norrington K, Alam H, Alonso-Gonzalez R, Gatzoulis M. The danger of wearing your heart on your sleeve. Int\u00a0J\u00a0Cardiol. 2014;175(1):e6\u20137."},{"issue":"1","key":"B17","series-title":"Heart","first-page":"11","article-title":"Bacterial endocarditis following repeated tattooing","volume":"85","author":"Satchithananda DK","year":"2001","unstructured":"Satchithananda DK, Walsh J, Schofield PM. Bacterial endocarditis following repeated tattooing. Heart. 2001;85(1):11\u20132."},{"issue":"1","key":"B18","series-title":"Int J Cardiol","first-page":"e28","article-title":"Bacterial endocarditis complicating body art","volume":"133","author":"Tse D","year":"2009","unstructured":"Tse D, Khan S, Clarke S. Bacterial endocarditis complicating body art. Int J Cardiol. 2009;133(1):e28\u20139."},{"issue":"2","key":"B19","series-title":"Am J Clin Dermatol","first-page":"131","article-title":"Necrotizing black tattoo reaction: what's in a name?","volume":"10","author":"Bhogal RH","year":"2009","unstructured":"Bhogal RH, Thomas SS. Necrotizing black tattoo reaction: what's in a name? Am J Clin Dermatol. 2009;10(2):131\u20133."},{"issue":"3","key":"B20","series-title":"J Emerg Med","first-page":"436","article-title":"Streptococcal necrotizing myositis: a case report and clinical review","volume":"46","author":"Hourmozdi JJ","year":"2014","unstructured":"Hourmozdi JJ, Hawley DA, Hadi CM, Tahir B, Seupaul RA. Streptococcal necrotizing myositis: a case report and clinical review. J Emerg Med. 2014;46(3):436\u201342."},{"issue":"2","key":"B21","series-title":"J Infect","first-page":"203","article-title":"Polymicrobial septicaemia with Pseudomonas aeruginosa and Streptococcus pyogenes following traditional tattooing","volume":"35","author":"Korman TM","year":"1997","unstructured":"Korman TM, Grayson ML, Turnidge JD. Polymicrobial septicaemia with Pseudomonas aeruginosa and Streptococcus pyogenes following traditional tattooing. J Infect. 1997;35(2):203."},{"issue":"1","key":"B22","series-title":"Aust N Z J Public Health","first-page":"27","article-title":"Life-threatening cellulitis after traditional Samoan tattooing","volume":"35","author":"McLean M","year":"2011","unstructured":"McLean M, D'Souza A. Life-threatening cellulitis after traditional Samoan tattooing. Aust N Z J Public Health. 2011;35(1):27\u20139."},{"issue":"3","key":"B23","series-title":"Cureus","article-title":"Necrotizing fasciitis camouflaging as cellulitis: a case report highlighting diagnostic pitfalls","volume":"18","author":"Palav S","year":"2026","unstructured":"Palav S, Gangula S, Patri JR. Necrotizing fasciitis camouflaging as cellulitis: a case report highlighting diagnostic pitfalls. Cureus. 2026;18(3):e104734."},{"issue":"2","key":"B24","series-title":"J Infect","first-page":"149","article-title":"Necrotising fasciitis and cellulitis after traditional Samoan tattooing: case reports","volume":"50","author":"Porter CJ","year":"2005","unstructured":"Porter CJ, Simcock JW, MacKinnon CA. Necrotising fasciitis and cellulitis after traditional Samoan tattooing: case reports. J Infect. 2005;50(2):149\u201352."},{"issue":"3","key":"B25","series-title":"Cureus","article-title":"Legal tattoo complicated by sepsis and necrotizing fasciitis requiring acute surgery","volume":"13","author":"Uggeri S","year":"2021","unstructured":"Uggeri S, Nasi F, Ghidoni M, Gilioli F, Guicciardi N. Legal tattoo complicated by sepsis and necrotizing fasciitis requiring acute surgery. Cureus. 2021;13(3):e14139."},{"issue":"3","key":"B26","series-title":"Cureus","article-title":"Necrotizing fasciitis occurring after a conventional tattoo","volume":"16","author":"Vogel M","year":"2024","unstructured":"Vogel M, De Bodt J, Jacques JM. Necrotizing fasciitis occurring after a conventional tattoo. Cureus. 2024;16(3):e55368."},{"issue":"12","key":"B27","series-title":"South Med J","first-page":"1427","article-title":"Toxic shock syndrome mimicking pelvic inflammatory disease presumably resulting from tattoo","volume":"86","author":"Cowan RK","year":"1993","unstructured":"Cowan RK, Martens MG. Toxic shock syndrome mimicking pelvic inflammatory disease presumably resulting from tattoo. South Med J. 1993;86(12):1427\u201331."},{"key":"B28","series-title":"Int J Infect Dis","article-title":"Skin biopsy PCR enables rapid diagnosis of tattoo-associated staphylococcal toxic shock syndrome","volume":"170","author":"Destoop J","year":"2026","unstructured":"Destoop J, Senoune S, De-Waard A, Dubourg G, Cassir N. Skin biopsy PCR enables rapid diagnosis of tattoo-associated staphylococcal toxic shock syndrome. Int J Infect Dis. 2026;170:108808."},{"issue":"3","key":"B29","series-title":"Korean J Crit Care Med","first-page":"184","article-title":"Toxic shock syndrome following tattooing","volume":"30","author":"Jeong KY","year":"2015","unstructured":"Jeong KY, Kim KS, Suh GJ, Kwon WY. Toxic shock syndrome following tattooing. Korean J Crit Care Med. 2015;30(3):184\u201390."},{"issue":"Supplement_1","key":"B30","series-title":"Am J Respir Crit Care Med","first-page":"A6971","article-title":"Shock from a massively toxic tattoo","volume":"201","author":"Koster K","year":"2020","unstructured":"Koster K, LaFond E, Hayward BJ, Mailman J. Shock from a massively toxic tattoo. Am J Respir Crit Care Med. 2020;201(Supplement_1):A6971."},{"issue":"1","key":"B31","series-title":"Int J Emerg Med","first-page":"185","article-title":"Tattoo-associated toxic shock syndrome: a case report","volume":"18","author":"Kubo T","year":"2025","unstructured":"Kubo T, Yumoto T, Hagiya H, Iio K, Naito H, Nakao A. Tattoo-associated toxic shock syndrome: a case report. Int J Emerg Med. 2025;18(1):185."},{"issue":"1","key":"B32","series-title":"Forensic Sci Med Pathol","first-page":"332","article-title":"Fatal toxic shock syndrome following tattooing","volume":"22","author":"Schreiner K","year":"2026","unstructured":"Schreiner K, Balikowski M. Fatal toxic shock syndrome following tattooing. Forensic Sci Med Pathol. 2026;22(1):332\u20136."},{"issue":"1","key":"B33","series-title":"Crit Care Med","article-title":"638: a case of staphylococcal toxic SHOCK syndrome from a SKIN and soft tissue infection","volume":"53","author":"Woodruff RI","year":"2025","unstructured":"Woodruff RI, Eldeiry D, Luis Sabater E, Gordon J. 638: a case of staphylococcal toxic SHOCK syndrome from a SKIN and soft tissue infection. Crit Care Med. 2025;53(1)."},{"issue":"11","key":"B34","series-title":"J Radiol Case Rep","first-page":"28","article-title":"Glenohumeral joint sepsis after joint injection through a new tattoo","volume":"11","author":"Becker R","year":"2017","unstructured":"Becker R, Haight S. Glenohumeral joint sepsis after joint injection through a new tattoo. J Radiol Case Rep. 2017;11(11):28\u201335."},{"issue":"1","key":"B35","series-title":"Hawaii J Med Public Health","first-page":"5","article-title":"A case of severe septicemia following traditional Samoan tattooing","volume":"72","author":"Elegino-Steffens DU","year":"2013","unstructured":"Elegino-Steffens DU, Layman C, Bacomo F, Hsue G. A case of severe septicemia following traditional Samoan tattooing. Hawaii J Med Public Health. 2013;72(1):5\u20139."},{"key":"B36","series-title":"BMJ Case Rep","article-title":"Vibrio vulnificus septic shock due to a contaminated tattoo","volume":"2017","author":"Hendren N","year":"2017","unstructured":"Hendren N, Sukumar S, Glazer CS. Vibrio vulnificus septic shock due to a contaminated tattoo. BMJ Case Rep. 2017;2017."},{"issue":"3","key":"B37","series-title":"Trop Geogr Med","first-page":"301","article-title":"Pseudomonas septicaemia following tribal tattoo marks","volume":"36","author":"Mathur DR","year":"1984","unstructured":"Mathur DR, Sahoo A. Pseudomonas septicaemia following tribal tattoo marks. Trop Geogr Med. 1984;36(3):301\u20132."},{"issue":"4","key":"B38","series-title":"Cureus","article-title":"Gram-negative bacteremia with atypical neurologic presentation following tattoo application","volume":"17","author":"Ojo AO","year":"2025","unstructured":"Ojo AO, Marquez-Santos D, Rahemipour R, Aftabi A, Mel\u00e9ndez-Garcia A, Shahab S, et\u00a0al. Gram-negative bacteremia with atypical neurologic presentation following tattoo application. Cureus. 2025;17(4):e82373."},{"issue":"6","key":"B39","series-title":"Can J Ophthalmol","first-page":"e273","article-title":"Complications of ocular tattooing: a Canadian case series","volume":"54","author":"Chan W","year":"2019","unstructured":"Chan W, Freund PR, Gjerde H, Lewis D, Russell L, Samad A, et\u00a0al. Complications of ocular tattooing: a Canadian case series. Can J Ophthalmol. 2019;54(6):e273\u2013e7."},{"issue":"4","key":"B40","series-title":"Arch Ophthalmol","first-page":"518","article-title":"Candida endophthalmitis after tattooing in an asplenic patient","volume":"120","author":"Alexandridou A","year":"2002","unstructured":"Alexandridou A, Reginald AY, Stavrou P, Kirkby GR. Candida endophthalmitis after tattooing in an asplenic patient. Arch Ophthalmol. 2002;120(4):518\u20139."},{"issue":"6","key":"B41","series-title":"Urology","first-page":"1472","article-title":"Xanthogranulomatous pyelonephritis in an adolescent","volume":"76","author":"Chalmers D","year":"2010","unstructured":"Chalmers D, Marietti S, Kim C. Xanthogranulomatous pyelonephritis in an adolescent. 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Antibiotics (Basel). 2024;13(1)."},{"issue":"4","key":"B46","series-title":"Lancet Microbe","article-title":"Causes, patterns, and epidemiology of tattoo-associated infections since 1820","volume":"6","author":"Yoon S","year":"2025","unstructured":"Yoon S, Kondakala S, Daddy-Gaoh S, Foley S, Kweon O, Kim SJ. Causes, patterns, and epidemiology of tattoo-associated infections since 1820. Lancet Microbe. 2025;6(4):101006."},{"key":"B47","series-title":"BMC Public Health","first-page":"625","article-title":"Awareness of health risks related to body art practices among youth in Naples, Italy: a descriptive convenience sample study","volume":"11","author":"Gall\u00e8 F","year":"2011","unstructured":"Gall\u00e8 F, Mancusi C, Di Onofrio V, Visciano A, Alfano V, Mastronuzzi R, et\u00a0al. Awareness of health risks related to body art practices among youth in Naples, Italy: a descriptive convenience sample study. BMC Public Health. 2011;11:625."}],"updated-by":[{"DOI":"10.1556\/1886.2026.11145","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:00:00Z","timestamp":1793145600000}}],"container-title":["European Journal of Microbiology and Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.akjournals.com\/view\/journals\/1886\/aop\/article-10.1556-1886.2026.00045\/article-10.1556-1886.2026.00045.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.akjournals.com\/downloadpdf\/journals\/1886\/aop\/article-10.1556-1886.2026.00045\/article-10.1556-1886.2026.00045.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:03:28Z","timestamp":1791889408000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.akjournals.com\/view\/journals\/1886\/aop\/article-10.1556-1886.2026.00045\/article-10.1556-1886.2026.00045.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":47,"URL":"https:\/\/doi.org\/10.1556\/1886.2026.00045","relation":{},"ISSN":["2062-509X","2062-8633"],"issn-type":[{"value":"2062-509X","type":"print"},{"value":"2062-8633","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]}}}