First Pediatric Outbreak of Mycobacterium abscessus Hand and Foot Disease in the United States

Mycobacterial skin infection
Mycobacterial skin infection
Immunocompetent children acquired Mycobacterium abscessus cutaneous infections after exposure to the pathogen in a wading pool.

After 12 children were infected with Mycobacterium abscessus via contamination from an indoor wading pool, transmission was halted via proper pool maintenance, environmental remediation, and collaboration between medical and public health professionals, according to a report published in the Journal of the Pediatric Infectious Disease Society.

Between February and May 2013, Idaho public health officials and pediatric infectious disease physicians investigated the possible outbreak in children whose only common exposure was an indoor wading pool.

A questionnaire was administered to parents and clinical as well as environmental specimens were submitted for mycobacterial examination.

A total of 12 cases were identified, 10 of whom were female and all of whom were immunocompetent. Specimens from 4 of 7 children grew M abscessus or M abscessus/M chelonae.

An environmental investigation of the pool found that maintenance did not fully comply with state rules and M abscessus/chelonae was isolated from pool equipment. Isolates from the pool ladder and 1 patient were 87% similar when comparing pulsed-field gel electrophoresis composite patterns and 90% similar between isolates from 2 patients.

This outbreak is considered “an extraordinary occurrence of illness” in Idaho and demonstrates the “the value of inquiring about exposure to recreational pools when evaluating patients who have lesions compatible with M abscessus infection on the hands and feet.”

Environmental remediation of the pool included hyper-chlorination, disinfecting and scrubbing pool surfaces, draining the pool, and replacing worn materials. 

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The risk factors for this type of infection are poorly understood, but improper pool maintenance likely plays a role and investigators point out that “clinical guidelines for treatment of nontuberculous mycobacterial infections and guidelines for proper maintenance of pools are readily accessible.”


Carter KK, Lundgren I, Correll S, et al. First United States outbreak of Mycobacterium abscessus hand and foot disease among children associated with a wading pool [published online May 29, 2018]. J Pediatric Infect Dis Soc. doi:10.1093/jpids/piy036