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Body piercing poses a risk for
serious disease. Because it invades subcutaneous areas, piercing
has a high potential for infectious complications. Such complications
result from introduction of skin or mucous membrane microflora
into subcutaneous tissue or from the ongoing presence of colonies
of these microflora at the piercing site. Pain, edema, and prolonged
bleeding may occur immediately after piercing, and a cyst, scar,
or keloid may form at the piercing site. In various surveys,
the rate of earlobe piercing infections alone has been estimated
at 11% to 24%. Skin lesions or anatomic abnormalities at the
site of piercing, as well as valvular heart disease, are risk
factors for complication. Staphylococcal endocarditis of the
mitral valve after nasal piercing, Neisseria endocarditis after
tongue piercing, and Staphylococcus epidermidis endocarditis
and mastitis following nipple piercing have been reported. Even
though a consistent correlation is not known between piercing
and endocarditis, the number of case reports is increasing,
and a correlation may well exist.
Persons at high risk for complications should be treated
with preventive antibiotics, just as persons at high risk
for complications receive antibiotic treatment before dental
procedures. The correlation between dental procedures and
endocarditis has been reviewed by Van der Meer et al., who
prospectively examined all cases of infective endocarditis
in the Netherlands over a 2-year period. Of 427 patients who
had been hospitalized, 64 had previous dental or other procedures
in the preceding 3 months. Only 48 of the 438 patients met
the qualification of having native-valve and cardiovascular anomalies that increased their risk of getting
endocarditis. Using these 48 patients as study cases, the
researchers found no significant difference in presence of
dental procedures between patients and matched controls without
endocarditis (odds ratio 1.2, 95% confidence interval 0.03
to 2.3). Two other studies reported similar results. No study
has examined the correlation between piercing and endocarditis.
In the United States, body piercing, which is becoming increasingly
common, is mainly performed by unlicenced practitioners. Only
26% of states have regulatory authority over tattooing establishments,
and only six of these states exercise authority over body-piercing
establishments. Piercing occurs in regulated and unregulated
shops, department stores, jewelry shops, homes, or physicians’
offices. Generally no antibiotic is used, and sterilization
methods vary. Studies show that ear piercing can cause cephalic
tetanus (a local form of tetanus caused by wounds or other
head and neck infections), Pseudomonas infections, or perichondrial
auricular abscesses, especially with Pseudomonas aeruginosa.
Tongue or oral piercing can cause Ludwig’s angina or
may be complicated by normal oral flora, such as Haemophilus
aphrophilus, as in this case. Genital piercing may result
in Escherichia coli infection and may increase the risk for
sexually transmitted diseases through tissue damage and exposure
and unwanted pregnancy because of condom rupture. Systemic
infections, such as toxic shock syndrome or sepsis, have also
been reported. Among noninfectious cases, granulomatous perichondritis
of the nasal ala, sarcoidlike foreign body reaction from multiple
piercing, paraphimosis from a distal penis pierce, and speech
impairment, together with difficulty in chewing and swallowing
from oral jewelry, have been reported. Metal-associated problems
include allergy (especially to nickel), eczematous rash, and
lymphocytoma. We describe an incidence of H. aphrophilus endocarditis
following tongue piercing.
To read the rest
of this excellent article on body piercing, produced by the
CDC, please click here: http://www.cdc.gov/ncidod/EID/vol8no8/01-0458.htm
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