gms | German Medical Science

GMS Infectious Diseases

Paul-Ehrlich-Gesellschaft für Infektionstherapie e.V. (PEG) (PEG)

ISSN 2195-8831

Bacterial infections in patients with nipple piercings: a qualitative systematic review of case reports and case series

Review Article

  • corresponding author Luis M. Acuña-Chávez - Facultad de Medicina, Universidad Nacional de Trujillo, Peru; Sociedad Cientifica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Peru
  • Christian A. Alva-Alayo - Facultad de Medicina, Universidad Nacional de Trujillo, Peru
  • Giamfranco A. Aguilar-Villanueva - Facultad de Medicina, Universidad Nacional de Trujillo, Peru; Sociedad Cientifica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Peru
  • Kevin A. Zavala-Alvarado - Facultad de Medicina, Universidad Nacional de Trujillo, Peru; Sociedad Cientifica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Peru
  • Cristhian A. Alverca-Meza - Facultad de Medicina, Universidad Nacional de Trujillo, Peru
  • María M. Aguirre-Sánchez - Facultad de Medicina, Universidad Nacional de Trujillo, Peru
  • Anyelo A. Amaya-Castro - Facultad de Medicina, Universidad Nacional de Trujillo, Peru

GMS Infect Dis 2022;10:Doc03

doi: 10.3205/id000080, urn:nbn:de:0183-id0000802

Published: March 30, 2022

© 2022 Acuña-Chávez et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at


The main objective of this review is to identify the most frequently isolated bacteria in patients with infections related to nipple piercings in case reports and case series. In addition, the aim is to describe clinical manifestations and antecedents. There is a protocol of this review. The terms “bacterial infections”, “nipple piercing” and their synonyms were considered. Pubmed/Medline, Scopus, Embase, Web of Science core collection and Ovid/Medline databases were searched until November 15, 2021 without date or language restrictions. Two authors extracted the articles and three other authors performed the selection, first by title and abstract, and second by full-text revision. Discrepancies were resolved with yet two other authors. Quality was assessed using the Joanna Briggs checklists. Finally, data extraction was realized. A total of 1,531 articles were extracted, of which 20 articles were included, and one article was added by hand-searching. The final number of articles included was 21, all of them with acceptable quality of evidence. Twenty-seven patients were considered (23 women and 4 men), aged between 15–60 years old. The most frequent bacterial genus in case reports and case series was Staphylococcus (n=10), and the most frequent species was M. fortuitum (n=6), although etiology seems to be diverse. The breast was the main affected organ, and the most frequent findings were fluid collection, pain, erythema, granulation tissue and swelling. The suspicion of infection by this bacterial species could be taken into account when it is associated with nipple piercings; however, larger studies are required to give a conclusion based on the evidence.

Keywords: bacterial infections, breast abscess, nipple piercing, MeSH-NLM


Piercing is a type of body modification performed by inserting a large gauge needle through skin or cartilage, creating a fistula-like opening, usually adorned [1]. A survey in the United States reported that 35% of participants claimed to have had piercings, and 14% in places other than the earlobe [2]. Additionally, a survey conducted in France showed that people aged 25 to 34 had the highest prevalence of having a piercing, with greater frequency in women [3]. The most common visible locations for those perforations are the face, nose and ears; the semi-visible areas are the navel and tongue; and not-visible, such as nipples and perineum, have become common types of body art in both genders [4].

Nipple piercings (NP) can cause both non-infectious and infectious complications. Non-infectious complications include injuries when playing contact sports, galactorrhea when nipples are stimulated, etc. [5]. On the other hand, NP could favor the access of pathogens that lead to local infections at the area of perforation that could spread to surrounding tissues, causing mastitis or abscesses [6].

The isolation of the specific type of bacteria could be essential to choose the most appropriate treatment. In general, the therapeutic approach for breast abscess recommends accompanying the drainage with antibiotics focused on the suspicion of S. aureus [7]. However, the presence of NP may predispose to infections caused by other types of pathogens. There are systematic reviews about etiology and complications from ear cartilage [8], tongue [9] and lip [9] piercings. However, to date there is no systematic review about the complications or etiology of NP, the incidence of which appeared to be 21% [10]. Additionally, the presence of NP is significantly associated to the development of breast abscess [11], a clinical manifestation of bacterial breast infections. Therefore, in order to answer a specific question with evidence-based methodology, this systematic review focuses on bacterial infections in patients with nipple piercings. Nowadays, the main source of information about bacterial infections associated with NP are case reports and case series. Consequently, in order to determine which are the most commonly isolated bacteria in these patients, these types of publications have been critically reviewed in this article. In addition, clinical manifestations and antecedents are described.

Materials and methods

Case reports and case series about bacterial infections in the mammary region, heart, skin or blood in patients with an antecedent of NP were searched. In this review, “case series” are defined as those studies in which more than 5 cases are reported [12]. There is a pre-published protocol of this systematic review registered in PROSPERO, CRD42021236900 ( This review was conducted in accordance with PRISMA [13] (Attachment 1 [Attach. 1], Supplementary Material 1).

Data sources and search

PubMed, Scopus, Embase, Web of Science core collection and Ovid/Medline databases were searched until November 15, 2021. The terms “bacterial infections”, “nipple piercing” and their synonyms were considered; however, terms referring to piercings in other body locations were excluded. There were no date or language restrictions. The PubMed search strategy was modified for use in other databases (Attachment 1 [Attach. 1], Supplementary Material 2). Additionally, a hand-search was performed in the same databases to identify other potentially relevant articles.

Selection criteria

The inclusion criteria were: 1) having an NP; 2) bacterial infection in the mammary region, associated skin, heart or blood; and 3) isolation and identification of the bacterial genus and species. The following exclusion criteria were considered: 1) incorrect population: patients infected by other types of microorganisms (viruses, fungi, parasites) or patients without NP; 2) incorrect publication type: revisions, misprints, etc.; 3) not having access to full-text; and 4) reports that did not specify causative agent. In addition, not all patients from every selected article were included; in contrast, just those patients in which the infection-causing bacteria was identified were included, defined as “eligible cases”.

Selection of studies

Two authors (GAAV, MMAS) exported the articles from the databases to Rayyan software ( Then, duplicates were removed to continue with the selection, carried out independently by three authors (LMAC, KAZA, CAAM), first by title and abstract, and second by full-text revision. Discrepancies were resolved with two other authors (CAAA and AAAC).

Data extraction

Data were extracted and verified by all the authors. The following data were extracted: 1) author; 2) age and sex of the patient; 3) compromised nipple; 4) the length of time the patient had the NP; 5) clinical presentation and antecedents; and 6) isolated bacteria and treatment in each case.

Quality assessment

The quality was assessed using the Joanna Briggs Institute checklist for case reports [14] and for case series [15]. Acceptable quality was considered for cases that satisfied 5 appraisal items [16].


Selected studies

A total of 1,531 articles were extracted from PubMed (n=175), Scopus (n=444), Embase (n=486), Web of Science core collection (n=137) and Ovid/Medline (n=288). Additionally, one article was added by hand-searching in the five electronic databases mentioned [17]. Removal of duplicate articles resulted in a total of 488. In the selection by title and abstract, 431 articles were eliminated. With the remaining 57, a full-text review was carried out, in which 36 articles were excluded for the reasons given in Figure 1 [Fig. 1], where the flowchart of the selection process according to PRISMA is shown [13]. Finally, 21 articles were considered in this review [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37].

Characteristics of the selected studies

Twenty-one articles were included for qualitative synthesis, all of them with acceptable quality of evidence (Attachment 1 [Attach. 1], Supplementary Material 3). Four out of 21 articles were case series, and the rest were case reports. Regarding the case reports, one of them presented three eligible cases [19]; on the other hand, three of the case series presented more than one eligible case: one of them presented three [27] and the other, four [30]. All other articles only presented one eligible case, such that 27 patients were considered in total. The following data is summarized for each eligible case: 1) patient characteristics; 2) clinical presentation and antecedents; and 3) isolated bacteria. Additional information can be found in Table 1 [Tab. 1].

Patient characteristics

Of the 27 patients, 23 were women [17], [19], [20], [23], [24], [25], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37] and 4 were men [18], [21], [22], [26], with an age range between 15–60 years old. With regard to the piercing location, 15 patients had the piercing in the right nipple [17], [18], [20], [21], [23], [25], [27], [28], [29], [31], [34], [35], [36], 7 in the left nipple [19], [22], [24], [26], [32], [33], and 1 in both nipples [37]; however, in four patients this information was not described [30]. The time between the placement of the piercing and the infection was not specified in nine cases [18], [24], [28], [30], [33]; on the other hand, regarding those that were specific: 3 patients had NP for a period less than 1 month [17], [23], [27]; 7 patients had NP for a period greater than 1 month but less than 6 months [19], [22], [25], [26], [29], [34], [37]; 6 patients had NP for a period greater than or equal to 6 months but less than or equal to 1 year [19], [20], [21], [27], [32], [36]; and only 3 patients had NP for more than 1 year [27], [31], [35].

Clinical presentation and antecedents

The breast was the main affected organ in the clinical presentation. Breast fluid collection was found in 22 patients [17], [18], [19], [20], [21], [23], [24], [25], [26], [27], [28], [29], [31], [32], [33], [34], [35], [36], breast pain or tenderness in 10 patients [18], [19], [23], [25], [27], [28], [32], [34], [35], [36], breast enlarging or swelling in 9 patients [17], [18], [19], [21], [25], [26], [27], [34], breast erythema in 8 patients [17], [18], [19], [25], [26], [31], [32], [34], and granulomatous tissue in 5 patients [19], [24], [28], [36], [37]. The following findings were not reported in more than one patient: chest wall cellulitis [22], retroareolar cellulitis [21], dyspnea and productive cough with bloody sputum [22], hyperpigmentation [24], breast induration [17] and endocarditis [22].

Some antecedents were reported, as follows: sexual contact with possible exposure of the pierced nipple [21], [31], smoking [19], [29], [35], breast implants [19], [32], pectoral and calf implants [18], exposure or swimming in dirty water [33], or in the ocean [24], [26], touching the nipple with objects [35] and the presence of prosthetic aortic valve [22]. Clinical presentation and antecedents of the patients are summarized individually in Table 2 [Tab. 2].

Isolated bacteria

The most frequently isolated bacterial genera were Staphylococcus (n=10) and Mycobacterium (n=9), all in different patients except for two of them [19], [34]. All isolated mycobacteria were non-tuberculous mycobacteria (NTM). In total, there were 6 cases of infection due to M. fortuitum [24], [25], [26], [29], [33], [37]; 8 cases due to coagulase-negative Staphylococcus [19], [22], [32], [34], [35], 4 of them confirmed as S. epidermidis [22], [32], [34], [35]; 2 due to N. gonorrhoeae [21], [31]; 2 due to S. aureus [23], [27]; 2 due to S. agalactiae [19], [27]; and 2 due to P. acnes [28], [30]. In addition, the following bacteria were identified in one patient only: A. turicensis [35], G. terrae [20], P. melanogenica [25], P. intermedia [17], P. anaerobius [17], Nocardia sp. [33], M. chelonei [34], P. harei [35], M. abscessus [36], M. holsaticum [19], M. agri [19], M. brumae [19], Actinomyces [27], P. acnes [30], C. amycolatum [30], H. parainfluenzae [30], group A beta-hemolytic Streptococcus [18], a “green microaerophilic Streptococcus” [19], and a rare gram-positive coccus not otherwise specified [30]. On the other hand, some cases corresponded to co-infections, for example: M. fortuitum was reported as coinfection in two cases, in one of them with P. melanogenica [25] and in the other case with Nocardia sp. [33]; S. epidermidis was also reported as coinfection in two cases, in one of them with M. chelonei [34] and in the other case with Actinomyces and P. harei [33]; also, one of the S. agalactiae cases was actually a co-infection with coagulase-negative Staphylococcus [19]; moreover, P. intermedia was reported with P. anaerobius [17]; finally, there was a co-infection of C. amycolatum, P. acnes and H. parainfluenzae [30]. Isolated bacteria, as well as treatments for each patient are summarized in Table 3 [Tab. 3].


Cases of breast abscess in non-lactating patients usually present a combined flora of S. aureus, Streptococcus, and anaerobic bacteria [38]. In this review, the most frequent bacterial genus was Staphylococcus (n=10); followed by Mycobacterium (n=9), specifically coagulase-negative Staphylococcus and NTMs, respectively; and the most commonly identified species were M. fortuitum (n=6) and S. epidermidis (n=4).

The fast-growing mycobacteria, or Runyon’s group IV, are the most common cause of soft tissue Mycobacterium infection and they are often related to trauma [39]. According to the literature, infections by M. fortuitum (a fast-growing type of mycobacterium) appear to be unusual [40]. M. fortuitum usually causes skin and soft tissue infections after direct inoculation, such as in trauma, surgery or cosmetic procedures; although, according to literature, it seems to be less frequent in the latter [41]. However, M. fortuitum was the most frequently isolated bacterial species in this review. In addition, M. fortuitum has also been isolated in infections related to other cosmetic procedures besides piercings, such as pedicures [42], [43], tattooing [44], and mesotherapy [45]. Five of the six cases of infection by M. fortuitum reported fluid collection. This fact is corroborated in the literature, since in most cases this type of bacteria causes pustules, nodules with or without suppuration, granulomas with the presence of a central or necrotic caseous area and a sporotrichoid pattern, with susceptibility to certain antibiotics, such as amikacin, clarithromycin, azithromycin, erythromycin, cefoxitin, and doxycycline [46].

Staphylococcus was the most frequent bacterial genus found in this review. S. aureus can cause localized inflammation, cellulitis, or even the formation of abscesses, which begin as a localized acute inflammatory response [47]. In fact, according to literature, most primary breast abscesses are associated with S. aureus infection, therefore empirical antibiotics are usually based on suspicion of this bacterium [7]. However, in this review, S. aureus was reported less frequently than S. epidermidis, which was isolated in 4 patients (although coagulase-negative staphylococcus was reported in 8 patients). Nevertheless, it should be noted that S. epidermidis was not the main cause of breast infection in two of these patients [34], [35]. S. epidermidis is a harmless commensal of the skin and mucous membranes; however, this pathogen can also cause infection from exogenous sources, such as endocarditis from native and prosthetic valves [48], catheter surfaces [49], and medical implants [50]. The latter has been reported in this review. One of the included articles reports a case of S. epidermidis infection in a patient with history of bilateral augmentation with silicone implants two years before placing the NP in both nipples [32]. In addition, there was a similar case with pectoral and calf implants; however, in this patient group, A beta-hemolytic streptococcus was isolated [18]. Additionally, another of the reviewed cases reports a native valve endocarditis due to the spread of S. epidermidis from a previous mastitis [22]. Since S. epidermidis is a human commensal, all of the case reports suggest a contamination by the normal flora of the skin in which the access point is the hole created by the NP.

Two cases of N. gonorrhoeae infection were also identified. These two patients reported recent sexual contact involving the NP, one with the partner’s penis [31], and the other with the mouth [21]. N. gonorrhoeae can be easily transmitted from men to their sexual partners, since it can adhere to sperm, causing high bacterial concentrations in this fluid [51]. In one of these patients [31], penis-nipple contact was doubtful, but mouth-nipple contact was reported; in the same way in the other one [21], in which all types of contact with ejaculatory fluid were denied, but vigorous contact of mouth-mouth and mouth-nipple type was confirmed. Although the main transmission mechanism is through direct penile-vaginal contact or vice versa, representing approximately 70% of the cases according to literature [52], saliva could represent the transmission path in the cases presented in this review, since the presence of N. gonorrhoeae in saliva and pharyngeal secretions has been previously demonstrated [53].

A large number of patients were women. This seems to be related to the fact that the use of NP is more common in women, but actually literature suggests that NP is more common in men [2], [54]. However, NP could cause more problems in women than in men, since women have more adjacent subcutaneous tissue in the breast region, which represents an entry route for pathogenic organisms [40]. Obesity [19] and smoking [29], [35] were the main antecedents reported in this review. In fact, these two variables were previously identified as risk factors for the development of breast abscess [11], [55]. Moreover, it is advisable to ask the patient about the history of NP, even when this is not evident in the clinical presentation, since the patient could have removed it before [36].

It is suggested to start antibiotic treatment as soon as a bacterial skin infection is suspected, after taking a culture, then maintaining or changing the antibiotic according to the results of the antibiogram, depending on the individual case. Additionally, if the case corresponds to a breast abscess, it will be necessary to drain or aspirate the fluid. On the other hand, culture results sometimes could be negative, but because of clinical features and the casuistry found in this review, the clinician will have to assess whether to continue or suspend the antibiotic treatment. Most of the patients – 22 out of 27 total to be precise – presented fluid collection in the mammary region. The therapeutic approach guides for breast abscesses recommend accompanying the drainage with targeted antibiotics for the suspicion of S. aureus [7]. Although etiology in patients with NP seems to be diverse, the suspicion of infection by M. fortuitum could be taken into account. However, we suggest larger studies (i.e., case control studies) to confirm, based on evidence, a possible association between NP and M. fortuitum infection. Despite having considered thorough exclusion criteria and a critical appraisal checklist, the results of the case reports and case series by their nature are not representative for the entire population. However, as it constitutes the only evidence available about the etiology of bacterial infections in patients with NP, this systematic review provides an important first step in determining the etiology of infections among different bacterial species in patients with nipple piercings, especially if the infection persists despite the initial treatment.


  • The bacterial species with the highest frequency in the case reports and case series of patients with infections and NP was M. fortuitum.
  • Despite the limitations of this review, the suspicion of infection by M. fortuitum could be taken into account, especially if the infection persists despite the initial treatment.
  • Larger studies are needed to determine an association between NP and M. fortuitum infection.



We would like to thank Dr. María Soledad Ayala Ravelo for her supervision and guidance throughout the preparation of this manuscript.

We would also like to thank Dr. William Aguilar Urbina for guiding us with his methodological and clinical expertise in the process of drafting the discussion of results.

Authors’ ORCIDs

Competing interests

The authors declare that they have no competing interests.


Armstrong ML, Koch JR, Saunders JC, Roberts AE, Owen DC. The hole picture: risks, decision making, purpose, regulations, and the future of body piercing. Clin Dermatol. 2007 Jul-Aug;25(4):398-406. DOI: 10.1016/j.clindermatol.2007.05.019 External link
Laumann AE, Derick AJ. Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol. 2006 Sep;55(3):413-21. DOI: 10.1016/j.jaad.2006.03.026 External link
Kluger N, Misery L, Seité S, Taieb C. Body Piercing: A National Survey in France. Dermatology. 2019;235(1):71-8. DOI: 10.1159/000494350 External link
Caliendo C, Armstrong ML, Roberts AE. Self-reported characteristics of women and men with intimate body piercings. J Adv Nurs. 2005 Mar;49(5):474-84. DOI: 10.1111/j.1365-2648.2004.03320.x External link
Holbrook J, Minocha J, Laumann A. Body piercing: complications and prevention of health risks. Am J Clin Dermatol. 2012 Feb;13(1):1-17. DOI: 10.2165/11593220-000000000-00000 External link
Stirn A. Body piercing: medical consequences and psychological motivations. Lancet. 2003 Apr;361(9364):1205-15. DOI: 10.1016/S0140-6736(03)12955-8 External link
Dixon J. Primary breast abscess. UpToDate. 2017. Available from: External link
Sosin M, Weissler JM, Pulcrano M, Rodriguez ED. Transcartilaginous ear piercing and infectious complications: a systematic review and critical analysis of outcomes. Laryngoscope. 2015 Aug;125(8):1827-34. DOI: 10.1002/lary.25238 External link
Hennequin-Hoenderdos NL, Slot DE, Van der Weijden GA. The incidence of complications associated with lip and/or tongue piercings: a systematic review. Int J Dent Hyg. 2016 Feb;14(1):62-73. DOI: 10.1111/idh.12118 External link
Mayers LB, Judelson DA, Moriarty BW, Rundell KW. Prevalence of body art (body piercing and tattooing) in university undergraduates and incidence of medical complications. Mayo Clin Proc. 2002 Jan;77(1):29-34. DOI: 10.4065/77.1.29 External link
Gollapalli V, Liao J, Dudakovic A, Sugg SL, Scott-Conner CE, Weigel RJ. Risk factors for development and recurrence of primary breast abscesses. J Am Coll Surg. 2010 Jul;211(1):41-8. DOI: 10.1016/j.jamcollsurg.2010.04.007 External link
Huamán-Guerrero M, Pichardo-Rodríguez R, De La Cruz-Vargas JA. Como hacer un reporte de caso, principios metodológicos. Rev Fac Med Hum. 2016;16(2):47-52. DOI: 10.25176/RFMH.v16.n2.668 External link
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009 Jul;6(7):e1000100. DOI: 10.1371/journal.pmed.1000100 External link
Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, Currie M, Qureshi R, Mattis P, Lisy K, Mu P-F. JBI Critical Appraisal Checklist for Case Reports. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. Adelaide: Joanna Briggs Institute; 2020. Available from: External link
Munn Z, Barker TH, Moola S, Tufanaru C, Stern C, McArthur A, Stephenson M, Aromataris E. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth. 2020 Oct;18(10):2127-33. DOI: 10.11124/JBISRIR-D-19-00099 External link
Son H, Song HJ, Seo HJ, Lee H, Choi SM, Lee S. The safety and effectiveness of self-administered coffee enema: A systematic review of case reports. Medicine (Baltimore). 2020 Sep 4;99(36):e21998. DOI: 10.1097/MD.0000000000021998 External link
Brook I. Recovery of anaerobic bacteria from 3 patients with infection at a pierced body site. Clin Infect Dis. 2001 Jul;33(1):e12-3. DOI: 10.1086/320891 External link
de Kleer N, Cohen M, Semple J, Simor A, Antonyshyn O. Nipple piercing may be contraindicated in male patients with chest implants. Ann Plast Surg. 2001 Aug;47(2):188-90. DOI: 10.1097/00000637-200108000-00014 External link
Jacobs VR, Golombeck K, Jonat W, Kiechle M. Drei Fallbeispiele von Brustabszess nach Brustwarzenpiercing: Unterschätzte Gesundheitsprobleme eines Modephänomens [Three case reports of breast abscess after nipple piercing: underestimated health problems of a fashion phenomenon]. Zentralbl Gynakol. 2002 Jul;124(7):378-85. DOI: 10.1055/s-2002-35545 External link
Zardawi IM, Jones F, Clark DA, Holland J. Gordonia terrae-induced suppurative granulomatous mastitis following nipple piercing. Pathology. 2004 Jun;36(3):275-8. DOI: 10.1080/00313020410001692639 External link
Pendle S, Barnes T. Neisseria gonorrhoeae isolated from an unexpected site. Sex Health. 2016 Nov;13(6):593-4. DOI: 10.1071/SH16124 External link
Ochsenfahrt C, Friedl R, Hannekum A, Schumacher BA. Endocarditis after nipple piercing in a patient with a bicuspid aortic valve. Ann Thorac Surg. 2001 Apr;71(4):1365-6. DOI: 10.1016/s0003-4975(00)02273-6 External link
Bader MS, Hamodat M, Hutchinson J. A fatal case of Staphylococcus aureus: associated toxic shock syndrome following nipple piercing. Scand J Infect Dis. 2007;39(8):741-3. DOI: 10.1080/00365540701199881 External link
Maroun E, Cakrabarti A, Sandin R, Greene J. Mycobacterium fortuitum Breast Infection After Nipple Ring Placement – Case Presentation and Review of the Literature. Infect Dis Clin Pr. 2012 Sep;20(5):309-11. DOI: 10.1097/IPC.0b013e318255d530 External link
Bengualid V, Singh V, Singh H, Berger J. Mycobacterium fortuitum and anaerobic breast abscess following nipple piercing: case presentation and review of the literature. J Adolesc Health. 2008 May;42(5):530-2. DOI: 10.1016/j.jadohealth.2007.10.016 External link
Drifmeyer E, Batts K. Breast Abscess After Nipple Piercing. Consultant. 2007 Apr;47(5):481-2.
Leibman AJ, Misra M, Castaldi M. Breast abscess after nipple piercing: sonographic findings with clinical correlation. J Ultrasound Med. 2011 Sep;30(9):1303-8. DOI: 10.7863/jum.2011.30.9.1303 External link
Shoyele O, Vidhun R, Dodge J, Cheng Z, Margules R, Nee P, Sieber S. Cystic neutrophilic granulomatous mastitis: A clinicopathologic study of a distinct entity with supporting evidence of a role for Corynebacterium-targeted therapy. Ann Diagn Pathol. 2018 Dec;37:51-6. DOI: 10.1016/j.anndiagpath.2018.08.005 External link
Siddique N, Roy M, Ahmad S. Mycobacterium fortuitum abscess following breast nipple piercing. IDCases. 2020 May 28;21. DOI: 10.1016/j.idcr.2020.e00847 External link
Baker G. Nipple Piercing-Associated Infections: Case Series with Review of the Literature and an Association with Granulomatous Mastitis – Abstracts from USCAP 2019: Breast Pathology (100-298). Lab Invest. 2019;99(S1):14-5. DOI: 10.1038/s41374-019-0234-9 External link
Ceniceros A, Galen B, Madaline T. Gonococcal breast abscess. IDCases. 2019;18:e00620. DOI: 10.1016/j.idcr.2019.e00620 External link
Cornelissen AJ, Solberg L, Qiu SS, Tuinder S, van der Hulst R. Breast Implant Infection After Nipple Piercing. Aesthet Surg J. 2017 Jan;37(1):NP3-NP4. DOI: 10.1093/asj/sjw193 External link
Abbass K, Adnan MK, Markert RJ, Emig M, Khan NA. Mycobacterium fortuitum breast abscess after nipple piercing. Can Fam Physician. 2014 Jan;60(1):51-2.
Pearlman MD. Mycobacterium chelonei breast abscess associated with nipple piercing. Infect Dis Obstet Gynecol. 1995;3(3):116-8. DOI: 10.1155/S1064744995000433 External link
Abdulrahman GO Jr, Gateley CA. Primary actinomycosis of the breast caused by Actinomyces turicensis with associated Peptoniphilus harei. Breast Dis. 2015 Jan;35(1):45-7. DOI: 10.3233/BD-140381 External link
Trupiano JK, Sebek BA, Goldfarb J, Levy LR, Hall GS, Procop GW. Mastitis due to Mycobacterium abscessus after body piercing. Clin Infect Dis. 2001 Jul;33(1):131-4. DOI: 10.1086/320885 External link
Lewis CG, Wells MK, Jennings WC. Mycobacterium fortuitum breast infection following nipple-piercing, mimicking carcinoma. Breast J. 2004 Jul-Aug;10(4):363-5. DOI: 10.1111/j.1075-122X.2004.21393.x External link
Toomey A, Le JK. Breast Abscess. Treasure Island (FL): StatPearls Publishing; 2020.
Ferringer T, Pride H, Tyler W. Body Piercing Complicated by Atypical Mycobacterial Infections. Pediatr Dermatol. 2008 Mar-Apr;25(2):219-22. DOI: 10.1111/j.1525-1470.2008.00638.x External link
Patel T, Scroggins-Markle L, Kelly B. A Dermal Piercing Complicated by Mycobacterium fortuitum. Case Rep Dermatol Med. 2013 Aug;2013:149829. DOI: 10.1155/2013/149829 External link
Zurita-Cruz JN, Márquez-González H, Miranda-Novales G, Villasís-Keever MÁ. Estudios experimentales: diseños de investigación para la evaluación de intervenciones en la clínica [Experimental studies: research designs for the evaluation of interventions in clinical settings]. Rev Alerg Mex. 2018 Apr-Jun;65(2):178-86. DOI: 10.29262/ram.v65i2.376 External link
Winthrop KL, Abrams M, Yakrus M, Schwartz I, Ely J, Gillies D, Vugia DJ. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med. 2002 May;346(18):1366-71. DOI: 10.1056/NEJMoa012643 External link
Redbord KP, Shearer DA, Gloster H, Younger B, Connelly BL, Kindel SE, Lucky AW. Atypical Mycobacterium furunculosis occurring after pedicures. J Am Acad Dermatol. 2006 Mar;54(3):520-4. DOI: 10.1016/j.jaad.2005.10.018 External link
Suvanasuthi S, Wongpraparut C, Pattanaprichakul P, Bunyaratavej S. Mycobacterium fortuitum cutaneous infection from amateur tattoo. J Med Assoc Thai. 2012 Jun;95(6):834-7.
Quiñones C, Ramalle-Gómara E, Perucha M, Lezaun ME, Fernández-Vilariño E, García-Morrás P, Simal G. An outbreak of Mycobacterium fortuitum cutaneous infection associated with mesotherapy. J Eur Acad Dermatol Venereol. 2010 May;24(5):604-6. DOI: 10.1111/j.1468-3083.2009.03461.x External link
Kullavanijaya P. Atypical mycobacterial cutaneous infection. Clin Dermatol. 1999 Mar-Apr;17(2):153-8. DOI: 10.1016/s0738-081x(99)00008-5 External link
Kobayashi SD, Malachowa N, DeLeo FR. Pathogenesis of Staphylococcus aureus abscesses. Am J Pathol. 2015 Jun;185(6):1518-27. DOI: 10.1016/j.ajpath.2014.11.030 External link
Chu VH, Miro JM, Hoen B, Cabell CH, Pappas PA, Jones P, Stryjewski ME, Anguera I, Braun S, Muñoz P, Commerford P, Tornos P, Francis J, Oyonarte M, Selton-Suty C, Morris AJ, Habib G, Almirante B, Sexton DJ, Corey GR, Fowler VG Jr; International Collaboration on Endocarditis-Prospective Cohort Study Group. Coagulase-negative staphylococcal prosthetic valve endocarditis – a contemporary update based on the International Collaboration on Endocarditis: prospective cohort study. Heart. 2009 Apr;95(7):570-6. DOI: 10.1136/hrt.2008.152975 External link
Khardori N, Yassien M, Wilson K. Tolerance of Staphylococcus epidermidis grown from indwelling vascular catheters to antimicrobial agents. J Ind Microbiol. 1995 Sep;15(3):148-51. DOI: 10.1007/BF01569818 External link
Rubino C, Brongo S, Pagliara D, Cuomo R, Abbinante G, Campitiello N, Santanelli F, Chessa D. Infections in breast implants: a review with a focus on developing countries. J Infect Dev Ctries. 2014 Sep;8(9):1089-95. DOI: 10.3855/jidc.3898 External link
James-Holmquest AN, Swanson J, Buchanan TM, Wende RD, Williams RP. Differential attachment by piliated and nonpiliated Neisseria gonorrhoeae to human sperm. Infect Immun. 1974 May;9(5):897-902. DOI: 10.1128/iai.9.5.897-902.1974 External link
Kirkcaldy RD, Weston E, Segurado AC, Hughes G. Epidemiology of gonorrhoea: a global perspective. Sex Health. 2019 Sep;16(5):401-11. DOI: 10.1071/SH19061 External link
Chow EP, Lee D, Tabrizi SN, Phillips S, Snow A, Cook S, Howden BP, Petalotis I, Bradshaw CS, Chen MY, Fairley CK. Detection of Neisseria gonorrhoeae in the pharynx and saliva: implications for gonorrhoea transmission. Sex Transm Infect. 2016 Aug;92(5):347-9. DOI: 10.1136/sextrans-2015-052399 External link
Bone A, Ncube F, Nichols T, Noah ND. Body piercing in England: a survey of piercing at sites other than earlobe. BMJ. 2008 Jun;336(7658):1426-8. DOI: 10.1136/bmj.39580.497176.25 External link
Bharat A, Gao F, Aft RL, Gillanders WE, Eberlein TJ, Margenthaler JA. Predictors of primary breast abscesses and recurrence. World J Surg. 2009 Dec;33(12):2582-6. DOI: 10.1007/s00268-009-0170-8 External link