There are many organisms that cause skin infections in the
outdoors, too exhaustive to mention for this article. Our
primary focus will be waterborne skin infections, which affect
the swimmer, water skier, scuba diver, snorkel enthusiast,
Vibrio vulnificus is bacteria closely related to the cholera
bacteria. It is very common in warm seawater. It is a gram-negative
bacillus. It is capable of causing limb-threatening infections,
specifically in those individuals who have severe liver disease
secondary to alcoholism, or individuals who have viral hepatitis,
or who are immuno-depressed. It can also be obtained by ingesting
contaminated seafood, specifically raw oysters. When skin
involvement does occur, it usually takes the form of cellulites,
a markedly reddened area of the skin, which is also very warm.
Usually an individual has had an open sore. They can develop
fluid filled vesicles, or blood filled bullae, which are larger
than vesicles. When ingested, individuals present with vomiting,
diarrhea, decreased blood pressure.
It has been underreported until recently. Now, many states
have mandatory reporting of cases. The Center for Disease
Control collaborates with Alabama, Florida, Louisiana, Texas
and Mississippi to monitor cases, especially along the Gulf
Vibrio vulnificus Treatment
The treatment is usually with antibiotics. For the clinicians
out there who are interested in this article, Doxycycline,
or a third generation Cephalosporin is very appropriate, and
some clinicians will use an adjunct Aminoglycosine with this
treatment regimen. As per the Center for Disease Control,
some recommendations for individuals who are immuno-compromised,
or have underlying liver disease:
1. Do not eat raw oysters or shellfish.
2. Cook your shellfish thoroughly.
3. Avoid cross contamination of cooked seafood with other
4. Avoid exposing open wounds to saltwater.
5. Wear protective clothing, such as gloves, when handling
This is a gram negative bacillus. It is found in freshwater
lakes, streams and stagnant water. It can be responsible for
serious skin infections, which can progress rather rapidly
through an open wound. Subsequently it is not uncommon to
see these in fishermen from a fishhook puncture, and the fisherman
continues to place his hands in the water, or swimmers in
freshwater lakes and streams who have an abrasion or cut to
their foot or leg from a rock or stick. When ingested, they
can cause a gastroenteritis, both vomiting and diarrhea. It
should be noted there are several different types of Aeromonas.
There is Aeromonas Caviae and Aeromonas Sobria. Caviae and
Sobria have been implicated in diarrheal disease. All Aeromonas
can be cultured from stool samples.
In 1998, California was the first state to mandate reporting
of Aeromonas isolates.
Aeromonas hydrophilia treatment
Cephalosporins, second, third and fourth generations, as
well as Bactrim and Quinolones are very effective against
This organism is found in salt and freshwater. It usually
follows a trauma to an extremity seen commonly in fishermen,
as well as swimmers. Also, this is not uncommon to individuals
who have home aquariums.
From time of exposure to infective symptoms is approximately
2-4 weeks. The first symptom is usually a nodule or papule
that is bluish or bluish-red in color. This occurs in about
30-35% of patients. There is localized pain and redness. There
can be fever and localized swelling of lymph nodes. The lesion
can increase and worsen over several months. In very rare
occasions, this organism can effect joints and bones as well
Mycobacterium marinum treatment
It is important to note that Mycobacterium marinum is resistant
to Isoniazid. However, other treatment options include Clarithromycin