Wilderness Medicine, First Aid, and Outdoor Skills
Waterborne Skin Infections

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Appendix A: First Aid Case and Kits, Dressings, and Bandages
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Appendix E: Decontamination Procedures
Appendix F: Glossary


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, or fishermen.

Vibrio vulnificus

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 Coast.

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 raw seafood.
4. Avoid exposing open wounds to saltwater.
5. Wear protective clothing, such as gloves, when handling raw shellfish.

Aeromonas hydrophila

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 Aeromonas.

Mycobacterium marinum

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 as tendons.

Mycobacterium marinum treatment

It is important to note that Mycobacterium marinum is resistant to Isoniazid. However, other treatment options include Clarithromycin or Bactrim.

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