Cutaneous Manifestations Following Exposures to Marine Life Clinical Presentation

  • Author: Zoltan Trizna, MD, PhD; Chief Editor: William D James, MD   more...
 
Updated: Jan 3, 2012
 

History

Patients can usually recall the circumstances of the encounter and the immediate sequelae. The encounter is usually noted because of either sudden trauma or an immediate stinging or burning pain. Dermatitis accompanied by local pain or systemic symptoms usually follows.

Recent travels and recreational activities are relevant. Ask about preexisting wounds, which can provide a portal of entry for infections. Some professions may ignore the risk of such infections.

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Physical

Examine location and characteristics of the affected areas. Certain contacts result in typical patterns and distribution (such as contact with tentacles resulting in characteristic linear eruptions on unprotected skin, seabather's eruption occurring on areas covered by clothing). Stingray injuries commonly affect the unprotected skin of the legs. Fingers are common areas for bites or injury when touching a life form that releases a toxin or inoculates microbes into the skin. Tips of sea urchin spines can break off and become embedded in the wound.

Carefully explore wounds. Look for penetrating injuries, especially over joints. Assess the wounded area for the presence of cellulitis, lymphangitis, pyogenic infections, cyanosis, and necrosis.

Some bacterial infections are typically observed on certain sites. Erysipeloid, caused by Erysipelothrix rhusiopathiae, typically affects the hands of anglers (see image below), although a diffuse cutaneous form has been described. Infection with this organism has been associated with septicemia and endocarditis.[8]

Erysipeloid. Courtesy of the Department of DermatoErysipeloid. Courtesy of the Department of Dermatology, UTMB at Galveston, Texas.

Vibrio vulnificus infection usually manifests on the lower extremities as hemorrhagic bullae progressing to ulceration and necrosis. It may also cause life-threatening sepsis.

M marinum infections may show sporotrichoid spread on the hand, wrist, and arm.

Venoms have rarely been described to cause injuries to other organs, such as acute renal failure.[9]

Delayed-type skin lesions such as erythema nodosum can occasionally be observed.[10]

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Causes

Bites and suction, where the injury is primarily mechanical, are caused by octopus, fish (eg, moray eel, barracuda, triggerfish), sharks, mammals (eg, sea lion, seal), and turtles.

Cuts, abrasions, lacerations, and punctures can be caused by any part of the animal that is sharp or pointed, including sea urchins, starfish, stingray, coral, barnacles, broken shells, cone shell, spines of fish fins (eg, surgeonfish, needlefish), and leeches. Inanimate objects can also cause these types of injuries.

Contact with toxic substances, including stings and other mechanical injuries resulting in the transfer of a venom, can occur after contact with fire coral, sea cucumber, bristleworm, sea anemone, sponges, stonefish, lionfish, scorpionfish, zebrafish, turkeyfish, catfish, jellyfish, Portuguese man-of-war (see image below), cone shell, starfish, and sea snakes (after bites).

Envenomation caused by Portuguese-man-of-war. CourEnvenomation caused by Portuguese-man-of-war. Courtesy of the Department of Dermatology, UTMB at Galveston, Texas.

Mechanical injuries can result in wounds inoculated with microorganisms during the injury or in the course of wound care.

Preexisting wounds can provide a readily available portal of entry for marine microorganisms (eg, V vulnificus) even in the absence of fresh trauma.

Irritant dermatitis attributed to algae has been described in anglers working with nets.

Delayed systemic sensitization has rarely been documented, manifesting as conjunctivitis, rhinitis, and asthma in anglers exposed to dragnets accidentally collecting red soft corals[11] and in a case of an angler using a marine worm as fishing bait.[12]

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Contributor Information and Disclosures
Author

Zoltan Trizna, MD, PhD  Private Practice

Zoltan Trizna, MD, PhD is a member of the following medical societies: American Academy of Dermatology and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

James J Nordlund, MD  Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine

James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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Mycobacterium marinum infection. Courtesy of the Department of Dermatology, UTMB at Galveston, Texas.
Jellyfish stings. Courtesy of the Department of Dermatology, UTMB at Galveston, Texas.
Erysipeloid. Courtesy of the Department of Dermatology, UTMB at Galveston, Texas.
Envenomation caused by Portuguese-man-of-war. Courtesy of the Department of Dermatology, UTMB at Galveston, Texas.
 
 
 
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