Echinoderm Envenomation Differential Diagnoses

Updated: Jul 17, 2017
  • Author: Scott A Gallagher, MD, FACEP; Chief Editor: Joe Alcock, MD, MS  more...
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DDx

Diagnostic Considerations

Erysipelothrix rhusiopathiae

Secondary skin infection with Erysipelothrix rhusiopathiae as a result of small abrasions and lacerations acquired while handling marine animals, particularly fish and shellfish, is known as fish handler's disease.

Fish handler's disease appears as a well-demarcated cellulitis that is characterized by erythema, edema, and warmth. Erythromycin, cephalexin, and penicillin VK are referenced as appropriate first-line treatment.

Mycoplasma marinum

Chronic suppurative and granulomatous lesions may result from wound contamination with seawater containing M marinum.

While dissemination is rare, local debridement, adequate drainage, and prolonged antibiotic therapy (eg, doxycycline, co-trimoxazole) are essential to proper wound therapy.

Vibrio (V vulnificus, V parahaemolyticus) and Aeromonas (A parahaemolyticus, A damsela, A alginolyticus)

The most serious marine infections, while rare, result from infection with Vibrio and Aeromonas species. Necrotizing fasciitis, cellulitis, myositis, gas gangrene, and sepsis may result in loss of limb and life.

Vibrio vulnificus sepsis has a 20-50% mortality rate, depending on the source referenced. Aeromonas species infection may be equally severe, clinically resembling clostridial gas gangrene.

Sepsis from these organisms typically requires intensive care support and antimicrobial therapy based on sensitivity results. Initial antibiotic therapy should consist of parenteral broad-spectrum antibiotics, such as an aminoglycoside and third-generation cephalosporin.

Differential Diagnoses