Diagnostic Considerations
Erysipelothrix rhusiopathiae
Secondary skin infection with Erysipelothrix rhusiopathiae as a result of small abrasions and lacerations acquired while handling marine animals, especially fish and shellfish, is known as fish handler's disease.
It appears as a well-demarcated cellulitis characterized by erythema, edema, and warmth.
Erythromycin, cephalexin, and penicillin VK are all referenced as appropriate first-line treatment.
Mycoplasma marinum
Chronic suppurative and granulomatous lesions may result from wound contamination with seawater containing Mycoplasma marinum.
While dissemination is rare, local debridement, adequate drainage, and a prolonged antibiotic course (doxycycline, clotrimazole) are essential to proper therapy.
Vibrio (vulnificus, parahaemolyticus, damsela) and Aeromonas (parahaemolyticus, alginolyticus) species
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 the loss of a limb or death.
Vibrio vulnificus septicemia has a 20-50% mortality rate, depending on the source referenced.
Aeromonas infections may be similarly severe and may clinically resemble clostridial gangrene.
Sepsis with these organisms typically requires intensive care support and antimicrobial therapy, based on sensitivity results.
Initial antibiotic therapy is parenteral, broad-spectrum antibiotics, such as an aminoglycoside or third-generation cephalosporin.
Differential Diagnoses
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Lionfish (Pterois volitans) have long, slender spines with small venom glands, and they have the least potent sting of the Scorpaenidae family. Courtesy Dee Scarr.
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Scorpionfish (genus Scorpaena) have shorter, thicker spines with larger venom glands than lionfish do, and they have a more potent sting. Courtesy Dee Scarr.
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Stonefish (genus Synanceia) have short, stout spines with highly developed venom glands, and they have a potentially fatal sting. Courtesy Paul S. Auerbach, MD.
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Members of the genera Scorpaena, such as these scorpionfish, and Synanceia, such as the stonefish, usually are found well camouflaged on the sandy bottom of the sea or amongst rocks. Shoes or booties may provide some protection; however, it is best to avoid touching the sea bottom or to use a shuffling gait while wading. Courtesy Dee Scarr.
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Members of the genus Pterois, such as this lionfish, are usually free-swimming or hovering in small caves or crevices for protection. Provoking these fish by handling or cornering them may result in a painful envenomation. Courtesy Dee Scarr.
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In defense of the animals, envenomations and injury generally occur in response to a perceived threat, usually handling or stepping on the animals. Photo by Scott A Gallagher, MD.
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A 45-year-old diver was taking photographs in Australia at a depth of 60 feet. He suddenly noticed an excruciating pain in his left foot after resting his foot on a large stonefish. Photo courtesy John Williamson, MD and Surf Lifesaving Queensland.
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Top, Brown rockfish of the Scorpaenidae family. Lateral view of the left pelvic spine in articulation with the pelvic girdle. Middle, Anterior view of left pelvic spine (proximal portion) of the brown rockfish. Bottom, Lionfish spine.
