Coral reef skin infections. Coral Reef Infections: First Aid, Treatment, and Healing for Marine Wounds
What are the common causes of coral reef skin infections. How to provide first aid for coral cuts. What is the recommended treatment for marine wound infections. How long does it take for coral cuts to heal. What are the symptoms of coral reef skin infections.
Understanding Coral Reef Skin Infections: The Australian Mid-West Coastal Marine Wound Infections Study
Marine organism wound infections are a common occurrence in coastal regions of Western Australia. The Australian Mid-West Coastal Marine Wound Infections Study aimed to identify the causative organisms in marine wounds sustained in the subtropical and tropical coastal waters of the Indian Ocean, specifically in the Gascoyne region of north-west Western Australia. This research is crucial as local treatment guidelines are often based on studies from other regions, which may not accurately reflect the unique marine environment of the Australian coastline.
Key Findings of the Study
- 27 out of 28 patients had wounds that returned a positive culture
- Staphylococcus aureus was found in 64.3% of cases (18 out of 28)
- Vibrio species were present in 32.1% of cases (9 out of 28)
- 39.3% of patients had polymicrobial infections (11 out of 28)
These results suggest that a combination of flucloxacillin (or clindamycin) and doxycycline (or ciprofloxacin) would be a reasonable choice for empirical oral therapy in adults with marine wound infections in this region.
The Phenomenon of ‘Scollypox’: A Local Marine Wound Infection
‘Scollypox’ is a colloquial term originating from the Gascoyne region of Western Australia. It refers to suppurative skin lesions frequently acquired by commercial fishermen working on trawlers in coastal regions. The term ‘scolly’ is local slang for scallops, which are an important source of income for the local fishing industry.
Who is at risk of developing scollypox? Marine-associated skin infections can affect various groups, including:
- Commercial fishermen
- Fish packers
- Recreational fishermen
- Surfers
- Swimmers
- Tourists
These individuals may sustain lesions through various means, such as coral cuts and abrasions, contact injuries from marine life, filleting knife lacerations, penetrating hook injuries, or contamination of pre-existing wounds by seawater.
Risk Factors and Severity of Marine Wound Infections
Anecdotal reports from the Gascoyne region suggest that scollypox can result in severe skin infections with significant morbidity and mortality. Several factors contribute to the increased risk and severity of these infections:
- High prevalence of underlying health conditions in the region, including:
- Diabetes
- Obesity
- Liver disease
- Cardiovascular disease
- Alcoholism
- Higher rates of intravenous drug use among fisheries workers
- Unique marine environment of the Gascoyne bioregion, influenced by the Ningaloo reef and the Leeuwin current
Given these risk factors, it is crucial for healthcare providers to maintain a high index of suspicion for marine organisms in wounds sustained in coastal environments. This awareness ensures that appropriate antibiotic therapy is administered promptly.
Common Pathogens in Marine Wound Infections
Marine wound infections can be caused by a variety of organisms. Which pathogens are most commonly found in marine-associated skin infections?
- Common skin commensals:
- Group A Streptococcus
- Staphylococcus aureus
- Naturally occurring water pathogens:
- Pseudomonas species
- Serratia species
- Vibrio species
- Aeromonas species
- Erysipelothrix species
- Nontuberculous Mycobacteria species
- Soil-based organisms occasionally found in waterways:
- Enterobacter species
- Bacillus species
- Actinomyces species
- Klebsiella species
The presence and prevalence of these organisms can vary depending on environmental factors such as water temperature, salinity, pH, organic matter content, and seasonal changes.
Challenges in Treating Water-Related Infections
The Therapeutic Guidelines acknowledge that treating water-related infections can be challenging. Why is treating marine wound infections difficult?
- Diverse range of potential pathogens
- Varying antibiotic susceptibility profiles
- Polymicrobial nature of many infections
- Environmental factors influencing microbial populations
- Potential for rare or unusual pathogens
Due to these challenges, it is often recommended to seek expert advice when dealing with water-related infections, especially in cases that do not respond to initial empirical treatment.
Current Treatment Guidelines and Their Limitations
Current antibiotic guidelines for marine wound infections are largely derived from reports and research performed in the United States. While this approach may seem logical, it has limitations when applied to the Australian context. How do environmental factors affect marine microbiology?
- Organic matter content
- pH levels
- Water temperature
- Ambient light
- Salinity
- Oxygen content
- Seasonal variations
- Land-based rainfall and run-off
Given the extensive biodiversity of the Australian coastline, particularly in the Gascoyne bioregion with its unique features like the Ningaloo reef and the influence of the Leeuwin current, the marine organisms and their antibiotic susceptibility profiles may differ significantly from those found in other parts of Australia or internationally.
Empirical Treatment Recommendations
Based on the findings of the Australian Mid-West Coastal Marine Wound Infections Study, what is the recommended empirical treatment for marine wound infections in the Gascoyne region?
For adults with marine wound infections, a combination of the following antibiotics is suggested:
- Flucloxacillin (or clindamycin as an alternative)
- Doxycycline (or ciprofloxacin as an alternative)
This combination provides coverage for the most common pathogens found in the study, including Staphylococcus aureus and Vibrio species. However, it’s important to note that treatment may need to be adjusted based on culture results and the patient’s clinical response.
Importance of Local Research in Guiding Treatment
The Australian Mid-West Coastal Marine Wound Infections Study highlights the importance of conducting local research to inform treatment guidelines. Why is local research crucial for managing marine wound infections?
- Identifies region-specific pathogens
- Determines local antibiotic susceptibility patterns
- Accounts for unique environmental factors
- Improves the accuracy of empirical treatment
- Reduces the risk of antibiotic resistance
- Enhances patient outcomes
By understanding the specific pathogens and antibiotic susceptibility profiles in a given region, healthcare providers can make more informed decisions about empirical treatment, potentially improving outcomes for patients with marine wound infections.
Future Directions for Research and Treatment
The findings of this study open up several avenues for future research and improvements in the management of marine wound infections. What areas should future studies focus on?
- Longitudinal studies to track changes in pathogen prevalence over time
- Investigation of rare or emerging marine pathogens
- Development of rapid diagnostic tools for marine wound infections
- Evaluation of novel antibiotic combinations for empirical treatment
- Assessment of preventive measures for high-risk groups
- Exploration of the impact of climate change on marine microbiology
Continued research in these areas will help refine treatment guidelines and improve the management of marine wound infections in coastal regions of Australia and beyond.
Prevention and First Aid for Marine Wounds
While understanding the treatment of marine wound infections is crucial, prevention and proper first aid can significantly reduce the risk of complications. What steps can individuals take to prevent marine wound infections?
- Wear protective clothing when engaging in water activities
- Avoid contact with marine life and sharp coral
- Clean and disinfect any cuts or abrasions immediately after exposure
- Seek medical attention promptly for any wounds sustained in a marine environment
- Keep wounds covered and dry until fully healed
- Stay up to date with tetanus vaccinations
In the event of a marine wound, proper first aid can help reduce the risk of infection. What are the key steps for providing first aid for a coral cut or marine wound?
- Remove the person from the water to prevent further injury or contamination
- Rinse the wound thoroughly with clean fresh water or sterile saline solution
- Gently remove any visible debris or foreign material from the wound
- Apply an antiseptic solution if available
- Cover the wound with a clean, dry dressing
- Seek medical attention, especially if the wound is deep, gaping, or shows signs of infection
By following these prevention and first aid measures, individuals can significantly reduce their risk of developing serious marine wound infections.
Recognizing Signs of Infection
Early recognition of infection signs is crucial for prompt treatment. What symptoms should individuals watch for after sustaining a marine wound?
- Increased redness or warmth around the wound
- Swelling or tenderness
- Pus or discharge from the wound
- Fever or chills
- Increasing pain or discomfort
- Red streaks extending from the wound
- Swollen lymph nodes
If any of these symptoms develop, it’s important to seek medical attention promptly to prevent the infection from worsening.
The Impact of Marine Wound Infections on Public Health
Marine wound infections, while often considered a niche concern, can have significant implications for public health, particularly in coastal communities. How do marine wound infections affect public health?
- Increased burden on local healthcare systems
- Economic impact on fishing and tourism industries
- Potential for antibiotic resistance development
- Risk of severe complications in vulnerable populations
- Need for public education and awareness programs
Understanding the broader impact of these infections highlights the importance of continued research, improved treatment guidelines, and public health initiatives aimed at prevention and early intervention.
The Role of Climate Change
Climate change is increasingly recognized as a factor that may influence the prevalence and distribution of marine pathogens. How might climate change affect marine wound infections?
- Alterations in water temperature and salinity affecting microbial populations
- Changes in coastal ecosystems impacting pathogen distribution
- Increased frequency of extreme weather events leading to more land-sea interactions
- Potential emergence of new or previously rare marine pathogens
- Extended seasons for water-based activities, increasing human exposure
As climate change continues to impact marine environments, ongoing monitoring and research will be crucial to understand and address evolving risks associated with marine wound infections.
Advancing Treatment Through Technology
Technological advancements offer new opportunities for improving the diagnosis and treatment of marine wound infections. What emerging technologies show promise in this field?
- Rapid molecular diagnostic tools for pathogen identification
- Point-of-care testing devices for antibiotic susceptibility
- Advanced wound dressings with antimicrobial properties
- Telemedicine platforms for remote consultation and follow-up
- Artificial intelligence algorithms for predicting infection risk and treatment outcomes
These technological innovations have the potential to revolutionize the management of marine wound infections, enabling faster diagnosis, more targeted treatment, and improved patient outcomes.
The Importance of Interdisciplinary Collaboration
Addressing the challenges of marine wound infections requires a collaborative approach that spans multiple disciplines. Which fields should be involved in advancing research and treatment?
- Infectious disease specialists
- Marine biologists
- Environmental scientists
- Microbiologists
- Public health experts
- Emergency medicine practitioners
- Pharmacologists
- Epidemiologists
By fostering collaboration between these diverse fields, researchers and healthcare providers can develop more comprehensive strategies for preventing, diagnosing, and treating marine wound infections.
The Future of Marine Wound Management
As our understanding of marine wound infections grows and technology advances, what might the future of marine wound management look like?
- Personalized treatment plans based on rapid pathogen identification and antibiotic susceptibility testing
- Development of novel antimicrobial agents specifically targeting marine pathogens
- Implementation of predictive models to identify high-risk areas and periods for marine infections
- Integration of wearable technology to monitor wound healing and detect early signs of infection
- Increased use of preventive measures, including vaccines against common marine pathogens
- Global surveillance networks to track the emergence and spread of marine pathogens
These advancements could significantly improve outcomes for individuals who sustain marine wounds and reduce the overall burden of these infections on healthcare systems and communities.
Educating the Public and Healthcare Providers
Effective management of marine wound infections relies not only on medical advancements but also on education and awareness. What key areas should education efforts focus on?
- Raising public awareness about the risks associated with marine environments
- Training healthcare providers in the unique aspects of marine wound management
- Promoting proper wound care and hygiene practices among high-risk groups
- Disseminating information about local marine pathogens and their susceptibility patterns
- Encouraging responsible use of antibiotics to prevent resistance
By improving education and awareness, we can empower individuals to take preventive measures and seek appropriate care, while also ensuring that healthcare providers are equipped with the knowledge to effectively manage marine wound infections.
The Australian Mid-West Coastal Marine Wound Infections Study
Background
Marine organism wound infections are common in coastal regions of Western Australia. Local treatment guidelines are based on studies from elsewhere. The objective of this article was to identify the causative organisms in marine wounds sustained in the subtropical and tropical coastal waters of the Indian Ocean, Gascoyne region (north-west), Western Australia.
Discussion
S. aureus or Vibrio species were frequently seen in marine wounds, and infections were often polymicrobial. Our results suggest that flucloxacillin (or clindamycin) and doxycycline (or ciprofloxacin) would be a reasonable combination for empirical oral therapy in adults.
Results
The wounds of 27 out of 28 patients returned a positive culture. The two most common organisms were Staphylococcus aureus (n = 18/28; 64.3%) and Vibrio species (n = 9/28; 32.1%). The culture was polymicrobial in 11 patients (39. 3%).
Scollypox’ is a colloquialism originating from the Gascoyne region (north-west) of Western Australia. It refers to suppurative skin lesions frequently acquired by commercial fishermen working on trawlers operating in the coastal regions (Figure 1). The term ‘scolly’ is local slang for scallops, which represent an important source of income for the local fishing industry. Fish packers, recreational fishermen, surfers, swimmers and tourists also frequently present with lesions sustained in the marine environment via coral cuts and abrasions, fish, mammal and crustacean contact injuries, filleting knife lacerations, penetrating hook injuries, or contamination of a pre-existing wound by sea water.
There are anecdotal reports from the Gascoyne region of scollypox resulting in severe skin infections with significant morbidity and mortality. Patient factors are known to play a significant part in the development of skin and soft tissue infections. Hence, the high prevalence of diabetes, obesity, liver disease, cardiovascular disease and alcoholism in the region,1 coupled with higher rates of intravenous drug use among fisheries workers,2 means the local population is at particular risk of acquiring marine-associated skin infections with the potential for considerable pathogenicity. 3,4 It therefore remains paramount that there is a high index of suspicion for the possibility that such a wound contains marine organisms, so that appropriate antibiotic therapy is administered in a timely fashion.
Most infections sustained in a marine environment are caused by common skin commensals such as Group A Streptococcus and Staphylococcus aureus.5 Other pathogens are known to exist naturally in water (Pseudomonas species, Serratia species, Vibrio species, Aeromonas species, Erysipelothrix species and nontuberculous Mycobacteria species),6–8 while others are episodically washed into the waterways and oceans from the soil (Enterobacter species, Bacillus species, Actinomyces species and Klebsiella species).3,9,10
The Therapeutic Guidelines acknowledges that treatment of water-related infections is difficult and advises seeking expert advice.11 It is recommended that mild infections are treated empirically as for early cellulitis and erysipelas; however, treatment advice for specific water-related organisms depends on the water source. 11
Current antibiotic guidelines for such infections are largely derived from reports and research performed in the US. This would seem a sensible undertaking; however, marine microbiology is itself determined by the conditions of the water – organic matter content, pH, temperature, ambient light, salinity, oxygen content, seasons and land-based rainfall, and run‑off.12 With the extensive biodiversity of the Australian coastline, particularly the Gascoyne bioregion given the Ningaloo reef and influences of the Leeuwin current (Figure 2), the marine organisms and their respective antibiotic susceptibility profiles may not be reflective of the remainder of the Australian marine environment or elsewhere.
The purpose of the study was to isolate pathological organisms involved with marine-associated skin and soft tissue infections in the Gascoyne region. By identifying the antibiotic susceptibility profile of the pathological organisms, we could compare these findings to the Therapeutic Guidelines and review the appropriateness of the advised empirical therapy in our local situation.
Figure 1. Classic marine wound infection
The image shows a classic marine wound infection on the forearm (flexor surface) of a commercial fisherman operating off the Gascoyne coastline. Photograph by Dr Andy Foote
Figure 2. Mid-west region of Western Australia. Image courtesy of WA Primary Health Alliance
Method
All doctors from the emergency departments of Carnarvon and Exmouth hospitals were engaged to help identify suspected marine-associated skin and soft tissue infections in patients presenting from 1 May 2010 to 1 August 2013. To qualify for inclusion in the study, patients had to have suppurating lesions from which a wound swab could be obtained. Injuries sustained in river environments were excluded. A single swab was obtained from each patient.
Potential participants were provided with an information sheet detailing the purpose of the study, signed a consent form, and had demographic details and fishing history collected. If the participant was a child, a parent or guardian provided consent.
Wound swab microbiology, culture and sensitivity
A swab was collected from the suppurating marine wound and sent to the regional laboratory, which performed microbiology testing. A pre-completed wound swab microscopy, culture and sensitivity (MCS) form stipulated that the wound swab was for suspected marine organism infection. All swabs were cultured on the four standard media: blood agar, colistin–nalidixic acid blood agar, MacConkey agar and laked blood agar with gentamicin. Two additional plates – thiosulphate-citrate-bile salts-sucrose agar and Ashdown’s medium – were used in this study to allow for easier identification of less common pathogens associated with water-related infections.
Ethics approval
Ethics approval for the study was received from the human research ethics committees of the Western Australia Country Health Service (reference number: HRAC2010:22) and the University of Western Australia (reference number: RA/4/1/4227).
Results
Twenty-eight patients were recruited. The average age of participants was 35.8 years (range: 7–65 years). The majority were male (78.6%) and involved with the commercial fishing industry (57.1% versus 42.9% for recreational fishers). Approximately 85% of infected wounds were on the hands or feet, and 10 patients had more than one wound. Nineteen patients had no other health issues, but eight had one and one had two comorbidities. Three wounds were sustained in the estuarine environment.
Patients who were systemically unwell when they presented, had significant comorbidities and/or deep infected lacerations were admitted to hospital (n = 10; 35.7%). They were treated with a combination of intravenous ceftriaxone, intravenous flucloxacillin or intravenous ciprofloxacin plus intravenous erythromycin or oral doxycycline while awaiting culture results. The remaining 18 patients were treated successfully on an outpatient basis.
The most common culture result was S. aureus, found in 64.3% (n = 18) of wound swabs. Methicillin-resistant strains of S. aureus (MRSA) made up 16.7% (n = 3) of the S. aureus cultured; these were collected later in the study, cultured from three out of the last seven swabs taken. The next most frequent culture result was Vibrio species in 32.2% (n = 8) of the wound swabs. Shewanella species were cultured from 14.3% (n = 4), Pseudomonas species from 14.3% (n = 4) and Group G Streptococcus from 10.7% (n = 3) of the wound swabs. There were no Aeromonas species isolated. Table 1 shows the culture and antibiotic susceptibility results by patient.
Polymicrobial infection was common, with more than one species of bacteria cultured from 39.3% of the swabs and more than two species from 17.8%. There were no deaths within the cohort.
Sex, age (years)
|
Type of fishing
|
Comorbidity
|
Cultured bacteria (antibiotic susceptibility)
|
---|---|---|---|
M, 34
|
C
|
None
|
Staphylococcus aureus (flucloxacillin)
|
M, 46
|
R
|
None
|
S. aureus (flucloxacillin)
|
F, 26
|
C
|
None
|
S. aureus (flucloxacillin)
|
M, 28
|
C
|
IVDU
|
S. aureus (flucloxacillin)
Group A Streptococcus (flucloxacillin, penicillin)
|
M, 65
|
R
|
IDDM
|
S. aureus (flucloxacillin, penicillin)
Vibrio alginolyticus (ceftriaxone, ciprofloxacin, gentamicin, doxycycline)
|
F, 27
|
C
|
None
|
S. aureus (flucloxacillin, clindamycin)
|
M, 24
|
C
|
None
|
S. aureus (flucloxacillin)
|
F, 12
|
R
|
None
|
S. aureus (flucloxacillin, gentamicin)
|
M, 37
|
C
|
IVDU
|
S. aureus (flucloxacillin, clindamycin, ciprofloxacin)
V. alginolyticus (ceftriaxone,ciprofloxacin, gentamicin, doxycycline)
Shewanella putrefaciens (ciprofloxacin, cotrimoxazole, gentamicin, meropenem, ticarcillin and clavulanate, piperacillin and tazobactam)
Pseudomonas aeruginosa* (ciprofloxacin, gentamicin, ticarcillin and clavulanate, ceftazidime)
|
M, 42
|
C
|
None
|
S. aureus (flucloxacillin)
V. alginolyticus (ceftriaxone, ciprofloxacin, gentamicin, doxycycline)
|
M, 53
|
C
|
Alcohol abuse
|
S. aureus (flucloxacillin, clindamycin, penicillin)
Group G Streptococcus (flucloxacillin, clindamycin, penicillin)
|
M, 49
|
C
|
Asthma
|
S. aureus (flucloxacillin)
V. alginolyticus (ceftriaxone, ciprofloxacin, gentamicin, doxycycline)
Group G Streptococcus (flucloxacillin, clindamycin, penicillin)
|
M, 57
|
C
|
Hep C
|
S. aureus (flucloxacillin, clindamycin, cotrimoxazole)
|
M, 34
|
C
|
IVDU, Hep C
|
S. aureus (flucloxacillin, clindamycin)
|
F, 19
|
R
|
None
|
S. aureus (flucloxacillin, clindamycin)
Group G Streptococcus (flucloxacillin, clindamycin, penicillin)
|
M, 52
|
C
|
None
|
MRSA (ciprofloxacin, clindamycin, doxycycline, cotrimoxazole, fusidic acid, rifampicin, mupirocin)
|
F, 23
|
C
|
None
|
MRSA (ciprofloxacin, clindamycin, doxycycline, cotrimoxazole, fusidic acid, rifampicin, mupirocin)
|
M, 50
|
C
|
None
|
MRSA (ciprofloxacin, clindamycin, doxycycline, cotrimoxazole, fusidic acid, rifampicin, mupirocin)
|
M, 26
|
R
|
None
|
V. alginolyticus (ceftriaxone, ciprofloxacin, gentamicin, doxycycline, piperacillin and tazobactam,
Pseudomonas stutzeri† (cefepime, ciprofloxacin, gentamicin, piperacillin and tazobactam,
ticarcillin and clavulanate)
Bacillus species† (amoxicillin, doxycycline, vancomycin)
|
M, 11
|
R
|
None
|
V. alginolyticus (ceftriaxone, ciprofloxacin, gentamicin, doxycycline)
|
M, 28
|
C
|
None
|
V. alginolyticus (ciprofloxacin, gentamicin, doxycycline)
S. putrefaciens (ciprofloxacin, gentamicin, ticarcillin and clavulanate, ceftazidime)
|
M, 38
|
R
|
None
|
Vibrio parahaemolyticus (ciprofloxacin, doxycycline)
Shewanella algae (cefepime, ciprofloxacin, gentamicin, piperacillin and tazobactam,
ticarcillin and clavulanate)
Group A Streptococcus
|
M, 49
|
R
|
None
|
Vibrio fluvialis (ceftriaxone, ciprofloxacin, gentamicin, doxycycline)
Shewanella algae (amoxicillin, ciprofloxacin, cotrimoxazole, gentamicin, doxycycline)
Providencia rettgeri (ciprofloxacin, cotrimoxazole, gentamicin)
|
F, 36
|
R
|
None
|
Group A Streptococcus (penicillin)
|
M, 33
|
C
|
IVDU
|
Group A Streptococcus (penicillin)
|
M, 63
|
R
|
NIDDM
|
P. aeruginosa* (ciprofloxacin, gentamicin,ticarcillin and clavulanate, ceftazidime)
|
M, 33
|
R
|
None
|
P. aeruginosa* (ciprofloxacin, gentamicin, ticarcillin and clavulanate, ceftazidime)
|
One patient (male, aged 7 years, recreational fisher, no comorbidities) did not have any positive cultures. Antibiotic resistances from microscopy, culture and sensitivity are available from the authors on request. *Pseudomonas aeruginosa may be a surface coloniser in the presence of an ulcer; †Pseudomonas stutzeri and Bacillus species may be environmental contaminants; C, commercial; F, female; Hep C, hepatitis C infection; IDDM, insulin-dependent diabetes mellitus; IVDU, intravenous drug use; M, male; NIDDM, non-insulin dependent diabetes mellitus; R, recreational
|
Discussion
This study confirms that bacteria cultured from marine-associated wounds in the Gascoyne region are similar to those detected in marine infections in regions with a similar range of coastal ocean temperatures. 3,13–16 S. aureus was the most common bacterial species cultured, and Vibrio species were the second most common. More than one-third of the wound infections were polymicrobial.
Considering that the majority of wound swabs cultured S. aureus, the empirical use of flucloxacillin (or clindamycin if allergic to penicillin), as recommended by the Therapeutic Guidelines11 for treatment of cellulitis, was appropriate for this cohort. The three MRSA cultures were susceptible to ciprofloxacin, clindamycin and doxycycline.
In polymicrobial wound infections, it was common to culture organisms such as Vibrio species or Shewanella species in addition to S. aureus. These organisms were generally sensitive to doxycycline, so a combination of flucloxacillin plus doxycycline or clindamycin plus doxycycline appears to be a reasonable combination for empirical oral therapy on initial presentation in the Gascoyne. Vibrio species are not considered normal human flora, so their presence in wounds is presumed pathogenic; doxycycline is the empirical choice recommended by the Therapeutic Guidelines for water-associated Vibrio species infection. 11
Marine-associated infections (particularly Vibrio species infections) can progress rapidly to fulminant sepsis, especially in patients with comorbidities, with a high mortality rate. Therefore, the decision to commence intravenous therapy should be made early.3,14,16,17
Alongside antibiotic therapy, the essential principles of meticulous wound care with aggressive irrigation and cleaning/debridement of wounds, using ultrasonography to search for foreign bodies such as fish spines or coral fragments, checking and updating of tetanus immunisation status, plus regular clinical follow-up and wound review are also important aspects of patient care.10,14,17–19
The local learning points for the region’s doctors were:
- Marine-associated infections are frequently polymicrobial infections.
- Empirical antibiotic therapy should include cover for S. aureus plus marine organisms, such as Vibrio species and Shewanella species, while waiting for wound swab MCS results.
- Wound swabs from suspected marine-associated infections need to be labelled accordingly as the laboratory uses additional culture plates to assist in easier identification of marine organisms.
Implications for general practice
- Marine skin infections can become life threatening quickly, so treat them seriously, especially if the patient has a comorbidity. Consider discussing with an expert early and referring for intravenous antibiotics early.
- Marine infections are often polymicrobial, with S. aureus and Vibrio species being the most commonly isolated in our cases.
- Take a wound swab if the lesion is suppurating and label it as a suspected marine infection.
- Use the Therapeutic Guidelines for initial antibiotic therapy and note that more than one antibiotic may be required.
Authors
Andy Foote MBChB, FRACGP, District Medical Officer, WA Country Health Service Gascoyne Region, WA; Senior Lecturer, Rural Clinical School of Western Australia, University of Western Australia, WA. [email protected]
Robert Henderson MBBS, Radiology Registrar, Sir Charles Gairdner Hospital, Perth, WA
Andrew Lindberg MBBS, Anaesthetic Registrar, Royal North Shore Hospital, NSW
Carolyn Grigg MBBS, General Practice Registrar, Torquay Walk-in Clinic, Vic
Charlie Greenfield MBBS, MA, MD, PhD, FRCP, FRACP, SJOG, Physician, Medical Centre Geraldton, WA
Andrew B Kirke MBBS, BSc Hons, FRACGP, FACRRM, Senior Lecturer, Rural Clinical School of Western Australia, University of Western Australia, WA
Kirsten Auret MBBS, FRACP, FAChPM, Deputy Head of School, Rural Clinical School of Western Australia, University of Western Australia; Physician (Visiting Medical Practitioner), Western Australian Country Health Service – Great Southern, WA
Competing interests: None.
Provenance: Not commissioned, externally peer reviewed.
Acknowledgements
The authors would like to acknowledge the Rural Clinical School of Western Australia for support in the design and implementation of the study; medical staff of Carnarvon and Exmouth hospitals, Western Australian Country Health Services who assisted in gathering the data for this study; Dr Michael Leung, Clinical Microbiologist and Regional Microbiologist/Clinical Senior Lecturer, School of Pathology and Laboratory Medicine at the University of Western Australia; Dr Helen Van Gessel, Infectious Disease Specialist, Albany; Mr Luc Delhaize, Senior Scientist, Pathwest laboratory, Gascoyne Region; Sandy Van Houwelingen, Supervising Training and Development Officer, WA Fisheries Department; and Ray Bekeris, Master of the Fleet, NorWest Seafoods, Carnarvon, Western Australia.
Surf’s Up: Coping with Reef Wounds
Posted by sfadmin
Coral reefs are beautiful, there is no doubt about it! Those beautiful corals draw snorkelers and scuba divers from all over the world for a peek at underwater paradise. While the reefs are pretty to look at, nobody should be touching them. The coral plants themselves are very brittle and easily damaged, and they contain spores and toxins that are harmful to humans. Even a minor scrape against the coral can result in life-threatening injury. While all the warnings are about worst-case scenarios and many times it will just feel like a bad rug-burn for a few days, reef wounds should be taken seriously. A little bit of immediate care can do wonders for the long-term well-being of the injury and help to reduce scarring in the future.
What Really Happens with a Reef Wound
A reef wound can be as minor as a scrape against a piece of coral or as extreme as a deep cut with pieces of coral broken off inside the body. Most of the time, there is some debris in the wound with at least microscopic pieces of coral lodged in the flesh. None of the coral is sanitary, so of course having foreign entities even at microscopic sizes lodged in the flesh will be painful and will likely cause infection. Some coral is very toxic: in addition to causing infection from lack of sanitation, it may react like a sting and cause severe pain.
How to Treat a Reef Wound Right Away
The first thing to do is to clean the area really well. First scrub the wound with soap and water, and then flush the area with fresh water. To reduce the sting from toxins, flush the area with vinegar to get the pH back to a manageable level and help to neutralize the toxins. Some divers use a sterile syringe to wash the area, pressure washing out debris and helping to get all of the foreign matter out of the way. A betadine solution is good for the initial cleaning of the wound, if one is available. Of course, if the wound is deep or you can’t get everything out of it yourself, you should see a physician right away.
Follow-Up Care for Reef Wounds and Coral Cuts
After the initial cleaning, continuing to rinse the wound and applying an antibiotic salve or ointment is the best way to promote healing. Taking over-the-counter pain medications may be necessary to relieve the pain and tenderness from a reef wound. To prevent infection, oral antibiotics are important. If there are signs of infection, like swelling, excessive redness, blistering or weeping of the wound, one should seek medical attention. Alcoholics are more susceptible to aggressive bacterial infections from reef wounds, so should watch the wound very carefully. If the scar from the healing wound has a different color pigment than surrounding skin, seek help from a dermatologist.
Filed under: Scar Management
Tags: care for coral cuts, reef wounds, scar prevention, scar treatment
10 reasons why coral reefs are disappearing
“Underwater gardens” or “marine rainforest” is what coral reefs are called not only for their beauty, but also because they form one of the most diverse ecosystems on the planet. It takes many years for a coral reef to form. And, alas, nothing is needed for it to be destroyed. We tell why the beautiful creations of nature are destroyed.
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beauty
Earthquake
Earthquakes . The age of coral reefs in the lagoons of Belize is about 8-9 thousand years. An earthquake in the Caribbean with a magnitude of 7.3, which happened in May 2009, destroyed more than half of the reefs. At the time of the disaster, the reefs were recovering from natural disease and bleaching. But worst of all, they were poorly attached to the walls of the lagoon, and the avalanche easily destroyed a significant part of the reef. According to scientists, full recovery may take from 2 to 4 thousand years.
Sudden change in water temperature . Both warming and cooling of sea water leads to the eviction of symbiotic algae that inhabit corals. The algae are essential to the life of the reef and give it its famous vibrant color. Therefore, the process of algae loss is called bleaching.
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Oil spill . An explosion at a BP oil rig in the Gulf of Mexico in April 2010 resulted in one of the largest oil spills in history. An oil slick is a mixture of oil itself, natural gas and a dispersant. Contrary to common beliefs, an oil slick does not float on the surface of the water, but settles on the bottom, preventing oxygen from penetrating into coral reefs.
Killer algae . Many types of algae found in the Pacific Ocean can be detrimental to corals. The chemicals they release cause bleaching of nearby coral reefs. There are several versions why algae need such a function: perhaps in this way they defend themselves from other algae, perhaps they protect themselves from microbial infections. In any case, corals are sensitive to these substances, and contact with these algae can cause harm.
Microplastic contamination . A small piece of plastic thrown overboard becomes a serious threat to all marine life, including corals. The main problem is that they are not digested. Corals feed not only on algae, but also on zooplankton, which, in turn, can inadvertently consume microplastics. Plastic particles entering the coral’s digestive system can cause irreparable harm to the entire ecosystem.
Coral feeding starfish . The multi-beam starfish acanthaster is perhaps the main predator that threatens the corals of the Great Barrier Reef. Covered in venomous spines, they feed on coral, resulting in massive reef losses. On the one hand, this starfish helps to balance the population of the rapidly growing coral, on the other hand, the surge in the population of starfish puts the coral reef at risk of complete destruction. To prevent this from happening, the Australian government has taken a number of measures to control the predatory starfish population.
Shipping . If a ship hits a coral reef, it becomes a problem not only for the ship, but also for the reef. The ship can carry cargo that disrupts the ecosystem if it enters the water, in addition, food waste and cruise ship wastewater oxidize the water and cause toxic algae blooms. But all the processes associated with towing a ship are especially traumatic for coral reefs. Unfortunately, towing damage is usually irreversible.
Overfishing is the main cause of the extinction of many species of marine life and the destruction of coral reefs. First, we are talking about the violation of the balance of the ecosystem. Secondly, modern fishing methods cause irreparable harm to corals. This is trawl fishing, which literally crushes reefs, and the use of cyanide, with which corals are harvested. Needless to say, dynamite, which is still used in fishing, does not make life better for coral reefs.
Household waste . Within 15 years, the species of Elkhorn corals that once thrived in the Caribbean have declined by 90%. You will be surprised, but the reef was destroyed by … smallpox! Corals turned out to be defenseless against the disease, against which humans are successfully vaccinated today. The pathogens were contained in household waste that entered the sea water due to a sewer leak. Coral death within 24 hours of contact with the virus is inevitable.
Sunscreen containing the toxic compound oxybenzone causes massive coral bleaching. It only takes one drop of lotion to cause damage to the reef. First of all, the danger is posed by vacationers who use sunscreen and then swim in the waters near the reefs. The cream, applied to the skin, leaves oil-like stains on the water, which reach the seabed and damage the corals. But even someone who does not go to the beach can also be involved in the destruction of reefs. So, when washing off sunscreen in your own bathroom, a person hardly thinks that the water from his shower will at some point return to the sea. As always, at the root of all the troubles of nature is the anthropogenic factor.
Coral Diseases – Coral Prevention and Care • Orphek
RTL (Rapid Tissue Loss) appears to be the term many aquarists refer to for any coral disease that may occur with their corals. There are many coral diseases affecting corals that have the same symptoms as RTL. Some diseases affect SPS, some affect LPS and some affect soft corals. Most, if not all, does not affect all corals. Some of the known diseases are shown below.
Black band disease
Black band disease is characterized by complete degradation of coral tissue caused by a group of pathogenic microbes, which appears as a dark red or black spot. The spot usually appears between healthy coral tissue. The color of the band may be black, brown, or red depending on the number of pathogens present. White dots may appear, resulting in another patch of damaged/diseased coral. Tissue breakdown is caused by exposure to sulfur-rich feces at the base of the dressing.
Sick brain coral labyrinthiformis Diploria in Little Cayman Island. A white area of dead coral below which is the diseased part. The rest of the healthy coral below is black, out of view 1X
Studies of black band disease in boulder and brain corals in the Virgin Islands indicate that many colonies are chronically infected, but at low levels. The disease is caused by blue-green algae in association with bacteria and appears to be transmitted by contact. During daylight hours, the disease can spread up to 1 cm per day. An interesting environmental observation for brain corals is that, by killing living corals, the disease can convert about 4% of the coral area into free space each year, thus creating new substrates for succession processes.
White band disease and white plague
White band disease can be associated with RTL because sometimes there is a discoloration that increases over time but usually starts at the base of the coral. There are no known pathogens for this disease.
Bacterial Whitening
Another disease that can be mistaken for RTL. The hallmark of this disease is the loss of zooxanthellae without loss of coral tissue. This differs from environmental bleaching (RTL) in that Vibrio Schiloi or patogonica is present in the affected tissue. There is currently no cure.
Aspergillosis
This is a fungal disease that occurs only in lovers of the Caribbean and sea whips. Symptoms are purple spots appearing in random places on the affected coral. There is no known cure.
Dark spot disease
Dark spot disease appears as dark (brown or purple) pigmented patches of tissue on scleractinian corals. Coral tissue remains intact, but tissue death usually occurs in the center of the pigmented area. There are no known pathogens that cause this disease.
Ecological Whitening
Environmental conditions cause this disease together with nematodes or flatworms. Most refer to this as RTL (rapid tissue loss). There is no known medicine that is safe to use with fish or invertebrates. It is best to remove the corals and put them in a coral pit. This procedure will kill all parasitic invertebrates living on the corals. See below for creating the ideal environment.
For more information on coral disease, please follow this link.
http://www.artificialreefs.org/Corals/diseasesfiles/Common%20Identified%20Coral%20Diseases.htm
The diseases mentioned above are just a few of many, and for most of them there is no cure, so prevention is the best cure. If you have an infected coral, the best way to save the coral is to cut off a piece or parts of the unaffected area so that new coral can develop from those cuttings. It is recommended that any remaining affected corals be discarded so as not to go back into the aquarium and damage other healthy corals.
So what can we do to reduce the chances of corals getting sick? The best way is to prevent by maintaining a stable habitat for our corals.
Creating the perfect environment
Two common factors in all coral diseases are environmental stress and sudden changes in water parameters. Environmental factors can include injury from organisms such as nematodes or flatworms, or from fish that sometimes enjoy a delicious bite of coral. Care should be taken when choosing fish to make sure they do not eat coral. Most butterflyfish will eat a specific coral family, and angelfish will occasionally bite LPS corals and some anemone species.
It is highly recommended to give your new coral a dip in one of the many products available to expel any dependent invertebrates from the corals.
The water conditions that can cause this are higher than normal water temperature, nitrate levels greater than 5 ppm, or phosphate levels 0.5 or higher. Sudden changes in pH, calcium and magnesium can also lead to stress, which leads to illness. SPS corals are more prone to coral disease than other corals because they are less tolerant of changes in water parameters or less than ideal water parameters.
Creating Ideal Water Parameters
To succeed in a vibrant reef aquarium, we must first create a basic framework for the elements corals use for optimal growth. These elements include calcium (Ca), magnesium (Mg) and carbonates (CO3). Microelements of strontium (Sr) and barium (Ba) are very useful. The above elements are found in all coral skeletons. An incorrect ratio of these elements can seriously affect the strength of a coral’s skeleton, and if the ratio of these three elements is not maintained correctly, the coral’s health deteriorates and can become a brittle skeleton that breaks easily.
Think of the coral membrane as a skin with miniature pumps that move water from the water to the area between the membrane and the skeleton, where these elements are processed to grow and nourish the corals. New elements are constantly being introduced into the coral to replace the elements used by the coral, so the ratio of these base elements must always be maintained at the right level. The constant fluctuations in these elements stress the corals, which can lead to disease.
For rapid fragment growth, increased levels of these elements in their proper ratios result in faster growth. If you have a developed reef, then the natural levels found on the reef are all that is needed to keep the corals healthy, but this will result in a slower growth rate.
Below is a guide for maintaining the main elements in their own relationship.
Calcium and magnesium carbonates (dKH)
ATP – 465 1390 12.6
LPS – 440 1340 12.1
Soft – 430 1280 8.2
Nutrition
All corals need nutrition in the form of proteins, carbohydrates, amino acids and fatty acids. For most corals, photosynthesis provides 85% of the food they need. The remaining 15% can be supplied by products such as Red Sea Reef Energy, Parts A and B, or other brands offering the same nutritional needs. The coral also draws dissolved nutrients from the water as a food source. Be careful when using third party products to ensure the products do not raise NO3 or PO4 to dangerous levels. Good water circulation is essential to bring this food to the corals, and wave making devices are the best choice for this process.
Maintenance and development of Coral color
70 minor elements found in natural sea water. Of these, 31 are needed by corals to maintain health and color. Companies such as Red Sea and Fauna Marin provide these items to hobbyists at very reasonable prices. Without the use of these elements, coral color and health may be less impressive.
Orphek introduced this feature to help you succeed with corals. Photosynthesis is certainly one of the key factors leading to good coral growth. Light of the correct intensity and spectrum MUST be provided to achieve good coral health and growth. All Orphek LED lighting models easily provide the intensity and spectrum required for excellent coral growth and color.