What are the risks associated with coral scrapes and cuts. How can divers prevent coral injuries. What is the proper first aid for coral-related wounds. When should you seek medical attention for a coral skin infection.

Understanding Coral Skin Infections: A Diver’s Guide

Coral skin infections are a common concern for divers and snorkelers, with the Divers Alert Network (DAN) receiving approximately one inquiry per week related to coral contact injuries. These injuries can range from minor scrapes to more severe cuts and can lead to various complications if not properly treated. Let’s explore the mechanisms of injury, manifestations, prevention methods, and treatment options for coral-related wounds.

The Mechanisms Behind Coral Injuries

Why are coral injuries unique compared to other types of scrapes and cuts? The answer lies in the structure and composition of coral:

• Soft living tissues covering a rigid, abrasive structure (in stony corals)
• Presence of various antigens and substances that can cause inflammation
• Potential for foreign material to become embedded in the wound

These factors contribute to the prolonged healing process often associated with coral injuries. In some cases, wounds may take weeks or even months to heal completely, leading to confusion among both patients and healthcare providers.

The Role of Marine Organisms in Wound Complications

What makes coral cuts and scrapes different from typical outdoor injuries? The key difference is the presence of living marine organisms on the surface of corals, rocks, and wrecks. These organisms can introduce additional complications to the healing process, potentially leading to infections or allergic reactions.

Manifestations of Coral Skin Infections

The severity and type of reaction to a coral injury can vary depending on several factors:

1. Presence and amount of toxins
2. Size and location of the abrasion
3. Pre-existing sensitivity of the injured person

What are the most common symptoms of a coral skin infection? Typically, individuals experience:

• Burning sensation
• Pain
• Itching
• Rash (particularly with hydroid coral contact)

Fire Coral: A Special Case

Fire corals, belonging to the class Hydrozoa, present a unique challenge. These cnidarians contain nematocysts, which can cause envenomation upon contact. What happens when you touch fire coral? The result is often blistering, which may appear several hours after contact. Interestingly, these injuries may seem to heal initially but can relapse within a week or two, showcasing the delayed reaction typical of such envenomations.

Preventing Coral Skin Infections: Best Practices for Divers

How can divers protect themselves from coral injuries? Here are some essential prevention strategies:

• Avoid contact with coral and other living creatures underwater
• Wear a wetsuit or dive skin for added protection
• Carry a marine animal first aid kit during ocean dives
• Educate yourself on marine life identification and first aid techniques

By following these guidelines, divers can significantly reduce their risk of coral-related injuries and be better prepared to handle any incidents that may occur.

First Aid for Coral Scrapes and Cuts

What should you do if you sustain a coral injury? Follow these steps for proper first aid:

1. Thoroughly clean the wound with soap and water
2. Flush with a half-strength hydrogen peroxide solution, then rinse with water
3. Apply a thin layer of antiseptic ointment
4. Cover the wound with a dry, sterile, non-adherent dressing
5. Clean and redress the wound twice daily

Advanced Wound Care Techniques

For wounds that develop a crust, how should you proceed with treatment? Implement wet-to-dry dressing changes:

1. Cover the wound with a dry sterile gauze pad
2. Soak the pad with saline or diluted antiseptic solution
3. Allow it to dry, then remove the bandage
4. Repeat this process once or twice daily until the wound becomes non-adherent

This technique helps remove dead and dying tissue, promoting better healing.

Recognizing and Addressing Complications

What signs should you watch for that may indicate a more serious infection? Be alert for:

• Extreme redness or red streaks on the extremity
• Increased pain or fever
• Presence of pus
• Swollen lymph glands

If you observe any of these symptoms, it’s crucial to consult a healthcare professional promptly. They may recommend starting an antibiotic treatment, especially if there’s a risk of Vibrio bacteria infection.

Coral Poisoning: A Serious Concern

In cases of extensive abrasions or cuts from particularly toxic coral species, what additional symptoms should you be aware of? Watch for:

• Poor wound healing or continued pus drainage
• Swelling around the cut
• Swollen lymph glands
• Fever, chills, and fatigue

If you experience these symptoms, seek medical attention immediately, as they may indicate coral poisoning.

Long-Term Complications of Coral Injuries

What are the potential long-term effects of coral scrapes and cuts? Some divers may experience:

• Formation of granulomas due to retained debris
• Persistent itchy rashes or papules
• Delayed healing processes
• Recurring infections

These complications underscore the importance of proper initial treatment and ongoing wound care.

Advanced Treatment Options for Persistent Coral Skin Infections

For coral skin infections that prove resistant to standard treatments, what advanced options are available? Healthcare providers may consider:

• Prescription-strength topical corticosteroids to reduce inflammation
• Oral antibiotics for systemic infections
• Debridement procedures to remove dead tissue and promote healing
• Hyperbaric oxygen therapy for severe cases

These treatments should only be administered under the guidance of a medical professional experienced in treating marine-related injuries.

The Role of Immunology in Coral Skin Infections

How does the immune system respond to coral injuries, and why do some individuals experience more severe reactions? The answer lies in the complex interplay between the coral’s toxins and the human immune system. Some people may develop a hypersensitivity to coral antigens, leading to more pronounced or prolonged inflammatory responses. This variability in immune reactions explains why two divers with similar injuries may experience vastly different healing processes.

Environmental Impact of Coral Injuries: A Two-Way Street

While we’ve focused primarily on the impact of coral on human health, it’s essential to consider the reverse: How do human interactions affect coral health? When divers come into contact with coral, they may inadvertently:

• Damage the delicate coral polyps
• Introduce harmful bacteria or pollutants to the coral ecosystem
• Disrupt the coral’s natural defense mechanisms

This mutual vulnerability underscores the importance of responsible diving practices and environmental stewardship.

Sustainable Diving Practices for Coral Conservation

What steps can divers take to minimize their impact on coral reefs while also protecting themselves from injury? Consider adopting these sustainable diving practices:

1. Perfect your buoyancy control to avoid accidental contact with coral
2. Use reef-safe sunscreen to prevent chemical pollution
3. Participate in coral restoration and conservation projects
4. Educate fellow divers about the importance of coral protection

By implementing these strategies, divers can contribute to the preservation of coral ecosystems while reducing their risk of injury.

Emerging Research in Coral Skin Infection Treatment

What new developments are on the horizon for treating coral-related injuries? Recent scientific advancements show promising potential:

• Novel antimicrobial coatings for dive gear to reduce infection risk
• Gene therapy approaches to enhance wound healing in chronic cases
• Development of coral-specific antidotes to neutralize toxins more effectively
• Advanced imaging techniques for early detection of deep tissue damage

While many of these technologies are still in the research phase, they offer hope for more effective treatments in the future.

The Role of Marine Biologists in Injury Prevention

How are marine biologists contributing to the prevention and treatment of coral skin infections? Their work is crucial in several areas:

1. Mapping coral species distribution to identify high-risk diving areas
2. Studying coral toxin compositions to develop targeted treatments
3. Investigating coral-associated microbial communities to understand infection risks
4. Collaborating with medical professionals to improve treatment protocols

This interdisciplinary approach combines ecological knowledge with medical expertise, leading to more comprehensive strategies for managing coral-related injuries.

Psychological Aspects of Coral Skin Infections

Beyond the physical symptoms, how do coral skin infections impact divers psychologically? The prolonged healing process and potential for complications can lead to:

• Anxiety about returning to diving
• Frustration with ongoing treatment requirements
• Body image concerns due to scarring
• Depression related to limited physical activities during recovery

Addressing these psychological aspects is crucial for a holistic approach to treatment and recovery.

Support Systems for Injured Divers

What resources are available to support divers dealing with coral skin infections? Several organizations and communities offer assistance:

1. Online forums for sharing experiences and advice
2. Support groups for divers recovering from marine injuries
3. Dive club mentorship programs pairing experienced divers with those recovering from injuries
4. Professional counseling services specializing in adventure sport-related traumas

Utilizing these support systems can significantly improve the recovery experience for injured divers.

Legal and Insurance Considerations for Coral Injuries

What legal and insurance implications should divers be aware of regarding coral skin infections? Several factors come into play:

• Dive insurance coverage for marine life-related injuries
• Liability issues for dive operators in areas with known coral hazards
• International maritime laws governing injury claims in different jurisdictions
• Potential for class-action lawsuits related to inadequate warnings or protections

Understanding these aspects can help divers navigate the complexities of seeking compensation or coverage for their injuries.

Documenting Coral Injuries for Claims and Research

How can divers effectively document their coral injuries for insurance claims or research purposes? Follow these steps:

1. Photograph the injury site immediately and throughout the healing process
2. Keep a detailed log of symptoms, treatments, and recovery progress
3. Collect and preserve any visible foreign material from the wound (with medical supervision)
4. Obtain written statements from dive buddies or witnesses present during the incident

This documentation can prove invaluable for both personal claims and contributing to broader research on coral skin infections.

The Future of Coral Skin Infection Management

As we look to the future, what advancements can we anticipate in the prevention and treatment of coral skin infections? Several promising areas are emerging:

• AI-powered risk assessment tools for dive planning
• Nanotechnology-based protective coatings for dive gear
• Personalized medicine approaches tailored to individual immune responses
• Virtual reality training programs for coral avoidance and safe diving practices

These innovations hold the potential to revolutionize how we approach coral-related injuries in the diving community.

Global Collaboration in Marine Injury Research

How are international efforts shaping the future of coral skin infection management? Global collaborations are driving progress through:

1. Standardized reporting systems for marine injuries across dive destinations
2. Shared databases of coral species and their associated health risks
3. International conferences focusing on marine life injuries and treatments
4. Cross-border research initiatives combining expertise from various fields

These collaborative efforts are essential for developing comprehensive, globally applicable strategies for preventing and treating coral skin infections.

As our understanding of coral skin infections continues to evolve, so too do our methods for prevention, treatment, and management. By staying informed about the latest developments and adhering to best practices, divers can minimize their risk of injury while continuing to explore the wonders of the underwater world. Remember, responsible diving not only protects your health but also contributes to the preservation of delicate marine ecosystems for future generations to enjoy.

Coral Scrapes and Cuts – Divers Alert Network

Cuts and scrapes are the most common injuries incurred by divers and snorkelers. DAN receives about one inquiry a week related to someone who has come into contact with coral. A burning sensation, pain and itching are common and may also be accompanied by a rash. These injuries can have a latent evolution and take weeks or months to heal, confusing both patients and clinicians.

Mechanisms of Injury

Soft living tissues cover the surface of corals. In the case of stony corals, the rigid (abrasive) structure underneath makes the coral’s soft tissue easy to tear and get into the scrape or cut. Foreign material can prolong the wound-healing process since the different antigens and substances cause an acute inflammatory process and infection. Cuts and scrapes from sharp-edged coral and barnacles tend to fester and may take weeks or even months to heal. Granulomas can form if debris from the original wound remains in the tissue. The body attempts to remove it, resulting in an itchy rash or papule (small, raised, tender bump) that lasts for some time before the body eliminates it.

While most “raspberries” generally heal quickly, skin abrasions from a marine environment can sometimes be more challenging to treat than those we get from outdoor activities such as baseball or bicycling. Whether it is a coral, a rock or a wreck, they all share a common factor: They are covered by living marine organisms, which makes coral cuts and scrapes unique.

Manifestations

The extent of the reaction depends on the presence and amount of toxins, the size and location of the abrasion and the pre-existing sensitivity of the injured person. The most common manifestations are a burning sensation, pain and itching. A rash may accompany the injury if the coral is a hydroid, such as fire coral.

Most animals of class Hydrozoa become hydroids as a life stage. They are predominantly colonial, and while most of them are marine creatures, you can find a few species in freshwater environments.

Fire corals are cnidarians, so they contain nematocysts. Touching them with a simple rub can cause mechanical activation and envenomation. The manifestation is usually blistering, which typically appears a few hours after contact. They typically resolve in a few days, but it is quite common for these injuries to relapse within a week or two after what seemed to be healing progress. This delayed reaction is typical of these types of envenomations.

Prevention

When underwater, try to avoid contact with coral or any other living creature. Whenever possible, wear a wetsuit or dive skin to protect yourself if you are accidentally pushed into coral by another diver or a current. Ocean divers should consider a marine animal first aid kit for their travels. Ready supplies will speed up the time to properly administer first aid for injuries. Additionally, for divers who want to learn more about the various marine life injuries, there are courses in marine life identification, first aid courses and a variety of books and publications available.

First Aid

• Scrub the cut vigorously with soap and water, and then flush the wound with large amounts of water.
• Flush the wound with a half-strength solution of hydrogen peroxide in water. Rinse again with water.
• Apply a thin layer of antiseptic ointment, and cover the wound with a dry, sterile and non-adherent dressing. If you have no ointment or dressing, you can leave the wound open.
• Clean and re-dress the wound twice a day.
• If the wound develops a crust, use wet-to-dry dressing changes. Put a dry sterile gauze pad over the wound and soak it with saline or a diluted antiseptic solution (such as 1% to 5% povidone-iodine in disinfected water). Allow it to dry then rip the bandage off the wound. The dead and dying tissue should adhere to the gauze and lift free. The tissue underneath should be pink and may bleed slightly but should be healing. Change the dressings once or twice a day. Use wet-to-dry dressings for a few days or until they become non-adherent. Then resume the regular wound dressing described above.
• Look for any signs of infection: extreme redness, red streaks on the extremity, pain, fever, pus or swollen lymph glands. If you have any, consult a qualified health professional about starting an antibiotic. A possible Vibrio bacteria infection can cause illness and even death in someone with an impaired immune system (e.g., from AIDS, diabetes or chronic liver disease).
• Watch for coral poisoning, which can occur if abrasions or cuts are extensive or from a particularly toxic species. Symptoms include a wound that heals poorly or continues to drain pus, swelling around the cut, swollen lymph glands, fever, chills and fatigue. If you have these symptoms, see a physician.

Complications

The most frequent complications from non-stinging coral scrapes are inflammation (which leads to poor healing) and less commonly a secondary infection. Proper wound cleaning is crucial. If fire coral is the culprit, then a diluted acetic acid solution, such as household white vinegar, is a reasonable topical decontaminant and should be used as a soak to reduce the pain. Immersion in hot water can reduce the symptoms. Hot water is ideal, but you can use instant hot packs, cold packs or ice packs. Provide symptomatic treatment for the inflammatory response. Steroid creams are rarely helpful, and they can prolong a skin infection. If the inflammation is severe, you may administer systemic steroids in a moderate, tapering dose under the supervision of a trained medical provider. Oral antihistamines can sometimes help reduce the itching or burning sensation. 

Possible Complications of an Old Problematic Wound

It is not uncommon for divers to contact DAN concerned about a minor skin abrasion on their hands, knees or elbows that happened months ago and has not healed despite proper care. These chronic wounds often have a red and bumpy appearance, occasionally develop a crust and are usually painless. If common antibiotic ointments do not help, divers wonder if the cause may be a marine-specific pathogen.

Divers with an open wound, even a small cut or scrape, are at risk for skin infections. When an old problematic wound fits the descriptions above, it might have become infected with an opportunistic pathogen known as Mycobacterium marinum. Despite the name there are no marine-specific pathogens that affect humans. Some infections are more common in aquatic environments. M. marinum is responsible for a condition commonly known as fish tank granuloma, or aquarium granuloma.

The red and bumpy nodules, no larger than a centimeter, are granulomas — inflammatory immune cells trying to wall off the pathogen. Granulomas are usually isolated but can sometimes appear in small clusters. They are not necessarily painful. There may or may not be discharge from the wound.

Characteristics of

M. marinum That Affect Healing

• The pathogen is opportunistic. It causes infection only in the right conditions (environmental and patient-related), so it is often not considered as a potential culprit.
• It likes cooler temperatures, which is why these wounds tend to flourish in areas with lower body temperatures such as hands, knuckles, elbows and knees.
• Only specific antibiotics work, so the typical antibiotic treatments are usually unsuccessful.
• The life cycle is slow, which means treatments last a long time. Sometimes patients will abandon what could have been a successful treatment or doctors may look for other potential explanations for the symptoms.
• It requires specific culture media that a doctor would not ask for unless they suspected this pathogen. Standard culture results are often negative, which delays the diagnosis.

Allow your doctor to examine the wound and follow their standard procedures. The doctor will probably ask you how it happened or when it started. Tell them about the superficial abrasion in a marine environment. You may want to ask specifically if M. marinum could be the cause. Your doctor does not need dive-specific medical knowledge for this type of issue.

Fitness to Dive

Always take care of wounds and clean them thoroughly no matter the severity. The skin is our most effective and efficient means of immunological defense. A compromised wound can get seriously infected.

As a rule, treat wounds properly and let them heal before diving. This is particularly important before traveling to a remote location or one with limited local medical care capabilities. A skin lesion with the potential for infection might warrant a more conservative decision to stay ashore if you have such a trip planned.

Chronic skin lesions require specific consultation with your physician team before diving. Your doctor may prescribe treatment or a protective covering to prevent skin breakdown.

The Chief Resident Presenting with a Coral Cut Injury: Infections…

CASE REPORT

By Marc A. Ciampi, MD,
and Andre N. Sofair, MD, MPH

A30-year-old previously healthy male pre-sented with pain in his left knee and left groin. Five days prior to presentation, he had scraped his exposed left knee against a large brain coral while snorkeling in the Caribbean, near the island of Aruba. He noted local erythema, slight pruritus, and a small abrasion. After irrigating the wound, the patient used topical antibacterial cream daily. He remained afebrile with no evidence of local or systemic complaints. He denied significant pain, increasing erythema, or wound drainage. On the day of presentation, the patient developed notable groin tenderness and mild left-sided lumbar pain along with increasing knee pain. He denied fever, chills, night sweats, or fatigue. He had no significant past medical history and was taking no medications. He had no known allergies and denied recent ingestion of shellfish.

The patient was afebrile with normal vital signs and general appearance. Physical examination of his knee was notable for the presence of a raised, slightly erythematous rash showing a dermatograph of brain coral, and a 2 mm abrasion with no significant drainage or fluctuance. The joint was normal with no evidence of effusion or inflammation. The left leg revealed tender inguinal lymphadenopathy without lymphangitis. Abdominal examination showed mild left upper quadrant and left costovertebral angle tenderness; a spleen tip was not palpated.

He was empirically started on an oral fluoroquinolone antibiotic, levofloxacin, to treat his soft tissue infection. Oral doxycycline was added one day later to ensure adequate coverage of various marine microorganisms. He was treated for 10 days with resolution of his groin tenderness and back pain after two days of therapy. Over three weeks, the rash resolved completely without complications.

Discussion

Contact with coral or “coral cuts” may produce significant and sometimes dramatic cutaneous reactions.^1,2 Manifestations include localized erythema, urticara, and occasional pruritus.³ The local reaction can be a response to coral nematocysts, contamination of the wound site with microparticulate coral and calcium carbonate, possible bacterial infection, or toxin effects.

Although on a worldwide basis staphylococci and streptococci remain the most common causes of soft tissue infections, vibrios, and some Aeromonas spp. are virulent waterborne organisms that may infect wounds sustained in a marine environment.^1-8Erysipelothrix rhusiopathiae, coliforms such as Escherichia coli, and Mycobacterium marinum, M. balnei, or Pseudomonas spp. are also capable of producing localized infections after exposure to salt water.⁶ Wound infections acquired in this environment may also be polymicrobial.^7,9

Ecology and Epidemiology

The halophilic Vibrio spp. are naturally free-living aerobic inhabitants of marine environments. These organisms have been found in Europe, Asia, Australia, South America, and North America.¹⁰ In North America, they have been recovered from the waters of the Gulf coast, the entire East Coast from Florida to Maine, the California and Washington State coasts, and from the waters around Hawaii. Halophilic vibrios have been found in both water and marine sediments, adherent to plankton, or absorbed onto mollusks and crustaceans. ¹¹Vibrio spp. are taken up by filter-feeding molluscs such as oysters, clams, mussels, and scallops achieving concentrations as high as 10⁶ bacteria per gram of oyster during periods of warm water temperatures. Bacteria are also found in the intestines of some estuarine fish, which may transport them between oyster beds or serve as a source of wound infections.¹²

Vibrio spp. reside in ocean water or marine estuaries within a wide range of salinity (1-34 parts per thousand). Organisms have been isolated from brackish lakes and even from the Great Salt Lake.¹³ A salinity greater than 25 parts per thousand has adverse effects on their survival.

Intolerant of cold conditions, Vibrio spp. thrive during the summer and fall months, but they may also survive the winter months in marine sediment.^5,14-18Vibrio spp. are found in zones where there is decreased dissolved oxygen concentrations, possibly reflecting increased nutrient concentrations in such areas. Vibrios are rarely found in the open ocean, likely due to colder water temperatures, the absence of nutrients, the higher hydrostatic pressures, and the relatively higher salinity.¹⁸

Vibrio infections are acquired either by the consumption of contaminated food and water or through skin and soft tissue injuries.⁴ The primary food sources for acquisition are raw/undercooked oysters or other seafoods.^4,19 In those with skin and soft-tissue infections, nearly all report prior recreational or occupational exposure to sea water or marine organisms.⁹

Clinical Presentations

Three major presenting clinical syndromes have been described for vibrios including gastroenteritis, soft tissue infection, and septicemia. There have been additional case reports of vibrio-associated otitis media, pneumonitis, keratitis, meningitis, and endometritis.^4,13

Soft tissue infections caused by noncholera vibrios may present as one of two distinct clinical entities, primary vibrio cellulitis, or secondary cellulitis following primary bacteremia. ⁴ Direct cutaneous inoculation from abrasions, lacerations, or puncture wounds may result in primary vibrio cellulitis. With the exception of V. cholerae O1, primary vibrio cellulitis has been associated with all known Vibrio spp.^1,5,20-23 In hospitalized patients with vibrio wound infections, the majority are caused by V. vulnificus (43%), followed by V. parahaemolyticus (29%) and V. alginolyticus (18%). The case fatality for V. vulnificus was 11%, and for V. parahaemolyticus it was 5%.⁹

Wound infections range from mild, limited disease to rapidly progressive, necrotizing infections.^9,10,13,19 Virulence may be related to the organisms’ capsular polysaccharide and lipopolysaccharide. Many vibrios also produce degradative toxins and enzymes. These include chitinases, which allow vibrios to colonize the exoskeletons of marine zooplankton, as well as hemolysins and metalloproteases, which break down tissues at the site of colonization. Vibrios also produce siderophores that scavenge iron from host transport proteins, transferrin and lactoferrin. This may account for the increased virulence of Vibrio spp. in patients with iron overload states.¹²

Cellulitis usually occurs within 24-48 hours but can occur as early as four hours, or as late as 12 days after exposure.^20,24,25 Fever occurs in 45-80% of primary cellulitis cases.⁴ Infected wounds are usually erythematous or ecchymotic, swollen and notably tender with little to no purulent discharge.^4,24 Vesicles or bullae with secondary necrotic centers and necrotizing fasciitis have also been described.^{9,12,16,24,26}

Patients with a history of liver disease, renal disease, chronic illness or immunodeficient states are at considerably increased risk of generalized sepsis following cellulitis.^{4,9,19,20,27-30} In cirrhosis, it has been suggested that porto-systemic shunting may allow vibrios to bypass the hepatic reticuloendothelial system. Additionally, liver disease predisposes such patients to complement deficiencies, impaired chemotaxis, and phagocytosis.³¹ Iron overload states also contribute to fulminant vibrio infection. Increased bioavailability of free iron, found in patients with hemochromatosis, may stimulate bacterial growth and metabolism. In addition, iron overload may impair normal host phagocytic activity, increasing susceptibility to infections.^12,31,32 Septicemia occurs in 15% of patients with primary soft tissue infections and contributes to the high case-fatality rates. In those with bacteremia, the rate is 32%; without hematogenous involvement, the case fatality rate is only 1%.⁹

Secondary cellulitis in the setting of primary septicemia associated with Vibrio spp. carries a 32-50% mortality rate.^4,9,10,19,33 In these cases, there is usually a preceding history of having eaten raw/undercooked oysters or other seafood ingestion.^4,19 These individuals develop generalized, metastatic, macular, or papular lesions in the setting of primary bacteremia. Culture-positive cutaneous lesions have been reported with bacteremia caused by V. vulnificus, V. cholerae non-O1, V. parahaemolyticus, and rarely V. alginolyticus.^4,34

Treatment of Coral-related
Soft Tissue Infection

Local wound care should include soap and water, followed by aggressive irrigation and debridement with saline solution and hydrogen peroxide to remove foreign material from the site and prevent secondary infection or granuloma formation.³⁵

Given the potential polymicrobial nature of coral-related infections, broad-spectrum antibiotics should be considered. For those with obvious cellulitis, or as a prophylactic measure in those with abnormal immune systems, antibiotics with a spectrum of activity against staphylococci and streptococci should be used. In addition, antibiotics that are effective against halophilic Vibrio spp. should be administered.

Vibrio spp. frequently produce beta-lactamases and are often resistant to various beta-lactam antibiotics. The beta-lactam inhibitor, sulbactam, does not completely render these organisms susceptible to ampicillin. They are often resistant to cephalothin, cefuroxime, and cefoperazone, but sensitive to cefotaxime, ceftazidime, aztreonam, and imipenem.

Although the fluoroquinolones, ofloxacin and norfloxacin, are effective against these organisms, ciprofloxacin appears to have the greatest activity with an MIC₉₀ of approximately 0.25 mg/L. Trimethoprim/sulfamethoxazole is effective, as are the tetracyclines and chloramphenicol.³⁶ For those with devitalized tissue or fasciitis, surgical intervention is indicated. This may be particularly important when dealing with infections caused by Vibrio damsela.^16,21,37 (Dr. Ciampi is a Clinical Instructor in Medicine at Yale University and Dr. Sofair is an Assistant Clinical Professor of Medicine at Yale University with the Emerging Pathogens Program, New Haven, Conn.)

References

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Dolphins rub against corals and sponges to treat their skin

Indian bottlenose dolphins that live in the north of the Red Sea regularly rub against corals and sponges. Scientists have found that the mucus of these invertebrates contains biologically active substances, some of which have a negative effect on bacteria. Probably by contact with corals and sponges, dolphins prevent and treat skin infections with their secretions. The results of the study were published in an article for the journal iScience .

It is not easy for dolphins and whales to take care of their own skin, because their forelimbs have turned into flippers, and their hind limbs have completely disappeared. However, representatives of at least several species of these marine mammals have learned to cope with this problem. For example, killer whales ( Orcinus orca ) and beluga whales ( Delphinapterus leucas ) regularly rub against the sand and gravel at the bottom of the seas and river estuaries, peeling off the cornified layer of the skin and, probably, getting rid of skin infections and ectoparasites.

Indian bottlenose dolphins ( Tursiops aduncus ) from a Red Sea population around Hurghada and El Gouna (of approximately 360 individuals and long a focus of the Dolphin Watch research team) rubbing against soft corals Sar cophyton , horn corals Rumphella aggregata and sponges Ircinia . Often they even line up near the horn corals and sponges. At the same time, different types of invertebrates are used to treat different parts of the body. So, bottlenose dolphins rub their heads against sponges that are harder than corals. Similar behavior is demonstrated by dolphins that live off the coast of Florida and the Bahamas.

A team of zoologists led by Gertrud Morlock of the Justus Liebig University of Giessen suggested that bottlenose dolphins rubbing against corals and sponges not only cleanse the skin, but also fight skin infections. The fact is that many corals, including representatives of the genus Rumphella , produce mucus containing antimicrobial and cytotoxic compounds. By applying these secretions to their skin, dolphins could protect themselves from bacteria and fungi. In favor of this idea is the fact that bottlenose dolphins from the Red Sea sometimes pick off branches of horn corals and carry them in their mouths. From time to time, dolphins swing such branches, which stimulates the secretion of mucus, which settles on their heads in the form of yellowish and greenish spots.

To test the hypothesis, Morlock and her co-authors collected samples of corals and sponges that bottlenose dolphins from the Red Sea rub against. They carried out a chemical analysis of the mucus secreted by these invertebrates and also assessed its antimicrobial potential using bacteria Aliivibrio fischeri and Bacillus subtilis as examples. It turned out that the secretions of all three genera contain biologically active metabolites. In total, the scientists counted seventeen compounds with antimicrobial, antioxidant, or hormone-like properties. At the same time, the metabolites of horn and soft corals are more similar to each other than to sponge metabolites.

The results of the study confirm that Indian bottlenose dolphins use coral and sponge secretions for treatment. Primarily, this behavior helps prevent and treat bacterial skin infections, and may also help maintain skin health in other ways. The authors note that this is the first example of cetaceans self-medicating with secondary metabolites from other species. It is assumed that dolphins can use such compounds for other purposes. For example, Australian bottlenose dolphins ( T. a. australis ) catch and play with pufferfish, possibly for their poison, which gives a feeling of numbness or even an intoxicating effect.

Earlier, we talked about how Amazonian dolphins ( Inia geoffrensis ) from a Bolivian river played with an anaconda ( Eunectes beniensis ) in front of zoologists. Two adult males swam synchronously, raising their heads above the water, one holding the snake by the neck, and the other by the front third of the body. From time to time, they seemed to demonstrate the reptile to teenage dolphins who were there. At the same time, the anaconda itself died during the game.

Sergey Kolenov

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Dolphins line up for self-treatment of skin diseases in coral “clinics”

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If a person gets sick with a rash, he can go to the doctor and he will prescribe an ointment or tablets for him to treat it. Indo-Pacific bottlenose dolphins (a type of dolphin) also get skin diseases and are kind of like people lining up nose-to-tail at the clinic to rub themselves against corals.

New research shows these corals have medicinal properties, suggesting dolphins use marine invertebrates to treat skin conditions, eurekalert.org reports.

Thirteen years ago, co-author Angela Siltener, a wildlife biologist at the University of Zurich, Switzerland, first observed dolphins rubbing against corals in the northern Red Sea, off the coast of Egypt. She and her team noticed that the dolphins were selective about which corals they rub against, and they wanted to understand why. “I hadn’t seen the coral friction behavior described before, and it was clear that the dolphins knew exactly what kind of coral they wanted to use,” Ziltener says. “I thought, ‘There must be a reason.

Most dolphin research is done from the surface of the water, but because Siltener is a diver, she was able to study dolphins up close.

She and her colleagues were able to identify and sample the coral that the dolphins were rubbing against. The researchers found that repeated rubbing of dolphins against coral stimulated the tiny polyps that make up the coral community, and these invertebrates secreted mucus.

In order to understand what properties the slime contained, the team collected samples of these corals.

Using various surface analysis methods and adding high resolution mass spectrometry to analyze samples of gorgonian coral Rumphella aggregata, skin coral Sarcophyton sp. and the sponge Ircinia sp., they found 17 active metabolites with antibacterial, antioxidant, hormonal, and toxic activity.

This discovery of these biologically active compounds convinced the team that coral and sponge mucus serves to regulate the dolphin’s skin microbiome and treat infections.