What are the common causes of coral skin infections. How do coral scrapes and cuts manifest in divers. What are the best prevention and first aid methods for coral injuries. How can divers avoid complications from coral skin infections.

The Nature of Coral Skin Infections in Divers

Coral skin infections are a significant concern for divers and snorkelers, with the Divers Alert Network (DAN) receiving approximately one inquiry per week related to coral contact injuries. These injuries often present as cuts and scrapes, which are the most common injuries experienced by underwater enthusiasts. The unique nature of coral injuries stems from the combination of soft living tissues covering an abrasive rigid structure in stony corals, making it easy for the coral’s soft tissue to tear and become lodged in cuts or scrapes.

Why are coral injuries different from other skin abrasions? Unlike typical “raspberries” obtained from land-based activities, coral cuts and scrapes involve contact with living marine organisms. This interaction can introduce foreign material into the wound, prolonging the healing process and causing an acute inflammatory response or infection.

Mechanisms of Coral Injury

How do coral injuries occur? When a diver comes into contact with coral, especially stony coral, the rigid structure beneath the soft living tissue can easily tear the diver’s skin. This tearing action allows coral fragments and other marine debris to enter the wound, leading to potential complications. The presence of various antigens and substances from the coral can trigger an inflammatory response in the human body.

• Soft coral tissue tears easily due to the rigid structure underneath
• Foreign material from coral can enter the wound
• Antigens and substances from coral trigger inflammation

Manifestations and Symptoms of Coral Skin Infections

How do coral skin infections manifest? The most common symptoms include a burning sensation, pain, and itching. In some cases, a rash may accompany the injury, particularly if the contact was with a hydroid such as fire coral. The extent of the reaction depends on several factors:

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

In the case of fire coral injuries, which are caused by cnidarians containing nematocysts, blistering typically appears a few hours after contact. These injuries often follow a pattern of apparent healing followed by relapse within a week or two, which is characteristic of such envenomations.

Unique Aspects of Hydroid Injuries

Why are hydroid injuries particularly problematic? Hydroids, including fire corals, belong to the class Hydrozoa and possess nematocysts. Even a simple touch can trigger mechanical activation and envenomation. The resulting blisters may take several days to resolve, but the delayed reaction and potential for relapse make these injuries particularly challenging to manage.

Prevention Strategies for Coral Skin Infections

How can divers prevent coral skin infections? The primary prevention strategy is to avoid contact with coral and other living marine creatures. Here are some additional preventive measures:

• Wear a wetsuit or dive skin for protection
• Be mindful of currents and other divers that may push you into coral
• Carry a marine animal first aid kit during ocean dives
• Educate yourself on marine life identification and first aid techniques

Why is wearing protective gear important? A wetsuit or dive skin provides a barrier between your skin and potential coral contact, reducing the risk of injury even if you’re accidentally pushed into coral by currents or other divers.

First Aid Procedures for Coral Injuries

What are the proper first aid steps for coral injuries? Follow these guidelines to properly treat coral cuts and scrapes:

1. Thoroughly clean the wound with soap and water, scrubbing vigorously
2. Flush the wound with a 50% hydrogen peroxide solution, followed by 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

For wounds that develop a crust, use wet-to-dry dressing changes. This involves soaking a dry sterile gauze pad with saline or a diluted antiseptic solution, allowing it to dry, then removing it to lift off dead and dying tissue.

Monitoring for Signs of Infection

How can you identify a potentially serious coral infection? Watch for the following signs:

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

If any of these symptoms occur, consult a healthcare professional about starting antibiotic treatment, especially to prevent potential Vibrio bacteria infections, which can be particularly dangerous for individuals with compromised immune systems.

Complications Associated with Coral Skin Infections

What complications can arise from coral skin infections? The most common complications from non-stinging coral scrapes include:

• Prolonged healing time (weeks to months)
• Formation of granulomas due to retained debris
• Persistent itching and rash
• Development of tender, raised bumps (papules)

Why do some coral injuries take so long to heal? The presence of foreign material in the wound can significantly extend the healing process. The body’s attempt to remove this material can result in the formation of granulomas, leading to an itchy rash or papules that persist until the foreign matter is eliminated.

Coral Poisoning: A Serious Complication

What is coral poisoning, and how does it manifest? Coral poisoning can occur when abrasions or cuts are extensive or result from contact with particularly toxic species. Symptoms include:

• Poor wound healing or continuous pus drainage
• Swelling around the cut
• Swollen lymph glands
• Fever and chills
• Fatigue

If you experience these symptoms, it’s crucial to seek medical attention promptly.

Advanced Treatment Options for Persistent Coral Injuries

How should persistent coral injuries be managed? For injuries that don’t respond to initial first aid measures, consider the following advanced treatment options:

1. Consultation with a dermatologist or tropical medicine specialist
2. Debridement of the wound to remove any remaining foreign material
3. Prescription of topical or oral antibiotics if infection is present
4. Use of corticosteroids to reduce inflammation in severe cases
5. Hyperbaric oxygen therapy for particularly stubborn wounds

Why might hyperbaric oxygen therapy be beneficial? This treatment can enhance wound healing by increasing oxygen delivery to the affected tissues, promoting the growth of new blood vessels, and supporting the body’s natural healing processes.

Long-Term Management and Follow-Up Care

What long-term care is necessary for coral skin infections? Even after the initial healing phase, it’s important to monitor the injury site and take proper care:

• Continue to protect the area from sun exposure to prevent hyperpigmentation
• Moisturize the skin to maintain elasticity and prevent scarring
• Perform gentle massage to break down scar tissue
• Schedule follow-up appointments with a healthcare provider if healing is slow

How long should you monitor a coral injury? It’s advisable to keep an eye on the injury site for several months, as some complications, such as granuloma formation, can develop weeks or even months after the initial injury.

Psychological Impact of Prolonged Healing

Why is it important to address the psychological aspects of coral injuries? The prolonged healing time and potential for scarring can have a significant psychological impact on divers. Some may experience anxiety about returning to diving or frustration with the slow healing process. Addressing these concerns through support groups or counseling can be beneficial for overall recovery and maintaining enthusiasm for diving.

Educating the Diving Community on Coral Safety

How can the diving community improve awareness about coral injuries? Dive operators, instructors, and experienced divers play a crucial role in educating others about coral safety:

• Incorporate coral safety briefings into pre-dive talks
• Promote responsible diving practices that minimize coral contact
• Share personal experiences and lessons learned from coral injuries
• Encourage proper buoyancy control to reduce accidental coral contact
• Support conservation efforts to protect coral reefs

Why is coral conservation important for diver safety? By protecting coral reefs and promoting their health, we not only preserve these valuable ecosystems but also reduce the risk of injury to divers. Healthy corals are less likely to cause severe injuries, and preserving reef environments ensures safer diving experiences for future generations.

Developing New Protective Technologies

What innovations could help prevent coral injuries? The diving industry continues to explore new technologies to enhance diver safety:

1. Advanced materials for dive skins that provide better protection against coral cuts
2. Improved underwater navigation systems to help divers avoid coral contact
3. Development of coral-safe sunscreens and other topical products
4. Research into natural compounds that may accelerate healing of coral injuries

How might these innovations impact diving practices? As new protective technologies emerge, they have the potential to significantly reduce the incidence of coral injuries, allowing divers to explore reef environments more safely while minimizing their impact on these delicate ecosystems.

Global Perspectives on Coral Injury Management

How do different regions approach coral injury management? Coral injury treatment can vary across different parts of the world, influenced by local marine life, medical resources, and traditional practices:

• Caribbean: Emphasis on immediate cleaning with vinegar solutions
• Pacific Islands: Use of traditional herbal remedies in conjunction with modern medicine
• Australia: Advanced research into marine envenomations and their treatments
• Southeast Asia: Integration of traditional Chinese medicine with Western approaches

Why is a global perspective important? Understanding diverse approaches to coral injury management can lead to more comprehensive and effective treatment protocols worldwide. It also helps divers prepare for appropriate care when traveling to different regions.

Collaborative Research Initiatives

How is the scientific community advancing coral injury treatment? Collaborative research initiatives are crucial for improving our understanding and management of coral injuries:

1. International studies on the biochemistry of coral toxins
2. Comparative analysis of treatment efficacy across different regions
3. Development of standardized protocols for coral injury management
4. Investigation into the long-term effects of repeated coral injuries on divers

What benefits can arise from these research efforts? By pooling knowledge and resources, researchers can accelerate the development of more effective treatments, potentially reducing healing times and minimizing complications from coral injuries.

The Role of Technology in Preventing and Treating Coral Injuries

How is technology shaping the future of coral injury prevention and treatment? Advancements in various technological fields are offering new possibilities:

• Artificial Intelligence (AI) for rapid identification of coral species and their potential risks
• Virtual Reality (VR) training simulations for divers to practice coral avoidance
• Nanotechnology in developing more effective topical treatments
• Wearable devices that alert divers to proximity of coral structures

Why is technological integration important in diving safety? These innovations can provide real-time information and protection, potentially reducing the incidence of coral injuries and improving outcomes when injuries do occur.

Telemedicine in Remote Locations

How can telemedicine benefit divers in remote locations? The expansion of telemedicine services offers several advantages:

1. Immediate access to medical expertise for proper wound assessment
2. Guidance on appropriate first aid and follow-up care
3. Triage for determining if evacuation is necessary
4. Ongoing monitoring of wound healing progress

Why is this particularly relevant for coral injuries? Given the potential for delayed reactions and complications, having access to medical professionals who can provide ongoing assessment and advice is crucial, especially in areas far from advanced medical facilities.

Environmental Factors Influencing Coral Injury Severity

How do environmental conditions affect coral injuries? Various factors can influence the severity and healing of coral wounds:

• Water temperature: Warmer waters may increase the risk of infection
• Water quality: Polluted waters can introduce additional pathogens
• Coral health: Stressed or diseased corals may cause more severe reactions
• Seasonal variations: Some regions experience higher toxicity in certain seasons

Why is understanding these factors important? Awareness of environmental influences can help divers take additional precautions during high-risk periods and assist medical professionals in predicting potential complications.

Climate Change and Coral Injuries

How might climate change impact coral injuries? The ongoing effects of climate change on coral reefs could have several implications:

1. Increased coral bleaching events may alter the toxicity of some species
2. Changes in coral distribution could expose divers to unfamiliar species
3. Ocean acidification might affect the chemical composition of coral structures
4. Rising water temperatures could increase the risk of secondary infections

What does this mean for diver safety? As coral ecosystems change, divers and medical professionals will need to stay informed about potential new risks and adapt prevention and treatment strategies accordingly.

Legal and Ethical Considerations in Coral Injury Cases

What legal and ethical issues surround coral injuries? The unique nature of coral injuries can raise several considerations:

• Liability concerns for dive operators and instructors
• Environmental regulations regarding coral interaction and damage
• Ethical considerations in coral research and treatment development
• Insurance coverage for coral-related injuries and treatments

Why are these considerations important? Understanding the legal and ethical landscape helps protect both divers and marine ecosystems, ensuring responsible diving practices and appropriate care when injuries occur.

Developing International Standards

How can international standards improve coral injury management? Establishing global guidelines could have several benefits:

1. Consistent training for dive professionals in coral injury prevention and first aid
2. Standardized reporting mechanisms for coral injuries to improve global data
3. Unified approach to conservation efforts that impact diver safety
4. Collaborative development of best practices for coral injury treatment

What impact could these standards have? International standards could lead to better-informed divers, more effective treatments, and improved overall safety in coral-rich diving environments worldwide.

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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3. Habif TP, Habie TP. A color guide to diagnosis and therapy. Clin Dermatol 1996;3:2005.

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6. Bateman JL, et al. Aeromonas hydrophilia cellulitis and wound infections caused by waterborne organisms. Heart Lung 1988;17:99-102.

7. Pien FD, et al. Bacterial flora of marine penetrating injuries. Diagn Microbiol Infect Dis 1983;1:229-232.

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12. Strom MS, Paranjpye RN. Epidemiology and pathogenesis of Vibrio vulnificus. Microbes and Infection 2000; 2:177-188.

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14. Oliver JD, et al. Distribution of Vibrio vulnificus and other lactose-fermenting vibrios in the marine environment. Appl Environ Microbiol 1983;45:985-998.

15. Linkous DA, Oliver JD. Pathogenesis of Vibrio vulnificus. FEMS Microbiol Lett 1999;174:207-214.

16. Yuen KY, et al. Fatal necrotizing fasciitis due to Vibrio damsela. Scand J Infect Dis 1993;25:659-661.

17. Penman AD, et al. Vibrio vulnificus wound infections from the Mississippi Gulf coastal waters: June to August 1993. South Med J 1995;88:531-533.

18. Joseph SW, et al. Vibrio parahaemolyticus and related halophilic vibrios. Crit Rev Microbiol 1982;10:77-124.

19. Klontz KC, et al. Syndromes of Vibrio vulnificus infections. Clinical and epidemiologic features in Florida cases, 1981-1987. Ann Intern Med 1988;109:318-323.

20. Howard RJ, Lieb S. Soft tissue infections caused by halophilic marine vibrios. Arch Surg 1988;123:
245-249.

21. Tang WM, Wong JW. Necrotizing fasciitis caused by Vibrio damsela. Orthopedics 1999;22:443-444.

22. Ien F, et al. Vibrio alginolyticus infections in Hawaii.
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Skin infections – health articles

11/10/2022

Skin infections are divided into bacterial, viral, fungal and parasitic. These include diseases such as scabies, warts, herpes, fungal diseases, lichen, etc.

For the development of the disease is not enough only the causative agent of infection. For its vigorous activity and reproduction, certain conditions are necessary, for example, a weakening of the immune system. If a person has strong immunity, the disease may not be.

Causes

Infection is one of the leading causes of skin diseases. The infection multiplies, causing an inflammatory response. In addition, any infection releases toxins into the body, which disrupt the filter organs. Toxins released by infections are primary and aggressive allergens. The presence of infections in the body significantly increases the allergic component. The organs responsible for detoxification (liver, kidneys, lymphatic system) with a huge amount of toxins will no longer cope with their work, fully perform their functions. In fact, skin diseases are a pathological way of percutaneous elimination of toxins from the body.

Types of skin infections and their symptoms

Scabies – a characteristic symptom is itching at night, which prevents sleep and is very annoying. Also, scabies can be recognized by small itchy pimples and a gray line extending from them – this is the course of the tick.

Warts. In fact, they are a benign tumor caused by the human papillomavirus (HPV). There are several types of warts: common, genital warts, plantar, flat and senile. This disease is very common. They are skin neoplasms, often small. Although sometimes they can merge and grow to impressive sizes.

Herpes. In this case, we are talking about herpes type 1. There are also other types of herpes viruses, but they no longer belong to skin diseases, but more affect the internal organs.

So, herpes simplex virus type 1 (or herpes simplex virus) is an infection that lives in almost all of us. According to statistics, 9 out of 10 people on earth are infected with herpes. The first symptoms: small sores can be seen on the lips or near the nose. In the first hours, the skin begins to swell and hurt a little, causing discomfort. Symptoms of an exacerbated herpes virus, in addition to skin manifestations, may resemble a common cold – weakness, fever, etc.

Fungal diseases. Fungi, which, getting on the skin, hair and nails of a person, cause their change, a huge amount. You can get a fungal infection, like other skin diseases, by contact with a carrier (including animals), when using common hygiene items, shoes, as well as in baths and pools, that is, where it is warm and damp, especially if there are mechanical damage to the skin.

Symptoms of fungal diseases can be: itching, burning, redness, peeling, weeping, cracks, flaking of scales, the formation of round plaques with a scaly raised rim, a change in the color and texture of the nail, the appearance of clearly defined foci on the hairy surface of the skin in which the hair becomes dull, brittle and eventually fall out, the appearance of black spots, severe seborrhea or dandruff.

Lichen. These are diseases that can also be caused by viral microorganisms and fungi. Infectious varieties include ringworm, pink, multi-colored (or pityriasis). A common symptom of these diseases is a rash in the form of scaly plaques of a changed color and completely different size, causing itching.

Erythema multiforme exudative. Infectious disease with an acute course. The seasonal form develops more often in spring or autumn. It is caused by an infection against the background of cold factors.

The toxic-allergic form occurs due to intoxication of the body with drugs or after vaccination (more often in children).

Both forms are characterized by skin rashes in the form of pinkish spots or slightly raised papules. Bubbles filled with serous and sometimes bloody contents may appear in their middle. The disease is also accompanied by general malaise, fever. Often there is pain in the throat and joints.

Ostiofolliculitis or staphylococcal impetigo. The causative agent is often Staphylococcus aureus. The main cause of the disease is a violation of the rules of hygiene, excessive sweating. It is characterized by the appearance on the skin of small semicircular rashes filled with purulent contents. They are about the size of a pinhead. In the center of the abscess is a hair.

Accompanied by painful sensations in the area of ​​rash dislocation. In the absence of adequate treatment, the infection can spread deep into the epidermis, provoking the development of folliculitis, the appearance of boils.

Pyoderma. A wide group of pustular diseases, the causative agent of which are bacteria: streptococci, staphylococci and pathogenic fungi.
The main symptom is follicles that appear mainly on the skin of the face, back, chest, armpits and scalp. If you do not seek medical help in a timely manner, there is a high risk of developing sepsis, a life-threatening condition.
Actinomycosis. Chronic bacterial skin disease.
The main symptom is the appearance under the skin of a dense tuberous neoplasm (infiltrate), which consists of several nodules that have merged together. The skin in this area acquires a bluish-reddish tint. With the development of the disease, the infiltrate breaks through, forming fistulas from which purulent contents are released.

Thrush or yeast stomatitis – often diagnosed in newborns or debilitated children. It is characterized by the appearance of a white film (plaque) on the oral mucosa.

Diagnosis

In the diagnosis of skin diseases, it is especially important to detect latent infections that deprive the immune system of the ability to function normally. The condition of the internal organs, the disruption of which can cause skin diseases, is also assessed.

Therefore, examination for skin diseases consists of a carefully verified list of tests and examination by doctors of other specializations (for example, a cosmetologist-dermatologist), which are designed not only to detect skin diseases (often this can be done with the naked eye), but to identify the true causes of all existing disorders in the body. With such a systematic approach, the treatment carried out is enough to save the patient from skin disease for a long time, and often for life.

Treatment

Infectious diseases are treated in a complex manner. Conventionally, all treatment is divided into several stages, which depend on the established diagnosis and the individual characteristics of the organism of each patient.

Various methods of treatment are used: medications, including antibiotics of different groups. Homeopathic remedies, phyto and physiotherapy methods are also used. In certain cases, cryotherapy procedures are effective. Depending on the disease, ultraviolet blood irradiation may be needed. In addition, drugs are prescribed that improve the functioning of internal organs and strengthen the immune system.

Certain ointments, gels, mashes and creams are used externally. As an additional treatment, effective folk remedies are used.

Treatment is usually carried out on an outpatient basis, although in especially severe cases, a referral to a hospital is indicated.

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 stratum corneum of the skin and, probably, getting rid of skin infections and ectoparasites.

Indian bottlenose dolphins ( Tursiops aduncus ) from a Red Sea population near 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.