Another...your tank can be dangerous thread.

[Abominable Reefer]

My buddy's roomate got a tiny scratch on his finger cleaning a rat cage, and died a week later from a systemic infection.

Good thing you went to the doctor, you could have lost more than your thumb.

 

[Tcook]

The timing and clinical appearence fit nicely with a bacterial infection. The most common reason that these fail to grow in culture are because these patients are flogged in the ER with big-gun antibiotics (often times rightfully so) before an adequat culture can be taken. Swabs seldom grow what you want to see. A skin biopsy for culture and microscopic evaluation is the best route.

Mycobacterium, including M. marinum, are very slow growing often taking many weeks to produce a noticeable papule or nodule, sometimes in a sporotrichoid pattern (linear array of papules moving proximally up an extremity). These are granulomatous lesions, clinically and microscopically, and not rapidly purulent or necrotic.

Molluscum contagiosum is niether mycobacterium nor mycoplasma. It is caused by a poxvirus and is quite common in children who easily mount an immune response and clear the virus. It is a sexually transmitted lesion in immunocompetent adults.

 

[onthefly]

Tcook - Where'd you pull M. contagiosum out of? I did my PhD qualifying exam on it

EDIT: just saw where he mentioned the chimera of Molluscum and Mycoplasma...

 

[Mr_Quality]

My son had culture confirmed M. marinum, very different presentation.

The red streaks emanating from the lesion are called Lymphangitis. This condition is an inflammation of the lymphatic vessels. Beta-hemolytic Streptococci or Staphylococcus infections usually cause it. What you had looks to me like Staphylococcal scalded skin syndrome (SSSS). The progression was much too fast to be Mycobacterium marinum. M. marinum also would not have responded to Rocefin, but Staph would.

 

[Johnsteph10]

oops..mean mycobacterium...my bad. Wrote that at the end of a 24 hour shift..you'll have to forgive me.

17 hours and counting again. arg.

John

 

[onthefly]

I agree with Mike that the amount of hemalysis at the site and the lymphatic spread sounds like a staph infection. M. Marinum patients "seek medical help months after appearence of the lesion". The issue is whether this was another marine organism/pathogen or an opportunistic host infection. Hard to say since they could not culture anything. What ever it was, you had one hell of an immune response and are lucky you have your thumb.......

For some fun reading:
http://www.flesheatingbacteria.net/pages/story.html#
http://www.bact.wisc.edu:81/ScienceEd/stories/storyReader$89
http://www.emedicine.com/EMERG/topic782.htm
http://www.emedicine.com/derm/topic281.htm

Bare in mind in those pictures, 95% of the necrosis is mediated by the immune system, not by a direct bacterial agent.

 

[SeanT]

Thanks.
I don't know what was, but I sure don't want it again.

 

[Cody Ray]

Wow Sean, that is pretty bad. I must have an emunity, because I always put my bare hands into my aquarium with cuts and scraps.

I always seem to cut myself at the beach as well, but that doesn't stop me, however I wait to go back in until I stop bleeding, lol! Last summer I really stubed my toe on the way down to the beach, blood everywhere. Once it stopped bleeding, I went ahead and went body boarding.

This summer I was snorkling in Rocky Point. I was out a couple hundred yards. I held my breath and dove down to look at some sponges and what not on the underside of a large rock face. Then a large wave passed over and slammed me back first into the rock wall. My back was baddly cut, but I was able to swim back to shore.

The next day I was back out swimming.

 

[Johnsteph10]

This is an interesting discussion! Keep the stories coming!!!!

 

[Cody Ray]

Well, if you want more stories, thats fine, I have a ton of them, lol. However, I don't think that that was the purpose of this thread. I think that it was just to warn others. But if know one else cares, I could continue.

 

[JTrinidad]

Geez. Sounds like a nightmare I had in Biology class. Are we still talking reefs? LOL

 

[Cody Ray]

Well, a few years back I was comming back in from snorkeling in Rocky Point when a wave took me down and I cut my knee wide open. The tide had gone out pretty far, so I was just walking back. That really sucked too!

 

[lacie143]

did they do a marine TB test?

 

[Thunnus]

The most common reason that these fail to grow in culture are because these patients are flogged in the ER with big-gun antibiotics (often times rightfully so)

I have never worked in an ER that allowed starting antibiotics prior to blood and discharge cultures being collected for the very reason that you stated. Usually the orders for meds and cultures are written by our docs at the same time, but cultures are always collected first.

 

[Tcook]

You are correct. Cultures are typically performed prior to antibiotic use. The point that I was trying to make is that the appropriate culture for necrotizing, granulomatous, or deep infections is often not done. This would be a punch or wedge excision for culture. Swabs are often productive for ulcerated or draining lesions. My comments are not intended to depreciate the work done in ERs.

 

[Cody Ray]

One of these days I need to go to the doctor and get my knee checked out. I think that when I cut myself, a piece of coral may have been wedge in there. There is a pretty nice bump there.

 

[Lori M]

I was cleaning calupera off my live rock and a bristle worm got me. It layed a million tiny spines intot he side of my finger. It was a week ago and its still sore. Lil' b@stards!!!

Gloves=Good

 

[joeychitwood]

I have never worked in an ER that allowed starting antibiotics prior to blood and discharge cultures being collected for the very reason that you stated. Usually the orders for meds and cultures are written by our docs at the same time, but cultures are always collected first.

It is true that if cultures and antibiotics are ordered simultaneously, the cultures are usually drawn first. Exceptions would be potentially lethal infections, such as meningitis, where the antibiotic would be administered immediately upon making the presumptive diagnosis.

In reality, however, blood cultures are very often a waste of time and money, especially in febrile children. Many studies show that they very often miss the causative organism, report contaminants instead of pathogens and can lead to a false sense of security, when in fact therapy should be directed by clinical observations.

It doesn't surprise me at all that a culture was fruitless in your case. There could have been multiple causative organisms.

Rocephin is very often the first drug used in skin infections before knowing a cause and is generally well tolerated.

 

[minfinger]

You know I just thought about this, but I used to take my rocks that had Valonia (Bubble Algea) out of the water and peel/pop the bubbles. Several times I've been squirted in the face and on more than one occasion in the eye. Now I never had any problems, well no more than personal embarrassment, but it burned a little bit.

I kind of thought it might be bad, but since it never hurt me, I didn't care. And honestly, I'm not tlaking about 10 or 20 Valonia, I'm tlakingabout my 55G tank had 1000s!

 

[Thunnus]

joeychitwood is right. Too many nurses screw up cultures by not using basic sterile tecnique, and too many docs treat the lab results instead of how the patient presents.