Emerging Causes of Superficial and Invasive Infections Following Marine Injuries and Exposures
James H. Diaz, MD, MPH & TM, DrPH, FCCM, FACMT
Soft tissue bacterial infections following aquatic animal bites, stings, andminor injuries occur commonly and usually on the extremities in fishermen and beachgoers worldwide after freshwater and saltwater exposures. Louisiana has more tidal, saltwater, and brackish water shorelines (more than 7,000 miles) than any other state, including Alaska and Hawaii. As a result, Louisiana residents are often exposed to marine pathogens when fishing or working offshore or when enjoying Louisiana’s miles of shorelines. Althoughmany species of bacteria have been isolated frommarine wounds, superficial soft tissue and invasive infections following marine injuries and exposures are most commonly caused by a small number of bacterial species, including Aeromonas hydrophila , Edwardsiella tarda , Erysipelothrix rhusiopathiae , Mycobacterium marinum , and Vibrio vulni- ficus . In addition to these species, several other aquatic bacteria have recently been identified as emerging causes of superficial and invasive infections following marine injuries and exposures, including marine mammal (dolphins and seals) Brucella species, Chromobacterium violaceum , Comamonas species , Shewanella algae , and Streptococcus iniae . The objectives of this review are to describe the epidemiology, presenting clinical manifestations, diagnostic and treatment strategies, and outcomes of both the superficial and the deeper invasive infections caused by the newly emerging marine bacterial pathogens.
Soft tissue bacterial infections following aquatic animal bites, stings, and minor injuries occur commonly and usu- ally on the extremities in fishermen and beachgoers world- wide after freshwater and saltwater exposures. Although Louisiana’s shorelines are rapidly retreating today from levee projects, saltwater intrusions, and hurricane storm surges, Louisiana has more tidal, saltwater, and brackish water shorelines (more than 7,000 miles) than any other state, including Alaska and Hawaii. As a result, Louisiana residents are often exposed to marine pathogens when fishing or working offshore or when enjoying Louisiana’s miles of shorelines. Although many species of bacteria have been isolated from marine wounds, superficial soft tissue and invasive infections followingmarine injuries and exposures are most commonly caused by a small number of bacterial species, including Aeromonas hydrophila , Edwardsiella tarda , Erysip- elothrix rhusiopathiae , Mycobacterium marinum , and Vibrio vulnificus . Of the causative marine pathogens, the most seri- ous and often fatal invasive infections are caused by Vibrio vulnificus . In addition to these species, several other aquatic bacteria have recently been identified as emerging causes of superficial and invasive infections followingmarine injuries and exposures, including marine mammal (dolphins and seals) Brucella species , Chromobacterium violaceum , Comamo-
nas species, Shewanella algae , and Streptococcus iniae . The objectives of this review are to describe the epidemiology, presenting clinical manifestations, diagnostic and treatment strategies, and outcomes of both the superficial and the deeper invasive infections caused by the newly emerging marine bacterial pathogens. MATERIALS AND METHODS Initially, several search engines were queried for refer- ences using all keywords listed as medical subject heading (MESH) words for searches. The keywords included: marine injuries, marine animal injuries, marine infections, aquatic infections; marine bacteria; fish pathogens; aquaculture- related fish infections; marine mammal pathogens. The sources of US cases of superficial and invasive infections following marine injuries and exposures were provided by peer-reviewed, published case reports and series, descrip- tive studies, case-control studies, and Morbidity Mortality Weekly Reports (MMWR) published by the United States (US) Centers for Disease Control and Prevention (CDC). Infections were classified as superficial (abscess), spreading (cellulitis, lymphangitis), and invasive (arthritis, tenosynovi- tis, osteomyelitis, metastatic abscesses, e.g., neurobrucello- sis). Bacterial species were classified byGramstaining status,
J La State Med Soc VOL 166 May/June 2014 103
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