Tank related injury report part 1

[KC2PED]

Date: Mon, 4 Jul 2011 16:25:23 -0400 (EDT)
From: ProMED-mail <promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> Mycobacterium marinum, fish tank - USA: (CA)

MYCOBACTERIUM MARINUM, FISH TANK - USA: (CALIFORNIA)
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Date: Wed 15 Jun 2011
Source: ABC News Medical Unit [edited]
<http://abcnews.go.com/Health/Wellness/flesh-eating-fish-tank-bacteria-lead-teens-amputation/story?id=13837034>


What started as a small scrape from a corner of the family's fish
tank 5 years ago may end in the amputation of a champion teen
gymnast's hand. [The 13 year old girl] from Oak Hills, California, has
battled a rare, flesh-eating infection she contracted from the tank
when she was 8 and doctors have been unable to stop it from spreading.
The bacterium has now spread to the bones of her right hand. "I can't
use that hand at all. I'm in pain all the time," says Hannele.

Over the years, the infection has forced her to quit sports like
volleyball and gymnastics, despite having won an American Athletic
Union gymnastics championship. The infection has become so severe that
the 8th grader has been unable to write or do school work because her
dominant hand is constantly shaking with pain.

_Mycobacterium marinum_, sometimes referred to as fish tank
granuloma, usually eats away at only the surface of the skin. But in
this case it has infected several bones in her right hand, a
development that could mean amputation of her right hand. Doctors at
the Loma Linda Medical Center and UCLA Medical Center have tried
multiple types of antibiotics and 2 surgeries to remove infected
tissue, but the bacterium seems to have become drug-resistant. Fearing
she may be infected with a "superbug" strain of the bacteria, the Cox
family is seeking further treatment for her with infectious disease
experts at Denver, Colorado's National Jewish Health medical center
next week [week of 20 Jun 2011].

The ordeal began when [the girl] was only 8 years old, playing in the
fish tank that resides in the family's living room. "She had already
gotten in trouble a few times that week for sticking her arm in the
fish tank," says her mother. "So when she cut her hand on it she hid
it from me for a few days because she was worried about getting in
trouble. By the time I saw it, it was red and purple and oozing with
yucky green stuff. I soaked it in peroxide, but the cut wouldn't go
away." It took months for doctors to recognize that the wound was
infected with _M. marinum_. They originally thought it was a staph
infection or even MRSA [methicillin-resistant _Staphylococcus
aureus_].

Then came multiple rounds of antibiotics, some of which made [the
teenager] so sick that she had to quit sports. These drugs and 2
surgeries on her hand have been powerless against this strain of the
bacteria, however.

_M. marinum_ infection is a distant cousin to more serious infections
like tuberculosis and leprosy, but it is "exceedingly rare" for it to
persist and travel deeper into the tissue as it has in this case, says
Dr Michael Iseman, infectious disease expert at National Jewish Health
in Denver, Colorado. "The fact that she's had multiple surgeries
suggests that this is a more virulent, drug-resistant strain than
most," he says.

The bacterium can be found in salt or fresh water and has
historically been associated with surfboarding and more recently, fish
tanks. The bacterium is harmless unless introduced into an open wound
and infections are relatively rare, says Dr William Schaffner, chair
of the department of Preventive Medicine at Vanderbilt University
School of Medicine. _M. marinum_ infections can sometimes heal on
their own, but "it's a long-lasting infection and, without treatment,
it can take one to 2 years to resolve," says Schaffner. Treatment
consists of combinations of antibiotics and surgery.

Mild skin infections with _M. marinum_ are well known among aquarium
hobbyists, but the most famous disease risk among aquarium enthusiasts
is salmonella, says Dr Christopher Ohl, MD, an infectious diseases
expert at Wake Forest University School of Medicine. Salmonella
outbreaks have been periodically tied to fish, amphibian, and reptile
pets and the tanks they reside in; the most recent of which occurred
this April [2011] when 216 people contracted salmonellosis from pet
African dwarf water frogs.

Overall, however, fish tanks "pose very little risk" when properly
maintained, notes Schaffner. He recommends wearing latex gloves while
cleaning pet tanks and washing hands and forearms with soap and water
afterwards.

Ohl also recommends cleaning tanks outside or in a bathtub -- not in
the kitchen sink, to reduce the risk of contamination. Wash the
bathtub with bleach afterwards if used, he says. If you get a cut
while cleaning a fish tank, wash the wound with soap and water
immediately.

[byline: Courtney Hutchison]

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