coral sting wound infected - need responses

[littlewrentx]

I was stung by one of my corals when I was working on my tank Sunday afternoon. The sting was on my forearm about three inches from my elbow. I didn't pay much attention to which coral got me because it has happened before with no ill effects. It could have been a favia, toadstool, kenya tree, or mushrooms. I only have a few zoos and palys in the tank and they aren't in an area that could have made contact with my arm.

I washed my hands and arms with soap and water after working on my tanks. By evening, the wound showed signs of infection. I applied neosporin and put a bandaid on it and didn't think much about it. By Monday morning, the wound had formed an abscess with redness and swelling. I got an appointment today and my doctor put me on a 10 day cycle of antibiotics. The margins of the affected area measure 4" by 3" and I am running a low grade fever.

Does anyone have any experience or information on stings that I should share with my doctor?

Christiana 210-218-4037

[dmweise]

Are you sure it was a coral? It sounds more like a crustacean or worm sting. Do you have bristle worms in your tank? A small one may have been floating in the water column and poked you.

[justahobby]

Sorry to hear about your troubles. I would try researching palytoxins. I know soft corals carry this stuff and it can be a pretty potent punch. As dmweise mentioned, if its more of a pin-point sting a bristleworm is more likely culprit.
Just my 1 cent, but Neosporin and band aid probably didn't help. Your body can't push the poison out when the infected area is covered with petroleum and tape.

[Big_Pun]

i was stung by a bristle worm pretty good a couple weeks ago, felt like fiber glass/ cactus sting, i cought it right away and saw lots of little hairs on my fingers, used duct tape removed most before more got pushed, only hurt for a couple days like a splinter. maybe its something else

[JimD]

Could be an alergic reaction, nothing to fool with... Keep a close eye on it...

[littlewrentx]

It could very well have been a bristle worm. The doctor wanted to wound covered in case it was an antibiotic resistant bacteria (to keep it from spreading). I did not think my corals could sting with as much punch. A worm however could have done it.

[rabadanmarco]

i forgot where i heard this but...saposable ifyou are alergic to bees most likly a coral sting can really mess you up to...my friend is alergiv to bees and he was helping me with my tank and he moved the anemone...his fingers were red and irritated for days

[Bill S]

I've had more than a few similar problems.

After tearing my tank down at Xmas, I went to the Dr. because of a wound on my index finger. I had gloves on, but managed to nick it when fragging a chalace. Dang near ended up having my finger lanced. She put me on antibiotics, and it cleared up.

HOWEVER... I'm not sure that this is related, but I've had continuing problems with infections on my fingers from knocking barnacles off of the prop of our boat in Corpus Christi. I FINALLY got smart and bought some kevlar gloves. These little nicks become weeks-long infections.

I guess what I'm saying is that the stuff we play with is really, really hazardous. As is typical with allergic reactions, minor reactions get worse with exposure. Be particularly careful around palys and zoanthids.

[ErikH]

I do think people are very casual about their handling of these items. They come from the least explored place on the planet. :D BE CAREFUL. Wear glasses when fragging palys and zoas especially, they can burst open and take an eye out. Keep your curious animals out of harm's reach as well.

[ratboy]

Take all your antibiotics and make sure you go back if it doesnt improve. A possible concern would be Mycobacterium marinum which wouldnt be killed by commonly prescribed antibiotics.

[MKCindy]

What did they use to tell us, "Take a cut to the ocean to heal, get one at the ocean and it will take forever."

[Shawn]

A lot of these things have neurotoxins. I had a carpet anemone commit suicide on my hand. Left almost all of it's stinging cells in my hand. I got real sick and almost ended up in the hospital. The worst part is that the anemone died.

I learned at the emergeny room after having been barbed at Corpus by a catfish that them main way they treat all salt water related injuries is to soak the affected area in as hot a water as the person can stand. Nature shows confirm this. This usually neutralizes the toxins and allows them to leave the body.

[jroescher]

Check out the MAAST library. There are some articles posted there that deal with this.

http://www.maast.org/forums/forumdisplay.php?f=35

[littlewrentx]

I want to thank everyone for the feedback. I think the culprit was a bristle worm. I have been stung before by them, but usually on the finger where the skin is thicker. In the past, I was able to remove the spines with tweezers. I must have brushed my arm past one of the smaller worms and broke the little spines off when I instinctively wiped my other hand over the area that was stung. My immune system did not like any of this at all.

At the doctor appointment on Wednesday, he drew a line around the inflammed area and told me to keep an eye on it. I started an antibiotic that afternoon. Later that night, the redness had turned purple and the affected area kept getting bigger. I was also running fever, my joints were hurting, and the sting site was incredibly painful. (I did get some relief from applying a heating pad to the wound site. The pain was more than I ever expected- it friggin hurt!)

I ended up at the ER around 3:30 am. I went to the new Methodist hospital in Stone Oak and I didn't have to wait at all! They were so excited to have a patient that I was seen immediately (I never get this lucky). They shot the area full of lidocain and opened it up with a scalpel and to remove the necrotic tissue. I know this sounds gross, but it was such a relief to be out of pain. Unfortunatly, the lidocain wore off after an hour. I was put on a different antibiotic and given vicodin for the pain.

I consider myself to be a generally "safe" person. It isn't like I was juggling blue ring octopus or jumping rope with sea snakes. I will, however, be buying some of those arm length gloves.

Thanks again for all of your comments. It was very scary having such an intense reaction.

Christiana

[OrionN]

Injury related to water can become infected. Infection in this can can be from organism not typical of non water related injury. If it is infected, doctors need to be told that it is aquarium/salt water related because the antibiotic selection is different from other injury related infection. Often we need multiple antibiotic to appropriately cover the possible organism. Here is an exert from uptodate.com, a service I subscribe to regarding medical related information. As you can see, the initial antibiotic selection often included two to three antibiotics.

____

* Soft tissue infections can occur after both fresh water and salt water exposure, particularly if there is associated trauma. The most common bacteria to produce soft tissue infections in association with exposure to water or water-related animals include (AEEVM organisms) Aeromonas species, Edwardsiella tarda, Erysipelothrix rhusiopathiae, Vibrio vulnificus, and Mycobacterium marinum. (See "Introduction" above).

* Patients with underlying hepatic disease or cancer have an increased risk of infection caused by AEEVM and may present with life-threatening infections. (See "Underlying diseases" above).

* AEEVM can produce a variety of skin and soft tissue infections including cellulitis, abscess formation, wound infection, ecthyma gangrenosum, and necrotizing soft tissue processes (eg, fasciitis and myositis). Rapidly progressive soft tissue infection with fever, and in high-risk patients, sepsis, may occur with Aeromonas spp and V. vulnificus infection. In contrast, soft tissue infections due to M. marinum and E. rhusiopathiae are generally indolent and are not associated with systemic toxicity. (See "Clinical manifestations" above).

* Diagnostic tests including Gram's stain (and acid-fast staining when indicated) and culture should be performed on specimens taken from soft tissue drainage or biopsies. (See "Diagnosis" above).

* Besides AVEEM infection, skin and soft tissue findings following water exposure can be due to noninfectious causes, including injuries resulting from bites or venomous stings of aquatic organisms. (See "Differential diagnosis" above).

* Management of soft tissue infections following water exposure includes:

- Assessment to determine whether treatment requires hospitalization
- Empiric antibiotic administration
- Assessment of tetanus vaccination status
- Surgical consultation for potential debridement in patients with necrotizing infections

(See "Treatment" above).

* We recommend empiric antibiotic coverage for patients who develop a soft tissue infection following water exposure (See "Water exposure" above) to include coverage for both S. aureus and beta-hemolytic streptococci and the AVEEM organisms, except for M. marinum (Grade 1B). Appropriate antibiotics for initial empiric therapy include:

- Either a first generation cephalosporin (cephalexin 500 mg orally four times daily or cefazolin 1 g IV every eight hours) OR clindamycin (300 mg orally four times daily or 600 mg IV every eight hours, in those patients with immediate hypersensitivity reactions to penicillin) PLUS

- Levofloxacin (750 mg once daily) PLUS either of the following if the epidemiologic risk is present:

- Metronidazole (500 mg four times daily) if exposure to sewage-contaminated water or if soil-contaminated wound; (not necessary to include if the regimen includes clindamycin) OR

- Doxycycline (100 mg twice daily) for coverage of Vibrio species If seawater exposure

(See "Empiric antibiotic treatment" above).

* We recommend not including coverage for M. marinum in the empiric antibiotic regimen, in most cases. (Grade 1C). (See "Empiric antibiotic treatment" above).

* Initial broad-spectrum empiric therapy should be changed to a more narrow spectrum coverage when specific pathogens are identified in clinical specimens by the microbiology laboratory based upon the isolates susceptibility results. (See "Directed antibiotic therapy" above).

* In most cases, a duration of antimicrobial therapy for AEEVM soft tissue infections is 10 to 14 days. (See "Duration of treatment" above).

* We recommend a duration of treatment of at least three months for soft tissue infection due to M. marinum. (Grade 1B). (See "Duration of treatment" above).

[littlewrentx]

I made sure I told the doctor that it was a saltwater related injury. the first antibiotic was Septra and then after the ER visit, I was put on Ceflex and Bactoderm ointment. The swelling and pain is almost gone. The wound looks much better.

[Sherri]

Glad to hear you're doing better and thanks for sharing the experience with us...sometimes we forget exactly what we're dealing with....I "was" in the habit of wearing gloves....now I am again due to the "reminder". :)

[MRSBIGBIRD123]

Wow....glad to hear you are on the road to recovery. As Sherri stated, we take for granted, that our health is not going to be compromised, while we are "working" in our tanks.....we need to acquire the attitude that part of responsible reef keeping, is also taking care of ourselves.
Definitely keep us posted.

[runamukus]

We should treat our tanks as if it were a science experiment. And you know how controlled scientist are with their environments.

[phippsj]

This has been a rude awakening to me as well. I was cleaning off some zoas from some rock I purchased from a member who had taken their tank down. Half of the rock they seemed OK, but these ones had a really bad smell. I woke up the next day with a left hand that was completely infected, red lines down my arm, swelling and incredibly painful.

Doctor put me on antibiotics and it cleaned up quick. The dilema, as he explained it to me, as that they did not want to treat it for a sting first because if it was bacterial, then the steroid treatment for a sting would make the infection worse. I was told to take Benadryl along with my antibiotics. Three days later and I can now bend my thumb and fingers again.

Lesson learned!

[littlewrentx]

I just downloaded some pics off my camera. If anyone wants to see pics of the wound, send me your email address. It is kind of nasty so be warned.