Fish Handler’s Disease

Catching more than you bargained for…..

This blog was inspired by a recent case reporting the improper handling of a stingray.  In this particular case, a man visiting Florida and unfamiliar with the local marine life sustained a hand injury from the barb of a stingray while fishing.  The injury required surgery and years of recovery.

Stingray barbs, sharp and toxic

Stingray barbs, sharp and toxic

Those familiar with stingray know to be particularly cautious.  The barb can be dangerous and wounds sustained from them vulnerable to limb threatening infection.

Though, the stingray with its venomous, razor sharp barb is not the only fish capable of inflicting harmful injury.  The dorsal fins of many frequently caught fish can contain venomous spikes and bacteria exposing open wounds to dangerous infections.

In fact, the teeth and fins of many fish are notorious breeding grounds for bacteria and fungus putting wounds inflicted by them at great risk for infection.

Too often identifying the source of infection, such as that which was found in the above case (Fusarium solani bacteria), can delay proper treatment and result in permanent damage – particularly if the medical team treating the injury is unfamiliar with the region or marine life responsible for the injury.  This patient was eventually treated with debridement and skin grafting in conjunction with ketoconazole therapy (antifungal treatment). 1 Unfortunately recovery took years.

Understanding the marine life in your area and those fish of particular concern will help reduce these types of injuries – and facilitate the healthcare team involved in your care should an injury occur.  Also knowing some first quick steps in addressing such an injury before seeking medical attention can improve outcome.

Swimming with Bacteria

Fish fins and teeth, breeding ground for bacteria

Fish fins and teeth, breeding ground for bacteria

Aquatic fungi are often considered secondary tissue invaders following traumatic injuries or infectious agents. Because many fungi grow on decaying organic matter, they are especially common in the aquatic environment, particularly in warmer waters.  A number of mycotic infections have been reported in fish. Laboratory culture and complete clinical evaluations will further the understanding of these diseases – initially for scientists and then healthcare providers treating such injuries.  The education of sportsmen can go a long way in filling the gap in between.

The prevalence of infections resulting from Mycobacterium marinum bacteria or Erysipelothrix in those handling fish and shell fish has prompted the official classification now known as Fish Handler’s Disease.  

More than an Open Wound

Whether it occurs while unhooking, filleting or tossing back to the sea, when the skin is broken by a tooth or fin (particularly among those fish identified as toxic or high bacteria carriers), the injury has a far more damaging potential than a simple, open wound.

The largest organ of the human body, skin serves a valuable protective purpose for all that lies beneath – ensuring not only that our internal network remains intact but also that nothing harmful or disruptive gets in.  When this protective barrier is breached, not only is the wounded limb affected but the entire body.  Invasive bacteria and fungal infections can spread quickly.

While addressing the initial wound, such as stopping blood loss and addressing pain, taking quick steps to reduce risk of a disseminated infection or invasive impact of a venomous/toxic encounter are key to a rapid recovery and reduction in longterm trauma.

A disseminated infection is an infection that enters at a single point and then spreads throughout the body, often affecting numerous organ systems such as that incurred by a stingray and other venomous fish. Beginning as a lesion, the injury gets progressively worse as the infection grows.  The right emergency care and ongoing treatment are key.

Immediate Action Following Toxic Exposure

Whether an open hand wound results form exposure to a known toxic barb or local Catfish fin, following these early steps will help in the ultimate healing process:

  • Bathe the wound in saltwater, removing any fragments of the spine
  • Stop the bleeding by applying pressure
  • Soak the wound in hot water until the bleeding stops, or apply a heat back. This will inactivate any venom still in the wound. Remove any pieces of the spine/fin/barb in the hand with sterilized tweezers (not advised if in the chest, abdomen, or neck).
  • Clean the wound with soap and water and dress it without taping it closed
  • Immediately go to the hospital or ER
  • Inform the medical staff of the area in which you were fishing and the type of fish you were handling

Preventing Fish Handler’s Disease and other Fishing Trauma

While not every incident during a fishing trip can be controlled, there are some things we can do to reduce risk of injuries escalating to more harmful levels.

These Include:

  • Wearing fishing gloves
  • Covering limbs with long sleeves/pants
  • Utilizing de-hooking devices while handling marine life
  • Washing hands and equipment after handling any fish, or after any exposure to open water

Reference

1.) Hiemenz JW, Kennedy B, Kwon-Chung KJ.  Invasive fusariosis associated with an injury by a singray barb.  J Med Vet Mycol. 1990;28(3):209-13.

Interesting and Informative Reading

http://www.wideopenspaces.com/ouch-the-7-common-fishing-injuries/

http://handlinefishing.com/whatsthisfish/dangerousfishes.htm

http://handlinefishing.com/whatsthisfish/dangerousfishes.htm

http://www.merckmanuals.com/vet/exotic_and_laboratory_animals/fish/mycotic_diseases_of_fish.html
http://www.drjball.com/article6.html