BEWARE: Bad Bug for Boaters

By Tom Neale, 1/12/2006

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I’m not a doctor and I’m not giving medical advice, but I just might try to get a medical degree if more docs don’t begin picking up on a very bad thing for boaters called Mycobacterium Marinum. Not only do I not have a medical degree, I can’t even pronounce half the words these folks use every day. But I do know a little about this. (That doesn’t mean I can pronounce it.) It’s a small organism distantly related to the one which causes tuberculosis. Those of us who mess about on the water are sometimes exposed to it. Untreated it can cause serious problems, and, in my opinion, too many docs don’t seem to know enough about it—as in, to recognize it. So I hope a few will read this. If they don’t, maybe you can keep the info in the back of your head and brief your doc if you think you have the problem and the doc hasn’t heard of this.

I got this thing some years ago from a tiny little barnacle cut on a finger while I was diving the bottom of my boat. Luckily I went to a dermatologist for my annual check and he saw it and diagnosed it. He knew what it was because he sees a lot of Chesapeake Bay watermen and because he keeps up. I had to take antibiotics for 3 months and it wasn’t fun, but it sure beat the alternatives.

Someone I know got it a few months ago, in a noted waterfront city. This person went to a dermatologist and told the dermatologist what it probably was. The symptoms were classic. The advice from the patient to the doctor was accurate. But it was basically ignored by the dermatologist who gave an absurdly inappropriate prescription. This person looked it up on the www (you should do this too), printed out a lot of info, missed yet another day of work, and went back to the dermatologist who finally “GOT IT” and gave a more appropriate prescription. I just read a letter from someone else who described a really difficult time with, you guessed it, missed diagnosis. This person says he had eighteen doctor visits, an MRI, biopsies and eight months delay before a dermatologist figured out his problem.

Cut Care

1. Everybody knows that sometimes soaking an infected area in warm salt water helps. But soaking a wound in salty water from the sea may cause many very serious additional problems.

2. We actually had a nurse in the BVI tell us once to soak an open infected wound in sea water. Some don’t realize that this is not a good thing to do.

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These are but two of several instances I’ve heard of when docs didn’t recognize this thing because, I suppose, not enough of their patients hang out on the water. (But beware, you can even get it from fish tanks as when you have tropical fish. Maybe this is the approach we should take to get the medical community tuned into this problem. Some of them have fish thanks in their waiting rooms and fine homes.)

It often enters the body through a small cut or abrasion. The initial wound may seem to heal, but the organism can then produce a skin abnormality, often not evident until 2 to 3 weeks after the exposure. It often starts as a small, violet bump on the hands or lower arms usually near the initial wound. Sometimes it’s several bumps. My cut was miniscule, one I would never have worried about—just an everyday part of being underwater. My bumps were several, around one of my knuckles, and they, at first, looked a little like warts to me, although I knew they weren’t. At first there was very little discomfort. They didn’t look like a big deal, but they didn’t look right either, and they weren’t going away. They can very slowly enlarge to a non-healing sore about a quarter to one-half inch in diameter. If untreated, or not treated correctly, this organism can affect underlying structures.

A doctor friend (a very good doctor and a very good guy who also is an avid boater and has been infected with the organism) said that treatment with antibiotics that cruisers might have such as doxycycline, trimethoprim/sulfamethoxazole (Bactrim), or clarithromycin (Biaxin) can be successful, but often must be continued for at least 3 months. But he would also admonish: don’t self treat based on this. If you think you’ve got anything like this, take it to a doctor and make sure the doctor knows about this as a possible diagnosis and what to do about it. If you let it go, surgery may be necessary. It can involve joints, tendons and bones. Of course, just because you see something that looks like this doesn’t mean you’ve got Mycobacterium Marinum. The point is that you should have it checked out by a doc who’s familiar with the issues.

Since that day I take steps to protect myself from things like this. For example, I never dive my bottom without wearing a long sleeved wet suit. Some people wear a long sleeved heavy sweat shirt. I much prefer the wet suit because it’s less bulky, less likely to get entangled on something, and it doesn’t get heavy as it gets wet. I also ALWAYS wear rubber coated work gloves on both hands, or some other heavy duty type of glove, that will prevent barnacles or other sharp things from cutting my hands.

Some areas on or around your boat are more prone to give barnacle or other cuts underwater than others. A prime time for getting cuts is when you clean the prop and inside its V strut. Another is when you clean the bow thruster propeller and tunnel. I’m particularly careful when the boat is near dock pilings. It’s really easy to forget what you’re doing and kick your feet into the encrustation of barnacles on the pilings. For that reason (and others) I always wear flippers and diving boots. If you wear open flippers with straps around the heel you’re still leaving that part of your foot exposed.

If I do get a nick (it still happens no matter how careful I am) I wash it really thoroughly in clean fresh water and dump a lot of hydrogen peroxide on it, repeatedly, to try to bubble out any bad guys that may have gotten in. I haven’t a clue as to how effective this is, but it’s what I do and at least it makes me feel better. I then pay close attention to the healing process and to surrounding areas (my surrounding areas). If anything looks a little weird I take it to a doc. (OK, I know “weird” isn’t a proper medical term, but hey, I told you I’m not a doctor.)

Here are some sites that may be of interest, although I can’t endorse any of them because, yep, you guessed it, I’m no doctor.
http://emedicine.medscape.com/article/223363-overview
http://www.medicinenet.com/mycobacterium_marinum/article.htm
http://emedicine.medscape.com/article/1105126-overview

There are also other health issues that boaters are more likely to encounter than the general population, such as the potentially quite serious vibrio vulnificus. You can read about some other health related stuff with which I’ve had problems or become aware of over my many years of being wet in a recent “Soundings” issue. It’s called “The Other Side of Paradise” and it’s on page 42 of the January 2006 issue.

We who mess about on the water should remember that there are gremlins out here that aren’t as common on dry land. Because of this, some of the dry land docs may not be entirely up to speed on them. We need to keep informed and if we think we’ve got a problem that isn’t being properly diagnosed, we should speak up and try to be helpful.

 

 

 

Copyright 2004-2005 Tom Neale