Skin and soft tissue infections following marine injuries and exposures in travelers

J Travel Med. 2014 May-Jun;21(3):207-13. doi: 10.1111/jtm.12115. Epub 2014 Mar 14.

Abstract

Background: Bacterial skin and soft tissue infections (SSTIs) in travelers often follow insect bites and can present a broad spectrum of clinical manifestations ranging from impetigo to necrotizing cellulitis. Significant SSTIs can also follow marine injuries and exposures in travelers, and the etiologies are often marine bacteria.

Methods: To meet the objectives of describing the pathogen-specific presenting clinical manifestations, diagnostic and treatment strategies, and outcomes of superficial and deep invasive infections in travelers caused by commonly encountered and newly emerging marine bacterial pathogens, Internet search engines were queried with the key words as MESH terms.

Results: Travel medicine practitioners should maintain a high index of suspicion regarding potentially catastrophic, invasive bacterial infections, especially Aeromonas hydrophila, Vibrio vulnificus, Chromobacterium violaceum, and Shewanella infections, following marine injuries and exposures.

Conclusions: Travelers with well-known risk factors for the increasing severity of marine infections, including those with open wounds, suppressed immune systems, liver disease, alcoholism, hemochromatosis, hematological disease, diabetes, chronic renal disease, acquired immunodeficiency syndrome, and cancer, should be cautioned about the risks of marine infections through exposures to marine animals, seawater, the preparation of live or freshly killed seafood, and the accidental ingestion of seawater or consumption of raw or undercooked seafood, especially shellfish. With the exception of minor marine wounds demonstrating localized cellulitis or spreading erysipeloid-type reactions, most other marine infections and all Gram-negative and mycobacterial marine infections will require therapy with antibiotic combinations.

Publication types

  • Review

MeSH terms

  • Aeromonas hydrophila / isolation & purification
  • Anti-Bacterial Agents / therapeutic use*
  • Chromobacterium / isolation & purification
  • Disease Management
  • Environmental Exposure / adverse effects
  • Gram-Negative Bacterial Infections* / diagnosis
  • Gram-Negative Bacterial Infections* / drug therapy
  • Gram-Negative Bacterial Infections* / etiology
  • Gram-Negative Bacterial Infections* / microbiology
  • Humans
  • Risk Factors
  • Seawater / microbiology
  • Severity of Illness Index
  • Shewanella / isolation & purification
  • Skin Diseases, Infectious* / diagnosis
  • Skin Diseases, Infectious* / drug therapy
  • Skin Diseases, Infectious* / etiology
  • Skin Diseases, Infectious* / microbiology
  • Soft Tissue Infections* / diagnosis
  • Soft Tissue Infections* / drug therapy
  • Soft Tissue Infections* / etiology
  • Soft Tissue Infections* / microbiology
  • Travel*
  • Vibrio vulnificus / isolation & purification
  • Wounds and Injuries* / complications
  • Wounds and Injuries* / microbiology
  • Wounds and Injuries* / therapy

Substances

  • Anti-Bacterial Agents