Soft tissue infections following water exposure
- Larry M Baddour, MD, FIDSA
Larry M Baddour, MD, FIDSA
- Professor of Medicine
- Mayo Clinic College of Medicine
Soft tissue infections can occur after both freshwater and saltwater exposure, particularly if there is associated trauma. Trauma can be caused by living creatures or by inanimate objects found in the aquatic environment. In addition, some aquatic creatures can transmit soft tissue infections outside the water environment. This can occur, for example, with the use of leeches for medicinal purposes to relieve venous congestion at surgical sites, as Aeromonas spp, a normal inhabitant of the foregut of leeches, may contaminate the wound and cause a secondary wound infection .
Although the array of microorganisms that can produce soft tissue infections following water exposure is extremely large, this discussion will focus on five bacteria that most commonly produce soft tissue infections in association with exposure to water or water-related animals. These include Aeromonas species, Edwardsiella tarda, Erysipelothrix rhusiopathiae, Vibrio vulnificus, and Mycobacterium marinum. The acronym AEEVM will be used here when referring to these organisms.
The epidemiology, clinical manifestations, diagnosis, and empiric treatment of AEEVM infections and specific treatment of Edwardsiella spp and M. marinum infections will be reviewed here. Treatment of Aeromonas spp, Erysipelothrix spp, and V. vulnificus infections is presented separately. (See "Aeromonas infections" and "Vibrio vulnificus infections" and "Erysipelothrix infection".)
Local trauma or injury, which can be either minor or major, coupled with water exposure is a common theme that predisposes to many of the AEEVM-related infections.
Trauma — Trauma leading to infection with AEEVM includes puncture wounds due to fishhooks and fish spines and lacerations due to boat motor propeller blades and a variety of other inanimate objects present in areas of wading and swimming. In addition to trauma by accidental puncture, bites from fish, alligators, crocodiles, sharks, and turtles can transmit AEEVM infections [2-4].
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- Water exposure
- Gender predominance
- Underlying diseases
- CLINICAL MANIFESTATIONS
- Differential diagnosis
- When to hospitalize
- Empiric antibiotic treatment
- Directed antibiotic therapy
- - Aeromonas
- - Edwardsiella tarda
- - Erysipelothrix rhusiopathiae
- - Vibrio vulnificus
- - Mycobacterium marinum
- Duration of treatment
- SUMMARY AND RECOMMENDATIONS