The following article was submitted by Alan Coulson, M.D., a panel physician at the Sandhills Center for Wound Healing and Hyperbaric Medicine in Hamlet. A vascular surgeon, he is board certified in hyperbaric medicine and a certified wound care specialist.
A patient of the Sandhills Center for Wound Healing and Hyperbaric Medicine asked me recently about swimming with an active wound. This reminded me of two things: Memorial Day marks the beginning of the barbeque and swimming season; and the mnemonic MAREVE because exposure to water other than clean drinking water can be very harmful to patients with wounds.
One of the areas of study when taking the Board Examination for Hyperbaric Medicine is the bacteria in water that can hurt patients. What may come as a surprise to some people is that water can be a source of deadly infection, sea water and pond water in particular.
The received wisdom is that bathing in salty water would be good for wounds, rather like the spa at Lourdes; but in fact nothing could be further from the truth.
MAREVE is an acronym for the names of deadly bacteria, which in some cases are worse than MRSA. They are: Mycobacterium marinum, AeRomonas species, Erysipelothrix rhusiopathiae, Vibrio vulnificus, and Edwardsiells tarda.
By raising awareness of these infections, we can hopefully avoid the tragedy that befell Aimee Copeland, a 24-year old Georgia woman whose medical condition was being described on Facebook by her father as she progressively lost limbs to infection with flesh-eating bacteria found in water.
She fell from a zip line into the Little Tallapoosa River and suffered a deep cut in her leg. In her case, the infection was caused by Aeromonas hydrophila.
Once the bacteria have entered the body through an old wound or a fresh injury, a battle follows between the white cells of the body and the invading bacteria.
Diabetes, cancer, liver disease and steroid use weaken a person’s immunity and make them more susceptible to infection. When it has progressed to the flesh-eating stage, emergency surgery is required.
More on these deadly bacteria:
• Mycobacterium is found in swimming pools, aquaria and in sea water. It is slow growing so it takes about six weeks from the time of exposure to the development of painful nodules on the elbows and hands, which then break down to form ulcers.
• Aeromonas species cause about half of the serious infections. They are found in fresh water lakes and rivers. The trauma is caused by stepping on something sharp while wading or by cutting one’s hand with a fish hook. They are more numerous in warmer months and the bacteria can cause cellulitis, a spreading redness of the skin that can progress to flesh-eating necrotizing fasciitis or gas gangrene. Interestingly, the first published outbreak was in 2004 among players in a game of mud football in Australia. In Copeland’s case, the same infection almost killed her.
• Erysipelothrix infection is also called fish handler’s disease because it affects seafood packers and often starts in the fingers. Pain starts about three days after exposure. Soft tissue infection can spread to cause heart valve infection.
• Vibrio vulnificus lives in the sea water on the East Coast of the United States. It invades the body through a wound and the hallmark is the abrupt deterioration of the patient. It usually affects men and the legs. Within one or two days, the aggressive bacteria produce cellulitis, ulcers and flesh-eating symptoms. Fevers and chills may progress to septic shock and death in 50 percent of cases.
Besides the experience of a wound care specialist, the other important requisite is a clinical laboratory with skills in handling specimens to get accurate diagnosis and antibiotic sensitivities.
We are lucky to have Dr. Dell Dembosky, pathologist, and the Sandhills Regional Medical Center Laboratory. They have done a fantastic job with the hundreds of specimens we have sent them. Two years ago, the hospital laboratory identified two rare fungus infections for us in Wound Care Center patients.
Bottom line is if you have an open wound: Keep it away from unclean water; even the aquarium in the home can infect cut fingers. If you develop redness, swelling, or pain in a wound exposed to water, please don’t wait. Seek medical attention.
About the Wound Care Center:
The Sandhills Center for Wound Healing and Hyperbaric Medicine is located at 108 Endo Lane, Suite 2, in Hamlet. It offers advance treatment for hard-to-heal wounds and houses two hyperbaric chambers. It is owned by Sandhills Regional Medical Center and managed by Healogics, formerly Diversified Clinical Services. For more information, call the center at 910-205-1525. Self-referrals accepted.