Erysipelas on a liveaboard

[vjongene]

Last summer I was in Micronesia on the Thorfinn for a two-week cruise in the rather isolated waters between Yap and Chuuk atolls. About one week into the cruise, the Captain developed a rather nasty-looking infection on his leg, after having suffered a minor scratch while working on the ship's power plant. After it started visibly swelling and turning red and purple, he treated it with antibiotics (I do not know which ones) and brought it more or less under control. He still had to go to a local clinic on Chuuk to have a doctor look at it.

Towards the end of the same trip, my dive buddy and I both developed similar symptoms, starting from an insect bite or minor scratch. We treated them with topical antibiotics (typical OTC cream), with limited success. My infected leg started hurting quite badly one evening on shore, and one my diving friends gave me a full dose of Augmentin (amoxicillin + clavulanate), which I started taking according to recommended dosage for a full 5-day treatment. The swelling and pain subsided rapidly (by the next day). My buddy flew off the next day, and I learned later that his infection had flared up pretty badly during his flight back to Switzerland. He ended up being hospitalized for several days and treated with massive doses of antibiotics. His infection was diagnosed as erysipelas, with a Streptococcus as the infectious agent. Another guest on board developed a similar problem a couple of days later, and he suffered excruciating pain with no possibility of treatment (no one knew what to do with him during a stopover in Guam) durng his flight home. He also ended up in the hospital.

For me, there was an epilogue in that I developed an allergy to amoxicillin and had a pretty bad rash for a few days.

The question is, is this a relatively common occurrence on dive boats? Having guests and crew confined in a relatively small space for extended periods of time cannot help. And the sharing of e.g. towels, kitchenware etc could also be a factor. Any other experiences and/or medical advice would be welcome.

Victor

 

[Saturation]

If this is a true story, its a fairly serious case of being colonized by a virulent strain of Streptococcus that is living in the boat. Given the flux of divers and crew in and out of liveaboards, it very possible to carry organisms into the boat that eventually stay there, and they can come from all over the world. Its also possible the strain of Strep comes from seawater. Many healthcare workers are divers, and can be a source for organisms.

Regardless, colonization is a typical risk for public locations, and worse it they are constantly damp.

A simple solution should be to wipe the whole ship down with dilute bleach. Its also vital for divers to carry broad spectrum antibiotics to a place like Chuuk, given the medical facilities there. I typically bring 2-3 doses of Augmentin and Cipro, and treat every wound, no matter how small, with serious washing and dressing.

Bleach is available most anywhere, worse case if not, vinegar is the next best substitute but bleach is preferred. You can also spray vinigar on wounds, and take the sting, to 'cauterize' it when in doubt. I also carry 50% vinegar in a spray bottle and pretty much spray any cuts aside from ears to prevent swimmer's ear. If bleach is available I use 25% bleach, only because I can tolerate it, its still effective at even lower concentrations.

To make the solution, fill a spray bottle 1/2 full with vinegar, then the rest with water. For bleach, fil the bottle 25% full, then the rest with water. I use a palmsize handheld pump perfume vaporizer spray you can get at Walmart for $1 each; it makes a mist like spray so it covers a large surface area compared to a spritzer.

In Chuuk for example, the general store in the main resort I recall carries both bleach and vinegar.

Not to scare anyone, but worse case, Strep. can give necrotizing fasciitis, i.e., flesh eating bateria. It moves fast, and is difficult to treat in all but first world facilities [ aka Guam or better.] Having seen it move, even if you are airlifted stat by DAN it will cause considerable damage so for health issues, always prevent the event.

 

[Duke Dive Medicine]

Marv, what's the history behind that wound photo?

 

[Saturation]

Its a stock photo from Wikipedia, to avoid copyright issues. There are various cases of strep fasciitis reported in water sports by small gashes that went out of control. Appearance is similar to the photo: redness, swelling, then black splotches as tissue falls off, moving upward in the facial plane rapidly, in hour timeframes.

Flesh-eating bacteria risk rare despite Ga. student case


Aimee’s Story In Her Father’s Words | University of West Georgia Psychology – Student’s Site | University of West Georgia Psychology

Even in the above link, the lady was in the USA, yet the speed of the infection is so rapid, you can read the rest. Imagine if the same happened in a remote diving location.

 

[Wookie]

This is actually relatively common oin shrimp boats working in the Gulf of Mexico. Shrimpers are prone to getting stuck witht he horns of brown or pink shrimp while heading them. I've heard horror stories of shrimpers going offshore for 30 days and being evacuated by the Coast Guard and having amputations because of infections like these, and the story goes, once a boat has infection, it always has infection unless all of the soft coverings (mattresses, cushions, chairs with broken vinyl, etc.) is removed and sterilized. My stories are anecdotal, but I've seen shrimpers offshore with the most horrendous suppurating sores and tight red skin next to the sores.

No, most dive boats do not have this problem, because if we did, we'd never get another customer once this hit the internet. All it takes is some care of the boat, wiping down all surfaces multiple times per day with chlorox wipes, etc., and making sure that the bedding is sterilized between trips. I'm glad I'm not trying to run a boat in Chuuk.

 

[TSandM]

I've seen streptococcal fasciitis first-hand, and it's unbelievable how fast it moves.

It would be a big job to wash down the whole boat with bleach, but it's what they ought to do.

 

[vjongene]

If this is a true story, its a fairly serious case of being colonized by a virulent strain of Streptococcus that is living in the boat. Given the flux of divers and crew in and out of liveaboards, it very possible to carry organisms into the boat that eventually stay there, and they can come from all over the world. Its also possible the strain of Strep comes from seawater. Many healthcare workers are divers, and can be a source for organisms.

This is a true story alright. There were a couple more guests whom I did not mention who came down with milder infections. As a general comment the ship is quite old and much larger than your average liveaboard, so keeping it germ-free would obviously be a difficult proposition. There were also some practices such as rinsing out after-dive towels and drying them in the machine room (oh the delicious fragrance of oil wastes after a strenuous dive!) that I am sure did not help. We will never know the origin of the strep, there were two German MDs on the ship who may have carried it. The Captain was definitely the first one affected.

 

[DandyDon]

Got to wonder if the boat treats it potable water or not, if that's what was used for washing & cleaning, as well as its source...?

 

[Saturation]

Its hard to wipe entire boats down, but a captain and crew's should consider they are most as risk since they are on the boat longer than their guests. For guests, I'd just recommend you wipe down your rooms yourselves just in case, and spray any wounds you get with vinegar. The Odyssey had a spritzer of vinegar mostly for sea lice or jelly fish stings, but that would do too so one can do this after every dive. You don't have to travel with vinegar or bleach, just buy it at your destination. A wise ship should also consider a bleach wipe down for all general shipboard cleanliness.

Vinegar - Wikipedia, the free encyclopedia

Lastly, if you have a snack of pork rinds or sushi, you have vinegar at the ready, another reason to use strong % compared to just disinfectant strength.

 

[Wookie]

The Captain was definitely the first one affected.

...on that trip that you were on. I can easily see the Staph living on the boat for a very long time, years even and only showing up when someone has an open wound.