Staph infections from surfing / diving?

[bluesbro1982]

Hey all:

I'm young and healthy, but I was wondering if anyone has caught anything from our "crystal clear' waters and if I should be worried about this. The following article appeared in Corky Carroll's surfing column in the OC register (yeah yeah, fascist paper I know...) and I was wondering if anyone had any thoughts on if this is strictly a surfer thing or if diving would put you more at risk with consant water contact, especially if you have a recent cut / scrape / whatever.

http://www.ocregister.com/ocregister/news/columns/article_1537000.php

**Article Text Follows**

Staph infection emerging as serious surfer ailment
CORKY CARROLL
CORKY CARROLL
Register columnist
SURF'S UP
corkysurf@aol.com

Last week I presented some information on an ear problem that many surfers have commonly called "surfer's ear" – something that has come into my life many times.

It frequently takes surgery to take care of this problem, and I have had it done five times. The doctor who finally got mine under control is Dr. Carol Jackson of Newport Beach.

I asked her to write about it for my column, and last week she shared her thoughts on this problem. This week I am continuing with what she wrote for me, this time about staph infections that are turning up more and more among surfers everywhere, but especially those here in the Orange County area.

Here is what she has to say.

"A new development in the past year has been the rise in a certain potentially serious staph. ... MRSA, for methicillin-resistant Staphylococcus aureus, is on the rise in the community, and possibly in the Southern California surf, especially off Huntington Beach. When recognized and treated early, it's not serious.

"The problem is that it is resistant to most antibiotics, with a couple of oral (pill) exceptions (sulfa-trimethoprim and sometimes rifampin and/or clindamycin). It can require IV treatment by potentially toxic antibiotics including vancoymycin and some other newer, more experimental drugs. It can spread to other organ systems and lead to septic (infectious) shock, stroke and loss of cardiac, kidney and other functions.

"Perhaps you're familiar with the case of Timmy Turner, which was in Surfer magazine. His story and some video of him are on the Web. He was treated at Hoag. It's still unclear, and there's little firm data on it, but it looks like soft tissue wounds and fresh tattoos in ocean waters can be a source of entry for getting the infection.

"There's a scientist at UCI who has been gathering data, and I've known two other surfers with it – one after exostoses removal. Unfortunately the waters are monitored for fecal contaminants (coliforms) but not tested for staph.

"There is a carrier state in which a person has this staph in their nasal and/or sinus passages, which can flare up. Soooooo, now before surgery I take a nasal swab for culture and sensitivity studies.

"If it's positive, it's straightforward to get rid of with Bactroban cream applied inside the nose for 10 days, and/or by 10 days of oral antibiotics to which the culture shows sensitivity.

"My own thought is that some surfers have acquired it, and due to good general health either don't have much or ... are carriers with no symptoms.

"A word of caution to Southern California surfers: Don't ignore severe headaches even if they clear up, and fevers even if they're under 100 degrees F, nausea, loss of energy or drainage from the nose or ear that has a foul odor, or color such as yellow, brown or green!

"Get checked by nasal culture and CAT scans. For soft tissue lesions that enlarge, become red and sore like boils, it could be MRSA. Get them checked and cultured. Play it safe and stay out of the surf if you have any sores, cuts, lesions, fresh tattoos or recent surgical incisions."

Wow, that scares me. Especially after what happened to Timmy Turner. Timmy is one of our best young surfers here in Orange County, and he almost died from this very kind of thing.

It was touch and go for a long time, and it had everybody who knows him saying prayers and holding their breath.

This is not something to take lightly or joke about. It is becoming a serious concern for all of us who surf on a daily basis as well as for everyone who enters the ocean along our shores.

Don't mess around with this. If you get any kind of symptoms, get help as fast as possible.

Contact the writer: Check out Corky's "Ask the Expert" feature at www.ocregister.com/sports/surfing/. The three-time international and five-time U.S. surfing champion also writes in Thursday's Huntington Beach Wave. E-mail him at corkysurf@aol.com.

 

[TSandM]

MRSA is becoming scarier and scarier. We are now being advised to culture all simple skin abscesses in healthy, normal patients, because of the rapidly increasing incidence of MRSA. This bug, unlike many multiply resistant bacteria, seems to have increased virulence and tends to cause an invasive and nasty infection. Unfortunately, the antibiotics most of us choose for initial treatment for skin and soft tissue infections are ineffective against it, and one simple antibiotic that DOES tend to be effective is so rarely useful against other things that we don't tend to prescribe it.

I think all of us docs are going to find ourselves doing cultures (which are expensive) on more and more "routine" infections because of this bug.

 

[Bob3]

Surfers needing hazmat suits, I guess it was only a matter of time. :shakehead

 

[60FT NDR]

Here is a thought from someone raised by a military medical corp father who was always talking about staff infections. Talk this info or leave it.

Divers are under the surface, for the most part, in 7/5mm or better suits. We are almost fully protected from head to toe and we don't usually go in the water after a rain.

Surfers are on top of the water all the time (for HOURS at a time), unless they wipe out, in 5/3mm shorties at best and often just shorts. They don't care if there is any vis so they don't know what's in the water.

Dad says, "stay out of the water, like doc tells you, when you get a tattoo or stitches"
"Watch for sewage spills and high bacteria levels, rain run-off, etc and stay healthy."

I am not saying that we divers can't get it. Even I have cut myself underwater and continued the dive. But think about it, in my opinion, surfers just don't care about what they can't see.
Ruth

 

[Archangel]

MRSA is becoming scarier and scarier. We are now being advised to culture all simple skin abscesses in healthy, normal patients, because of the rapidly increasing incidence of MRSA. .

Our beloved Med Mod is talking about Methicillin Resistant Staph Aureus. Nasty nasty bug!

Staph Aureus I remember from medical school is resident on our skin and in our pharynx.

What causes swimmers/surfers ear is pseudomonas aeruginosa. Very unlikely we would run into MRSA or SA or strep bugs at 75 fsw, that is unless we are finning past a storm drain. . .

Have I missed something?

T

 

[Empty V]

Being a surfer of a measly 10 years, my group of 20 some-odd surf buddies and I, ranging from Santa Cruz to Baja, had a strict agreement with our mother earth. If we abide, she will share her beautiful ocean with us. When she is sick, we make sure not to agitate her.

Believe it or not there are some intelligent surfers out there. Right Mr. Guerin?


#1 always make sure your immunization chart is up to date.
#2 Try (sometimes it's impossible) to avoid surfing near drainage pipes and known runoff areas regardless of the weather.
#3 Never surf any sooner than 3 days after the rain has stopped

For clarification, 11 months out of the year we wear full 3.2mm wetsuits and sometimes booties. I've been cut, bruised and battered from surfing and can honestly say that I have never fallen ill from the ocean that we have been granted access to.

My 1/2 a cent.

Billy

 

[redrover]

MRSA is becoming scarier and scarier. We are now being advised to culture all simple skin abscesses in healthy, normal patients, because of the rapidly increasing incidence of MRSA. This bug, unlike many multiply resistant bacteria, seems to have increased virulence and tends to cause an invasive and nasty infection. Unfortunately, the antibiotics most of us choose for initial treatment for skin and soft tissue infections are ineffective against it, and one simple antibiotic that DOES tend to be effective is so rarely useful against other things that we don't tend to prescribe it.

I think all of us docs are going to find ourselves doing cultures (which are expensive) on more and more "routine" infections because of this bug.

Lynn,
I had to learn about MRSA the hard way (Mom in nursing home) and found it difficult to get much info. I was taught; be concerned about staph here, always wash cuts and abrasions thoroughly with simple soap and water. Do you think soap and water works with the MRSA as it does with the routine staph threat here in the tropics?

 

[TSandM]

Soap and water are almost always the first and probably most effective measures against bacterial infection in general. Staph can't get through intact skin; it requires a break in that barrier. If you have staph on your surface and wash well, you may very well get rid of it before it gets access to any microinjuries you have available as portals of entry.

Archangel, the original post was about MRSA in surfers. I agree that P. aeruginosa is the most common pathogen in external otitis, but that's not what the article was about.

 

[60FT NDR]

Ok, Sorry for statement that surfers don't care. That was a general statement that I really should have worded a little better!!!

Sorry Billy. My foot just entered my mouth.
Ruth

 

[ICY ICE]

Interesting articles....boils, headaches, nausea, ear/nose discharge could be caused by this bug (CDC Link)

6 divers tested:

An outbreak of Methicillin-resistant Staphylococcus aureus cutaneous infection in a saturation diving facility.
Wang J, Barth S, Richardson M, Corson K, Mader J.


Division of Hyperbaric Medicine and Wound Care, Department of Orthopaedics and Rehabilitation, University of Texas Medical Branch, USA.
We present a molecular epidemiological investigation of an outbreak of cutaneous tissue infection, which involved six divers during a 45 day saturation exposure dive. The cutaneous infection manifested as boils, foliculitis and small abscesses involving different body sites, including nose, external ear canal, necks, back, extremities, and buttocks. Staphylococcus aureus was consistently isolated from the skin lesions of affected divers. A study of the antibiogram revealed that all Staphylococcus aureus isolates were uniformly resistant to penicillin, oxacillin and erythromycin, but sensitive to clindamycin, tetracycline, trimethoprim-sulfamethoxazole, rifampin and vancomycin. Molecular typing by pulse field gel electrophoresis (PFGE) demonstrated that all the Methicillin-resistant Staphylococcus aureus (MRSA) isolates had an indistinguishable pulsed field gel electrophoresis pattern. The source of outbreak was identified as a colonized diver (diver D). Personal contact was most likely the mode of transmission among the six divers. Infection with MRSA should be suspected in outbreaks of boils that are not responding to standard antibiotic therapy among healthy divers and their close contacts. To our knowledge, this is the first report of Methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a saturation diving facility.
PMID: 14756230 [PubMed - indexed for MEDLINE]


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