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FAQs about Pet-fishing & Human Health: Bacterial Infections 

Related Articles: Wounds ArticlesMoray Eels Bite, But Are They Venomous? by Marco Lichtenberger,

Related FAQs:  Petfishing and Human Health 1Petfish & Health 2, Petfishing & Human Health 3, & FAQs on: Petfishing Concerns: Getting Poked, Spined, Stuck, Envenomized (injected), Bitten, Poisoning (ingesting), Skin et al. Contact, Companion Animal Involvement, Troubleshooting/Fixing, Parasitic Cross Zoonoses, Turn About's Fair Play... Stingrays

Three New MASNA Education Pages
The Marine Zoonotic Disease article (
http://masna.org/masna-education/zoonotic-diseases/
The Zoanthids and Palytoxin article (
http://masna.org/masna-education/palytoxin/
The Impacts of Releasing Marine Ornamental Species article (
http://masna.org/masna-education/release-invasion/

Very Worried...Small Granuloma(looking)On Left Finger     8/10/14
Greetings Crew, I'm a little concerned about 3 days ago a small red patch showed on my left pointer finger, below second knuckle. Initially it filled with very little pus(sorry for details here) and ruptured in 24hrs. It now looks like a red scaly patch about a 1/4in. No pain, although it is draining ever so slightly.
Coincidently, I had been researching wound management on WetWebMedia a few weeks ago and came across articles on Mycobacteria. Seeing the similarities, I immediately made appointment with my doctor. I made appointment for possible mycobac. infection. My doctor looked at my sore and said it is so small, barely looks infected and with very little drainage to culture,
don't worry unless it gets worse. I informed her I'm a at risk group. I'm a part time fish breeder(47 aquariums and 6 aqua. res.(8000g), part time open ocean kayak guide, very part time scuba instruct.etc., with lots of freshwater and saltwater contact. I occasionally receive fish from large fish farms in Asia and local pet stores(even more questionable in my area IMO). After a lot of convincing she decided to put me on antibiotics. At this point she hasn't researched Mycobac. mar. I happened to noticed on her sheet, she has spelt Mycobacteria, microbacteria. I ask if she can research Mycobac. mar please, so I can get on the right antibiotics. She responds. I'm not going to research something I haven't cultured.
<?... RMF>
I respond by saying, I heard this doesn't culture well and may take 4 weeks. She admits she has never heard of Mycobac. mar. and does research,( right in front of me). So I end up leaving with a combination antibiotics specifically geared toward Myco. mar. To be honest, now that I'm home, I'm having second thoughts on taking meds.
This thing is so small, I feel good, no swelling, no swollen lymps., I hate to take a combination of antibiotics, if I don't have to. I have a follow up appt. with my doctor in 3 days. She did attempt to culture sore. If it weren't for my insistence, I wouldn't have left with antibiotics. I'm not looking for medical advise in anyway, but perhaps if anyone has had similar experience, please chime in. Everything I've found online shows much more advanced cases, but they look similar. Thanks for any help if possible.
Aloha Brandon
<Hello Brandon. This is absolutely (probably legally) something we cannot advise on, and doing so would surely be a bad thing to do. Mycobacterium infections (also known as Mycobacteriosis) from fish rarely cause long term problems for humans, but occasionally they do cause health issues beyond the skin rash, very rarely serious/fatal ones if the person is immunocompromised. Talk with your doctor, and if necessary, they'll recommend treatment or further tests. You are right to consider the
possibility of Mycobacteria infections coming from aquaria, but at the same time, such infections are very rare, and without microscopic analysis of the infected tissue, you cannot diagnose them anyway. All sorts of bacteria
can get into scratches on the skin, and once there, spark an opportunistic infection of some kind. As aquarists we often fixate on the notorious disease we call "Fish TB" because of its scary name, but in practise there are all sorts of possible bacterial infections you can get from fish tanks (as well as herptile vivaria) including such favourites as Salmonella infections (which cause stomach upsets). And while Mycobacterium fortuitum and Mycobacterium marinum, among others, have been reported from aquaria, there aren't any quick treatments, a notorious problem with Mycobacterium spp generally. Antibiotics such as Minocycline and Rifampin are used across multiple months. Your general practitioner should be able to give you much
more depth on this, and if he/she can't, then discussions with an expert on zoonotic infections would be helpful. Cheers, Neale ("the wrong sort of Dr to be helpful here!").>

Steven pro; Mycobacterial involvement     7/15/14
Hi
<Mick>
My name is Mick Virgo, I am from South Australia
<Salud>
I was hoping to contact Steven Pro in regard to his article Mycobacterium Marinum which I found while Googling for information on this disease
<Will bcc him here>
My 20 year old Daughter contracted the disease 3 1/2 years ago working in a aquarium shop cleaning a quarantine tank and was punctured on the hand buy a catfish spine. She was initially treated with Clarithronycin as well as Ethambutol and has been suffering from the arthritis type symptoms he talks about for about 2 years.
<Yikes... I've encountered these infections over the years; am the person who shot the photo on Steve's hand...>
We have seen several specialist but none have been able to help her and I doubt they believe her when she tries to explain the symptoms and the origins
<And another PA friend of Steve's, Don.... I would ask your doctor to confer w/ American staff in the same field>
The reason for contacting Steve would be to ask if he knows anybody that might be able to help us, or shed some light on what direction to go from here as he describes to a tee what she is suffering at the moment. Would you possibly be able to pass this on to Steve
<Yes I will>
Thanks
Mick
<Welcome. Bob Fenner>

Important Question: Concern with autoinfection from hands in tanks        6/23/14
emailing you today because I have some concerns. I have no experience with saltwater or freshwater aquariums but have recently secured a position at a leading retail store selling many tropical fish, live rock,
corals, venomous fish and so on. I was unaware of some of the dangers upon taking the position.
<Mmm>
This is where the situation is unique. I know that I have no reason to panic, but instead to use caution and arm myself with knowledge so I can take steps to prevent accidents while cleaning the tanks etc but I have a nail-biting disorder. It's called Onychophagia. Most people find this revolting and something that you should just stop doing. But I simply can't. It is an obsessive compulsive behaviour that I have very, very little control over.
<Well; then I would definitely get/use gloves if you're going to have your hands in the water. More important and likely than trouble from livestock itself; all biological waters, including aquariums, have large mixes of microbial life... some of which you don't want to ingest. Akin to Coliform bacteria, Enterobius worms... from autoinfection, you want to thoroughly wash your hands after having them in the tanks>
I'm aware while at work to be washing and rinsing thoroughly and often but what I'm really worried about is the open wounds around my fingernails.
<You should be. I take it you're seen here on WWM: http://wetwebmedia.com/Wound.htm
the linked files above>

If I am to clean 4-8 30gallon tanks per day, amongst other tasks (handling and cleaning protein filters etc) am I especially at risk for contracting diseases?
<To some extent, yes... again, the elbow length gloves are the route I would go>
My worry is that when dealing with things that are microscopic, I can't be sure that I have cleaned my hands thoroughly enough and I can't stop myself from biting once I'm done work.
Should I be anxious about this?
<Yes>
I feel anxious. I would rather be safe and broke than have money and be sick. Thank you so much!! I look forward to hearing your answer.
<I had "the habit" of biting my nails and cuticles when I was younger... and sis still does. I would seek out the help of a dermatologist and their aid in turn in "conditioning" help to rid you of this compulsion.
Bob
Fenner>

Article: True, False or Mostly Hype, Disease from trop. fish   1/18/13
Hi Bob, Neale and Crewmembers,
<Hello!>
Best wishes to you all and thanks as always for all of your hard work and dedication. The aquarium community is indebted to all of you and I maintain that you cannot be thanked enough for your volunteer services.
<Thanks for the kind words.>
I have a short article I'd like you to check out at your leisure, which was written on a mostly gossip-type site with sometimes questionable information. A co-worker stumbled upon it and sent me the link:
http://www.dailymail.co.uk/sciencetech/article-2263812/Tropical-fish-diseases-passed-humans-Humans-risk-impetigo-pneumonia-diseases-drug-resistant-tropical-fish.html
<Ah yes, the Daily Mail newspaper. No scare story left untouched!>
My response was that I was always under the impression that fish (as pets) to human diseases for the most part are extraordinarily rare
<Thus far, yes.>
and vice versa but that I'd like to get the experts opinion from you guys...and yes, you guys are experts.
<Perhaps not as microbiologists though… or medics.>
Please don't try to deny it! Thanks as always for answering my question/giving your opinion and I hope you all have a wonderful day!
Nicholas
<Bottom line is that there's always been a risk of contracting things like Salmonella from aquaria and vivarium. Anywhere warm, damp and laden with decaying food can culture such bacteria. But what this article is about is scientists finding antibiotic resistance in fish. That doesn't necessarily put humans at risk, though it may mean that treating sick fish *with antibiotics* could be more difficult. Since antibiotics aren't used in the UK without a prescription, this is not a big deal; but in the US, where many aquarists use antibiotics (such as Maracyn) before using non-antibiotic medications, antibiotic resistance may become a major problem. The bigger picture so far as human health goes depends on whether humans could catch these antibiotic resistant bacteria. That's certainly an issue to think about, but the bacteria in fish rarely affect humans, so even if these bacteria are ten times as dangerous as before, they're still not very dangerous in real terms (going from a 0.001% risk to a 0.01% risk is a ten-fold change, but overall the risk stays small). I'm not a medic, but I wouldn't be any more scared of my fish tank than I am of handling raw meat, cleaning out the cat litter tray, or working soil in my garden. All these things expose me to bacteria, but if I'm sensible and don't do obviously stupid things (like, say, swallowing a sick Goldfish or injecting myself with muck from the filter ) then I can't see how this is a big deal at all. A wise doctor once said that the secret of health is 50% keeping clean and 50% getting dirty. In other words, you have to avoid germs of course but you also need to get exposed to them as well, so your immune system can develop. I'd guess that if you're healthy, interacting with animals, including fish, helps to develop your immune system. Cheers, Neale.>
Re: Article: True, False or Mostly Hype  1/18/13

Thanks Neale! As always your explanation seems absolutely reasonable to me.
<Always good to talk, Nick. Cheers, Neale.>

Question, Human/aquarist bacterial infections   5/3/11
Steve or other,
<BobF here>
I saw and heard your lecture in Orlando at MACNA and Steve discussed fragging coral with gloves on to prevent getting a bacteria or infection in the persons body. I can not remember the name of the bacteria or
infection.
<Mycobacteriosis mainly>
Could someone help me with this. I am pretty sure I have it in my hand and I need to know how to treat it.
<Mmm, see WWM, http://wetwebmedia.com/Wound.htm
and the linked files above, and importantly, a dermatologist, specialist re>
--
Thank you,
Regan White
<Welcome. Bob Fenner>

Blood in tank -- 09/09/10
Dear Mr. Brenner,,
<Close enough>
I have talked to you in the past regarding my goldfish Larry. Larry had a bulge on his right side that would enlarge anytime he had difficulty passing his stools. Through photos you considered that this may have been cause from a congenital defect.
<Possibly>
Sadly Larry passed away within the last half hour. When removing him from the 55 gallon tank his anus hemorrhaged and blood pooled into the tank. I do not know how much water to change the one remaining goldfish and algae eater in the tank.
<Mmm, maybe half>
Larry had an appointment to go to the fish vet next week to rule out tuberculosis. What do you recommend?
<That you wash your hands thoroughly (as usual) after they've been in the tank... not place them there if/when you have open wounds. Otherwise, enjoy, appreciate the life around you. Bob Fenner>
Thank you for all your help,
Susan

Sick Goldfish ... RMF's go    7/28/06 I would like to ask you a question about my goldfish. She is losing her orange color, having difficulty getting up to the surface of the water, and when she does make it up (with great effort) she gulps air and then descends again.   She spends most of her time just laying on the bottom of the tank, and she is listing to one side. <All bad signs> While searching the Web for answers I read about fish tuberculosis.  My fish seems to have many of the symptoms. This concerns me (because I don't know if it is or isn't, and I don't know what to do for the fish) and also because it said that this disease is transferable to humans.   <Yes> While I washed my hands afterwards, I did clean out the tank by hand, stirring   up the gravel, washing off the rock, etc. <Unless there are breaks in your skin...> My cat also drank from the fish tank  while I was transferring the fish to a bowl.  Should I be concerned about  the possibility of TB, how could I know for sure if this is what my fish has, and what can be done for the fish? <Not able to tell from here... however Mycobacterial transference is not likely> If it is not TB, then I thought it  could be a swim bladder problem (my fish does have trouble with constipation),  but why is she losing her color? <Could be several influences> Thank you for listening to my question.  Any help you could give me is most appreciated. <Have you read here: http://wetwebmedia.com/FWSubWebIndex/gldfshdisease.htm and the linked files above? BobF>

Sick Goldfish ... Tom's much better go   7/28/06 <<Greetings. Tom here today.>> I would like to ask you a question about my goldfish. <<Fire away.>> She is losing her orange color, having difficulty getting up to the surface of the water, and when she does make it up (with great effort) she gulps air and then descends again. She spends most of her time just laying on the bottom of the tank, and she is listing to one side.   <<Not good, certainly, but having "peeked" at the remainder of your post, I've noticed that you haven't included any of the very important information that would be useful here. What "type" of Goldfish, tank size, type of filtration, water parameters (critical!), diet, etc. From our perspective, it's like asking us why you just sneezed. A cold? Hay fever? Allergies? Someone tickled your nose with a feather? Sounds a bit silly but I think you see what I mean. Fish can display very similar symptoms from a wide variety of causes.>> While searching the Web for answers I read about fish tuberculosis.  My fish seems to have many of the symptoms. This concerns me  (because I don't know if it is or, isn't, and I don't know what to do for the fish) and also because it said that this disease is transferable to humans. <<Possible? Yes. Likely? No. I understand your concern but I would suggest that it's not warranted. What you've described thus far could simply be due to your pet being in too small of an aquarium or living in water conditions that are sub-par. At this point, I really don't know.>> While I washed my hands afterwards, I did clean out the tank by hand, stirring up the gravel, washing off the rock, etc. My cat also drank from the fish tank while I was transferring the fish to a bowl.  Should I be concerned about the possibility of TB, how could I know for sure if this is what my fish has TB, and what can be done for the fish?   <<I think you should be "aware", as we all should be. Concerned? No. To know for certain would require a laboratory and a pathologist. A couple of indicators would be a sunken stomach or detention (sinking) along the back of the fish. Protruded eyes, loss of scales, lesions on the body of the fish would also be indicative but not definitive. As for what can be done for the fish in the case of TB, there are some treatments that would likely be out of the realm of the typical hobbyist. In all likelihood, the animal couldn't be treated effectively.>> If it is not TB, then I thought it could be a swim bladder problem (my fish does have trouble with constipation), but why is she losing her color?   <<Here, we go back to my earlier comments. Goldfish, regardless of their opportunistic feeding habits, require lots of vegetation in their diets. They don't process proteins well and become "compacted" when fed a diet that is too high in these. Much information on our site about the appropriate diet for Goldfish as well as the environment that they require to thrive.>> Thank you for listening to my question. <<Not a problem at all.>>   Any help you could give me is most appreciated. <<If you wouldn't mind, I'd like you to give me your name when you post again. Tom>>

Re: Sick Goldfish   7/28/06 Thank you for your reply, Tom. <<Good to talk to you again, Debra.>> I do not know the technical name for  the Goldfish--she is orange in color, having a regular, slim, not a "fancy"  body type, with a black dot on her tail (which has always been  there).   <<What you have is either a Common Goldfish or a Comet Goldfish. Both are very similar with the Comet staying a bit slimmer than the Common as it matures. Both can attain 12"-14" in length at adulthood. (Can't blame you if you just did a "double-take".)>> She is now about 2.5 inches long from mouth to tail tip. She is in a two gallon tank. <<Way too small but I'll get back to this as we go on.>> It used to have an air stone, but I put a charcoal and "sponge type" filter in the tank when I found out that it would do a better job of filtering out the ammonia in the tank.   <<Good...with a proviso. While the airstone will do nothing for the ammonia, it does agitate the surface water of the tank and helps in oxygen exchange. This is where your Goldfish is getting its air to breathe. The larger the surface area, the more oxygen that enters the tank. The fact that she's gulping air indicates that she isn't getting enough oxygen from the water. (Small piece of "trivia": A fish's gills are much more efficient in extracting oxygen from water than our lungs are in extracting it from the air. We can "afford" this inefficiency because oxygen is so plentiful in our environment compared to a fish's. I add this for emphasis as well as a bit of extra information.) Side note: activated carbon is effective for no more than 3-4 weeks.>> I changed 80% of her water about every 1-2 weeks, with periodic full tank water changes. When she got sick, I did  a full tank change and rinsed her rock, gravel, sides of the tank, and plastic ornamental plants as I do periodically. <<When ammonia/nitrites are an issue, this amount is likely appropriate but, for now, I'd prefer to see you change out 15%-20% once a week. This presupposes that your ammonia/nitrite levels are at 0 and nitrates are below 20. A fish store can test a sample of your water for you if you don't have a test kit...which I would highly recommend getting.>> Previously, I was using regular filtered tap water for the water changes with several drops of "stress coat" to condition the water, but when she got sick, and I consulted a pet shop, they recommended that I use bottled water, which I did (I still added a couple of drops of Stress Coat, too). <<Neither "filtered" tap water nor bottled water are the best choices here. Filtering water removes elements that fish need, so-called "trace elements" though major and minor elements would be involved, as well. We almost always recommend that you acclimate your fish to whatever source of water you have at the tap - without filtering. Adding a good quality dechlorinator - one that eliminates chlorine and chloramine - is all you need to do. (Chloramine is a combination of chlorine and ammonia, used in increasing numbers of areas because chlorine alone dissipates so quickly. Chloramine does not. Stress Coat TM) only removes chlorine, by the way. If your source of water is treated with chloramine, you'd be introducing ammonia to the tank.>> I called my cat's Vet but was told that they don't see fish. <<About what you'd expect from a "cat doctor". :)>> They gave me the number for a fish Vet at U of P. I left several messages, but no one called back yet. I was told the Dr. was only in intermittently--so I turned to the Internet, and your postings for help.   <<Along with your commitment to your pet, we might just get this turned around.>> My Goldfish was very healthy prior to last week (except for the chronic constipation--I did try the peas in the past, but it seemed to only help a little-). She is still hanging on at the bottom of the tank, but is staying in one spot and if I put food in, she will  struggle to rise to the surface, but she mainly gulps a lot of air when she is  up there.   I don't know the chemical status of the water, but I just changed it all with the bottled water, so I don't think there is an ammonia   build up.   <<Goldfish excrete ammonia through their gills just like we exhale CO2. Regardless of the lack of fish waste/detritus in the tank, ammonia is going into the water. Back to what I mentioned about aquarium size now, your Goldfish needs to be in, at least, a 30-gallon tank. Commons and Comets are generally considered to be "pond fish" because of their adult sizes. Unless kept in a sufficiently large indoor tank, you'll ultimately run into one problem after another. Growth will be slowed/stunted leading to health problems like bone disease. Most importantly, despite your best efforts, a two-gallon tank can't dilute the toxins in the water adequately to provide a  high-quality environment for your fish. Any measurable amount of ammonia in the tank will cause the gill membranes to swell/thicken (basically being chemically burned) to the point that your fish will start to suffocate. The "immediate" thing to do now is put the airstone back into the tank and turn that "bad boy" up high! And, start making plans to get a much larger aquarium...>> She is very pale. When she is at the bottom, she lists to one side a bit. She does not look particularly emaciated, though. In fact, she looks fat like she is still constipated--and there are no visible lumps, bumps,   discolorations or spots (other than the one that she was born with), her eyes are not abnormal. She definitely has some sort of equilibrium issue, but she doesn't really fit nicely into any one disease category.   <<All typical of water quality issues with the possible exception of the constipation.>> When I first got her, I fed her the small pellet type food. When even the small pellets looked too large and hard (I would crush them a bit) I tried the flake food, but I think she prefers the pellets, so when she got sick, I switched back to the pellets). <<She needs vegetable matter in her diet, Debra. Goldfish don't process proteins at all well. Zucchini, spinach, shelled peas (which you've tried) among other common veggies are all good for her and will keep her "cleaned out". Brine shrimp also act as a laxative because of their "roughage". Also, do a search on our site regarding Epsom salts. Many folks have good success with a treatment of these.>> I hope this gives you more information, although I know it must be difficult to diagnose a fish sight unseen. Thank you for your time and any help you can give. <<I've probably given you more than you necessarily wanted here, Debra, but I've hit what I believe are the key points. Bigger tank, more filtration, aeration and diet. A little overwhelming, perhaps, but this is what your pet needs.>> Sincerely, Debra <<My best to you and your Goldfish. Tom>>

Re: Sick Goldfish   7/28/06 Dear Bob F., Thank you for your prompt reply. I did peruse the site you listed plus many others, but my fish did not fit nicely into any of the disease categories, so I  was still puzzled. I will copy Tom's email to me and my reply to Tom's email  FYI. <I see (place) all> I hope that this information will shed more light on the matter, and that  the problem may have a solution. And yes, my hands did have breaks in the skin  from playing with my cat who accidentally scratched me, and from torn cuticles,  that was why I was concerned. <... might be worth a visit to a medical center if you are indeed concerned>   I also quarantined my fish in a large glass  salad bowl while I was changing the water in her tank--I bleached out the salad  bowl and washed it with antibacterial soap --along with my improvised "net", a  slotted kitchen spoon (we do not have a dishwasher) but now I wonder if I should  just discard the bowl and the slotted spoon I used to transfer the fish  with. Sincerely, Debra <Mmm... there are a myriad of degrees-of-infectious microbes in most everyone's experience every day... I strongly suspect you have nothing to fear here. I would not discard these implements. Bob Fenner>

Re: Lugol's Dip and Gorgonians, Pete, will you take a look at, refer? & bacteria f', human dis.   -- 4/10/07 <Yowsa Pete! Thanks as usual for this dissertation! BobF> Dear Mark: Bob forwarded your email to me and asked me to lend a hand with your dilemma.  It's very difficult to say what may have caused the demise of  your H. kuda but I would be happy to share my thoughts on the matter with you  for whatever it's worth, sir. Like all fish, seahorses do occasionally develop various granulomas, malignant neoplasms, tumors and fibrosarcomas associated with certain diseases  or the aging process, but these primarily affect internal organs.   Furthermore, such growths are not characteristic of Vibriosis and, judging from  the symptoms you described -- or lack thereof -- it seems unlikely that a Vibrio infection was involved in this case. I am more concerned about the possibility that the tumor may have been a granuloma symptomatic of a Mycobacterial infection.  Granuloma disease is  caused by gram positive, acid-fast bacteria from either the genus Mycobacteria  or the closely related genus Nocardia invading the tissue and internal organs and organ systems. Both of these bacteria can affect the skin as well as the internal organs, causing nodules and granuloma. And both Mycobacteria and Nocardia can be transmitted to man, causing a localized, unsightly skin rash  after entering through a cut or break in the skin. Here is an excerpt from my new book (Complete Guide to the Greater  Seahorses in the Aquarium, TFH Publications, unpublished) that discusses mycobacteriosis in more detail, Mark.  It may help give you a better idea  whether or not the tumor you noticed could have been associated with granuloma  disease: MYCOBACTERIOSIS, A.K.A. PISCINE TUBERCULOSIS Mycobacteriosis is also known by the following synonyms: fish tuberculosis, piscine tuberculosis, granuloma disease, swimming pool granuloma, fish tank granuloma, and acid-fast disease (Aukes, 2004; Leddo, 2002a). Like all fishes, seahorses are susceptible to Mycobacteriosis. It is not uncommon in wild-caught  seahorses obtained from pet stores and is the second most commonly seen  bacterial infection of Syngnathids at large public aquaria after Vibriosis (Bull  and Mitchell, 2002, p20). Cause: Fish tuberculosis is caused by pathogenic Mycobacteria, of which two different species are the primary culprits: Mycobacterium marinum and  Mycobacterium fortuitum (Giwojna, Sep. 2003). Unlike most bacteria the plague  fish, these Mycobacteria are gram-positive, and take the form of pleomorphic  rods that are acid-fast and nonmotile (Aukes, 2004). When cultured on solid  media, they form cream-colored to yellowish colonies (Aukes, 2004). Mycobacteriosis is worldwide in distribution (Giwojna, Sep. 2003). All fish species are considered susceptible to it (Aukes, 2004). Although this disease can in fact infect almost all fish, certain species are more vulnerable than others (Giwojna, Sep. 2003). The most susceptible species are freshwater tropicals such as black mollies, all Gouramis, Neons and other tetras, all labyrinth air breathers, and most species of the Carp family (goldfish and Koi, for example), Aukes, 2004. Mycobacteria are ubiquitous and waterborne, and the aquatic environment is considered the disease reservoir for fish tuberculosis (Aukes, 2004).   Mycobacterium marinum has been cultured throughout the world from swimming pools, beaches, natural streams, estuaries, lakes, tropical fish tanks, city tap  water and well water (Aukes, 2004; Leddo, 2002a). Human epidemics of  granulomatous skin disease have occurred from swimming in infected water, and in  fact, this mode of human infection is far more common than infection from  exposure to infected fish tanks (Aukes, 2004; Giwojna, Sep. 2003). Clinical Signs: There is a very severe or peracute form of this disease, in which fish can simply be found dead without showing any telltale signs or symptoms (Bull and Mitchell, 2002, p20), but that is quite rare. In my experience, Mycobacteriosis  is a chronic disease that progresses quite slowly in aquarium fishes (Giwojna,  Sep. 2003). It may take years for an infected fish to develop any symptoms of  apparent illness and much longer before it becomes fatal (Aukes, 2004). The  glacial progression of the disease makes it difficult to diagnose. Some early  signs to look out for include lethargy, fin loss, emaciation, skin inflammation  and ulceration, edema, Popeye, and peritonitis (Aukes, 2004). There may be  superficial skin lesions that take the form of small subdermal lumps or pus-filled nodules of granulation tissue (Bull and Mitchell, 2002, p21). These  are simply the outward manifestations of a systemic infection that may already  involve many of the major internal organs (Bull and Mitchell, 2002, p21). In  later stages, nodules may develop in muscles or skeletal structure and deform  the fish. (Giwojna, Sep. 2003). As difficult as slow-moving TB may be to diagnose while the infected fish  is alive, once the victim expires, postmortem examination will reveal clear, unmistakable signs of Mycobacteriosis (Giwojna, Sep. 2003). The telltale granulomas will appear as gray or white nodules in the liver, kidney, heart  and/or spleen (Aukes, 2004). There is often black, necrotic tissue eating away  at the internal organs, and there may also be skeletal deformities. Diagnosis is then confirmed by the presence of acid fast bacteria in tissue sections (Giwojna, Sep. 2003).
Treatment and Control:
There is no practical method for treating mycobacteriosis or granuloma disease at the hobbyist level.  As discussed below, good aquarium  management can prevent Mycobacteria/Nocardia from becoming problematic.   Prevention is the watchword for this condition. Transmission: The bacteria can be transmitted through the water from open ulcers, through contaminated food (including live foods such as shrimp or molly fry), via feces  of infected fish, or through the consumption of infected, dead or dying fish in  the tank (although the latter does not apply to seahorses), Aukes, 2004.
Contributing factors:
This disease is not highly contagious and does not seem to spread from fish to fish readily (Aukes, 2004). However, fish TB it is often associated with poorly kept or dirty tanks with poor water quality (Aukes, 2004). Chronic stress  from factors such as overcrowding, malnutrition, or aggressive tankmates often  plays a role as well (Giwojna, Sep. 2003). Mycobacterium, the causative organism, is believed to be ubiquitously present, making it very difficult to eliminate it entirely. However, if good aquarium maintenance and management is followed, including vacuuming of the  gravel along with good filtration and regular water changes, combined with a nutritious diet and the addition of an enrichment product rich in vitamins, the problem can be minimized and eliminated as a cause of mortality (Aukes, 2004).   Any dead fish should quickly be removed and disposed of properly. Diseased live fish should be isolated and treated in a hospital tank (Giwojna, Sep. 2003).
Transmission to Man:
The seahorse keeper should be aware that piscine tuberculosis is one of the few forms of fish disease that is communicable to humans (Leddo, 2002a). This transmission usually manifests itself as an unsightly skin rash involving one or  more granulomas on the arms of the fish-keeper (Leddo, 2002a). In severe cases,  these nodules of inflamed tissue can become large and disfiguring. They can  spread and be very difficult to eliminate. The granulomas often take some 2-4  weeks after exposure before manifesting themselves, so the individual is  frequently unaware of how he or she contracted them and the condition very often  goes undiagnosed (Giwojna, Sep. 2003). The Mycobacteria that cause the disease  typically gain entry through a break in the skin such as a cut, scrape, or  abrasion on the hand or arm of the aquarist (Leddo, 2002a). Although unsightly,  the granulomas themselves are not a serious problem and are almost always  localized and most certainly curable in healthy individuals. But for those of us  whose immune systems are compromised by AIDS, kidney disease, diabetes, liver  dysfunction, chemotherapy or the like, the infection can sometimes become  systemic or, on rare occasions, even life threatening (Giwojna, Sep. 2003). Awareness is the appropriate response to the risk posed by fish tuberculosis. The seahorse keeper should be aware of the remote possibility of  being exposed to Mycobacteria via his aquarium, and take appropriate  precautions, but there is certainly no need to be overly concerned (Giwojna,  Sep. 2003). The aquarist should merely remain aware of Mycobacteria and follow the  usual sensible precautions. Nets, aquarium accessories and equipment, and any other items that may come in contact with the fish should be sterilized between uses to prevent cross-contamination (Giwojna, Sep. 2003). Avoid mouth-siphoning of the water in a Myco-positive tank (use a hand pump instead).    Mycobacterium cannot penetrate intact skin -- it only causes infection after  entering through open wounds or source, so make full use of aquarium gloves and  don't place your hands or arms in the aquarium if you have any cuts or scrapes (Giwojna, Sep. 2003). Handle sick fish carefully, dispose of deceased specimens properly, and scrub up afterwards. Do NOT dispose of dead fish by flushing them down the toilet, as this is a prime way to spread disease. Place the fish carcass in a plastic bag or wrap it in some foil and dispose of it with the solid waste of the household. And don't feed dying fish to larger carnivorous fish, since this an excellent way to spread infection (Giwojna, Sep. 2003). One thing hobbyists who are worried about fish TB can do to allay their concerns is to get their seahorses and live foods (crustaceans such as shrimp  are known vectors for Mycobacteriosis) from a High Health facility such as Ocean Rider rather than from their local fish store (Giwojna, Sep. 2003). Seahorses at  OR are routinely screened for pathogens and parasites by independent examiners  from an outside agency (DVMs with the Department of Agriculture), and I know for  a fact that Mycobacteriosis is one of the diseases they specifically check for  (Giwojna, Sep. 2003). Thus far, multi-organ histopathology has found no  granulomas and tissue sections have revealed no acid-fast bacteria -- conclusive  proof that Ocean Riders are free of Mycobacteria. <Close quote> That's the rundown on mycobacteriosis or granuloma disease, Mark. The very similar Nocardia is a gram positive, acid-fast, filamentous bacteria and is even more insidious than Myco. Nocardia is closely related to  the Mycobacteria that cause piscine TB or granuloma disease and, like  Mycobacteria, it can affect the skin as well as the internal organs, causing  nodules, granulomas and pyogranulatomous cysts. And like Mycobacteria, Nocardia  can be transmitted to man, so be sure to take appropriate precautions if you  suspect granuloma disease may have caused the death of your H. kuda. Here is some information from Paul Anderson explaining how professional aquarists typically deal with Mycobacterium/Nocardia: Fellow Seahorse Enthusiasts: Mycobacterium is a genus of bacteria that are ubiquitous in almost all environments. Mycobacterium infections occur in many (if not all) vertebrate  taxa (e.g., mammals, birds, fish, etc.). Some studies that have looked at prevalence of infection of Mycobacterium in wild animals have often found that a small percentage of wild animals are infected, even without clinical signs. The most common Mycobacterium species found in seahorses are M. marinum, M. chelonae, and M. fortuitum. There is currently no cure for mycobacterium infections in fish. The options available are to 1) depopulate and disinfect the system, or 2) maintain the fish but prevent cross-contamination by observing strict biosecurity protocols. The second option is often chosen by public aquaria with long-standing displays, when aquaculture/production of the infected  fish is not an issue. Many mycobacterium spp. can cause disease in humans, especially if the species is a rapidly growing one and/or if the person is immunocompromised. Of  the three species mentioned above, M. marinum is a slow grower, and grows at 25 degrees Celsius incubation, but not at 37 degrees Celsius. The other two are rapid-growing species and grow at both temperatures of incubation. The significance of 37 degrees is that it is human body temperature. While most infections of otherwise healthy people are limited to lesions on the extremities (even with infection by a rapid-grower), there is a greater risk of the rapid-growers to cause systemic disease (especially in immunocompromised  people). In a Myco-positive tank, the best option is not to come in contact with water or fish; wear gloves (sleeved gloves if necessary). Avoid mouth siphoning (use a hand pump). Having said that, in an aquarium situation mycobacterium only  causes infection if it enters a wound; it cannot penetrate intact skin.   Effective disinfectants against mycobacterium include spraying with 70% Ethanol and allowing the equipment to air-dry, and bleach baths (I use 50ppm bleach baths with a minimum contact time of one hour, this has been reported to be effective against M. marinum) followed by sodium thiosulfate neutralization baths. Ultraviolet light sterilization is also recommended in Myco-positive systems. If you've got Myco-positive tanks among other systems, common sense suggests performing husbandry on these systems last in your rounds. A note on ethanol: I have found in my experience that seahorses are very sensitive to ethanol, so I advise being very cautious to avoid overspray into tanks (while we're'¬"¢re on the topic, has anybody else observed this?) Check out the following for more information about mycobacterium infections in fish/aquaria: <_ http://edis.ifas.ufl.edu/VM055_ (http://edis.ifas.ufl.edu/VM055) > <_ http://www.mdsg.umd.edu/Extension/finfish/FF9.html_ ( http://www.mdsg.umd.edu/Extension/finfish/FF9.html) > Mainous, M.E., and S.A. Smith. 2005. Efficacy of common disinfectants against Mycobacterium marinum. Journal of Aquatic Animal Health 17:  284-288. Paul Anderson Ph.D. Candidate Department of Fisheries and Aquatic  Sciences University of Florida That's the situation when Mycobacteria is confirmed in an aquarium,  Mark. As long as you observe the proper precautions and practice good  aquarium management, it's a problem the aquarist can sometimes live  with...   Nocardia is a different matter.  When Nocardia is confirmed in an  aquarium, the only real recourse is to break down the entire aquarium, discard  the live rock, substrate, and invertebrates, sterilize everything, and start  over from scratch.  The problem is that Nocardia is saprophytic -- it  doesn't require a host to survive and it will persist in your system  indefinitely. These bacteria live off any kind of dead or decaying organic  matter; in nature they are commonly found in soil and wastewater -- in your  tank, Mark, they are no doubt entrenched in your substrate, live rock, filters,  everything -- where they act as a disease reservoir, ready to infect any new  fish and invertebrates (or careless humans) they encounter when the opportunity  presents itself. The risk of cross-contamination of your other tanks and specimens is great, compounded by the fact that human health (primarily yours, Mark) is also at risk  from this organism.  If your H. kuda was infected with Nocardia, then everything in your 25-gallon aquarium has been exposed to these bacteria and is potentially a source of infection. Leading the tank lay fallow indefinitely will  not help with Nocardia whatsoever.  If Nocardia killed your kuda, you must consider all the equipment, decor and specimens in the tank to be contaminated,  Mark -- treat them like you would toxic waste or any other biohazard. Even your  invertebrates are a risk. Your coral, macroalgae, etc,. are all sources of  organic matter, and can therefore harbor Nocardia and carry the infection. Do NOT disperse your live rock, substratum, Gorgonia and soft corals, macroalgae, equipment or accessories from the 25-gallon tank to your other aquaria, Mark, or you will be inoculating them with Nocardia and spreading the infection to all your tanks! And you must be extremely careful to avoid accidentally cross-contaminating your other tanks from your 25 gallon aquarium.  Any nets, hydrometers, or other equipment used in your 25-gallon aquarium should  be sterilized after every use and not placed into or used in any other tanks. Avoid working in infected aquarium with your bare hands, scrub/disinfect your hands and arms thoroughly after working on the tank, and do not place your hands in the 25-gallon tank and then place your hands in another aquarium. These bacteria can even be transferred from one aquarium to another by splashing water  droplets or as an aerosol via the mist generated from a protein skimmer or an  airstone. Be careful! That is what I typically advise hobbyists when Nocardia has been confirmed in their aquaria, Mark.  I hesitate to recommend such drastic measures when Nocardia or Mycobacterium have not been confirmed.  And the tumor that you described is not typical of the pyogranulatomous cysts that characterize Nocardia.  They most often present as greyish-white pimple like lesions on  the skin.   They are often motile when manipulated and may release a cheesy  exudate when compressed.  That does not sound like the hard mass you  detected beneath the skin near the vent of the H. kuda. So you're going to need to use your own judgment, Mark.  To be 100%  safe, you could discard the contents of your 25-gallon aquarium, sterilize everything, and start over from scratch.  Or you could dip the live rock,  Gorgonia, and corals with Lugol's solution as a precaution and then trust to  good aquarium management to keep the seahorses in your 40-gallon aquarium  healthy and happy.  Since Mycobacteria and Vibrio bacteria are virtually  ubiquitous, and normally only become problematic when the seahorses have been  stressed and their immune systems have been impaired, I might be inclined to  take the latter course in your case.  If you can provide your seahorses  with optimal water quality, a nutritious diet, and they stress-free environment,  the chances are good that your livestock will not be affected by granuloma  disease or Vibriosis.   Starting out with seahorses from a high-health  aquaculture facility that you obtain directly from the breeder will further  increase your chances for success.  As an added precaution, you may also  want to consider installing an ultraviolet sterilizer on your 40-gallon seahorse  tank after it has cycled completely and the biofiltration is  well-established. Best of luck with your new seahorse tank no matter how you decide to proceed, Mark! Respectfully, Pete Giwojna, Ocean Rider Tech-Support

Re: Lugol's Dip and Gorgonians, Pete, will you take a look at, refer?  -- 4/10/07 Dear Bob: <Pete!> I'm always happy to help when I can, sir. <And you do a fine job of it, I assure you> When I receive inquiries from aquarists regarding Mycobacteria/Nocardia, I feel it is very important to provide them with as much information as possible because of the possibility of human transmission and because they may be confronted with the decision as to whether or not it's necessary to depopulate their aquarium, sterilize everything, and start over from scratch.  So I  make it a point to try to arm them with all the facts they need to make an informed decision in that regard. <Yes... and one of the principal reasons for my encouraging the publication of your book, your articles (as well as others... including my own!) to get "complete answers" to folks... in a speedily manner> Hopefully, once we get my new book on seahorses published and into the  hands of the hobbyists, there won't be a need for us to devote so much time discussing these issues on the forums. <Heeeeee! You'll see...> Happy Trails! Pete Giwojna <And to you, Bob Fenner, out in HI, at times visiting with Carol and Craig and their (now four year old!!!) boys, Dylan and Cooper>

Swallowing water Hi Bob, I have a marine tank (46 ga.)that has been up for about 5 months. I houses a blue damsel, percula clown, coral beauty, yellow tang, cleaner shrimp, and a few crabs and snails. During routine maintenance this weekend while siphoning water out for a water change, I guess you could say that I swallowed a bit of water trying to start the siphon. I remember "drinking" some of the ocean water as a kid at the beach, but I'm sure the water in our tanks is a little more "full of waste" than the ocean. It happened 2 days ago. I feel fine. Anything I should worry about? Thanks. <Not really... unless you have ulcerations... open wounds in your buccal cavity... you're more than likely fine... I have swallowed actual gallons of water from fish tanks over the years... though I am the "Jimi Hendrix" of siphoning at this late stage. Bob Fenner> Jason

Human Poisoning from Sarcophyton? Anthony- After a somewhat panicked web search, I came across your article: http://www.reefkeeping.com/issues/2002-06/ac/feature/ on coral propagation in Reefkeeping magazine.  I say "panicked" because while I was attempting to cut a diseased portion of a Sarcophyton species off, I inadvertently cut my finger in the process.  The cut was shallow; so shallow that I did not realize I cut myself until the "operation" was complete, and it did NOT draw blood. However, I'm worried about any toxic reaction.  It's been two hours as I write this, with no sign of rash or anything at the cut site, or any symptoms that can't be explained by panic disorder. Are there any warning signs/window of time I should be looking out for a "bad" reaction?  Is it possible I introduced something harmful or lethal via this shallow cut?  I feel incredibly stupid for (a) doing this and (b) e-mailing someone I don't know about it, but I'd really like the opinion of an authority on this so I can rest easy or get myself to the hospital. Thank you very much for your time.. -Todd <Cheers, Todd. Very glad to hear about the propagation efforts! Sorry to hear you got a scare :p No worries though my friend. Nothing imminent is likely regarding a poisoning or allergic reaction. What risk there is no worse than the same risk of being bit or stung by a non-venomous fish or even simply putting your hand in the tank on a daily basis with a hangnail or other non-related wound. Specifically, there are nasty microbes in all aquatic environments and specifically we fear Vibrio or Mycobacterium.  Your first step of course was/should be to cleanse the wound thoroughly with soapy water and then use a disinfectant (antibiotic cream, peroxide, or the like). The doctor is unlikely to be necessary but do call at least to get his advice. Really... the concern here is more from a septic infection from the razor than anything the coral could impart.  Sarcophytons are specifically noxious to other corals and aquatic invertebrates with regard for allelopathic compounds. Again, since this is not an overtly poisonous (to humans) animal and you didn't even draw blood... it seems likely that you will have a very nice holiday week. The only poisoning that I see as being likely in your near future is alcohol poisoning tomorrow night <G>. Happy New Year, my friend. Anthony>

Sore Fingers...Infection from My Saltwater Tank?? - 8/13/03 Hi all at WWM.  I have a pretty serious question to ask of you,  I hope someone can get back to me (I've sent you another email about some live rock with no response so I hope this one makes it) First off,  I love your site and have learned a great deal from you all!  Me and my fish appreciate all the hard work u put into it.  I am just venturing into the hobby of saltwater fish and have just completed setting up my tank.  About 5 or 6 weeks ago I purchased some live un-cured Lalo rock from an online store.  When it arrived I rinsed in some saltwater which took me quite a while and placed it in the tank.  As I was finishing up I noticed that my thumb (also my first 2 fingers but more so my thumb) on my right had had gotten very tender and was a bit red.  I put it off to abrasions from handling the rock etc.  But,  over the course of the next few days my thumb and fingers felt worse.  They were reddish/purplish, slightly swollen, warm feeling and felt like razors or pins were in the pads of my thumb and the same 2 fingers.  Anyway, over the course of the next 5 or 6 weeks all my fingers except my pinkies (and they are starting to get sore now a little bit) have developed the same symptoms.  All those symptoms seem to be isolated to the pads of my fingers.  Now this morning I noticed that I have like these little white circle/spots/bumps under the skin but some are raised slightly.  They hurt when I try to feel them, again like a razor is in there.  They look like white things about the size of a sesame seed pushing up from under my skin on the pads of most of the fingers.  I also have a few that are now on the side of my finger. I went to my doctors today and they had no idea what it was.  They put it under the heading contact dermatitis and to come back in 2-3 wks if it didn't get better. I told her that I was concerned that I may have gotten something from handling the live rock with no gloves on (maybe even crystals of some sort got caught under my skin??) She thought I was basically crazy and said she wasn't aware of any infections etc. that I could get from live rock (she didn't even know what LR was till I told her!) I really hope you have an idea or suggestion as to what this may be.  I have done extensive research on your site and also found names of things (infections etc.) and done a web search but I'm still not sure of what this is.  I hope its not marine TB,  I don't think it looked like the pictures I saw but I'm getting worried that it is going to get worse instead of better. (its already been like 6 weeks and hasn't gone away)  Please,  any help would be of great help.  As I said,  2 of my others emails never got answered (maybe not great ?? LOL) but if for some reason you do respond to me without using the reply button,  the "0" in my screen name is actually a zero,  not the letter o. Desperately awaiting a reply, Jan <Jan... please do seek another doctors opinion. Also, read our coverage on diseases and mycobacterium as well as another former a colleague of ours (may not apply to you... but I hope it frightens you into wearing gloves properly to handle live rock!). My first impression from your symptoms stated was that you got calcareous spicules embedded into your skin from handling a sponge (common) or that you got setae (bristles) from segmented worms in there. This would definitely cause a prickly feeling like fiberglass in the skin. Please do seek a doctor with experience in aquatic pathogens. Likely little to worry about... but do play it safe. Speedy recovery, my friend! And please do give us a follow-up later. Kindly, Anthony  http://www.wetwebmedia.com/Wound.htm http://reefkeeping.com/issues/2003-07/sp/feature/index.htm >

Sore Fingers... Infection from My Saltwater Tank: Follow-up - 8/21/03 Hi crew at WWM...I just wanted to give you a follow up email about my fingers.   <much appreciation!> So as it turns out my symptoms were getting worse over the past week - the little bump things started to move up the sides of my fingers, they appeared on the palms of my hands and near my wrist.  Then Saturday morning I woke up and the joints in 3 of my fingers were really sore.   <Yowsa...> I called my Dr's office and got an appointment with the infectious disease doctor who finally saw me today....as it turns out I do in fact have a mycobacterium marinum infection. <Doh! I hate when that happens> (I'm pretty ticked at my Dr. as I originally asked her to look up M. Marinum and she told me to calm my "bacteria imagination" down.  Obviously she had no clue eergh)   <don't be too upset... keep in mind that few doctors (inland particularly) ever see the pathogen. Most go a lifetime and never do. You did the appropriate thing by seeking other opinions and research> Luckily I don't have the TB type but a different strain I guess?   <yep... really no biggie at all when caught early. Just some meds and the need for a lot of yogurt after the antibiotics <G>> Anyhoo,  I just filled a prescription for a pretty strong antibiotic which I'll take twice daily for at least 3 months. <ah, yes... have had several friends go through this... your tummy will be a but upset afterwards, but none the worse for wear> Hopefully they won't bother me - he said they were pretty strong and some people get sick etc. from them. <heehee... fruit and dairy will not be your friends for a while. Eat them strategically with green bananas, rice and olives to ...er, counter the effects. Doh!> Guess we'll have to see. I really wanted to thank Anthony (he happened to be the one to reply to my original email) for getting back to me with his input and suggesting I see the infectious disease doctor.   <very welcome my friend> I guess I've learned my lesson,  I really had no idea all the lil' nasties one could get from an aquarium.   <they are rare... but it is very important to wear gloves when working with aquatics and most any creatures in animal husbandry. Few are toilet trained <G>> I will surely wear gloves whenever my hands/arms go into the tank!   <very good investment> I've only had the tank a few months and I'm learning so much from your website.  I'm on here everyday reading every saltwater subject you have!  I'm glad that this ordeal hasn't scared me away from the hobby.   <excellent to hear and very intelligent. Truly a rare happenstance. No need to avoid your love and passion for the sea because of it>> Probably not possible... besides the clean up crew I only have 2 fish,  well 3 if you consider my "evil" blue damsel a fish LOL but I could watch them all day!  My daughter and I will sit up late at night with the flashlight checking out the live rock creatures....amazing! Once again,  you guys and gals are terrific.  My fish and I thank you for all the hard work you put into maintaining the site. <very very welcome my friend!> One more thing,  I've been trying to purchase Bob Fenner's book CMA and thought I had seen it available for sale on your web-site.   <actually from Di his wife direct, but they have been in Indo for the last two weeks... will be back next week> I went to purchase it yesterday and can't seem to find the link anymore.  Is it now only available thru the 3 web-stores you have links for (Di's store etc.)   <not at all... er, that is.. if you don't want it signed... it is on Amazon.com and numerous other mail order aquatics places (Custom Aquatic, Marine Depot, Champion Light and Supply, That Pet Place, Barnes and Nobles, etc)> I really wanted an autographed copy and Di's store wouldn't put the order thru, some error or something so I figured they may have run out. <Ahhh, yes... some glitch due to their absence no doubt. Do try them again next week my friend> If you could let me know if its possible to get it through your site still I'll get it here otherwise I'll just order it un-autographed ;-) online somewhere.  Jan <best regards, Anthony>

Sore Fingers... Just an Update/Reply Hi again WWM (and Anthony,  my "reply" guy). <cheers, dear> Just happened to be browsing your site (oh alright,  I'm here reading everyday!) and happened to see a reply from a Dr. to my "finger dilemma" post.   <Ahhh, yes... Dr. Allen> If I could clarify my "being ticked at my Dr." reply that would be great ....the only reason I was a lil' upset at my Dr. was because when she told me she had no idea what it was and lets go with c. dermatitis for a few weeks and see if it goes away,  I gave her a paper with the name of (what I thought I had) Mycobacterium and asked if she wouldn't mind just looking it up for me - not only did she refuse to look it up she chuckled at me and told me to "calm my bacteria imagination down"!   Mind you that I live on the East Coast/Boston area so very near the ocean and also telling her my fears of handling the live rock,  I think she should have made an effort to at least check it out for me while I was there (I even told her about this site, which is where I originally read of it, and she didn't want to know...) <yes... agreed, the dismissive attitude even without your coastal residency is indeed disappointing> I just wish she was a big enough person/dr. to admit she had NO idea and either look it up for me or immediately refer me to someone else, instead she told me I had c. derm and that was it... <truly disappointing> And yes,  I will be sure to inform her that I actually *do* have what I asked her to look up for me and not just an over active "bacteria imagination" lol...maybe it will help some other patient out. <exactly> By the way...any idea of about how long it takes for the antibiotics to start working some magic?  I know its only been about 10 days but my fingers are still sore/sorer, more bumps appearing <hmmm... variable for folks but slow. Many stay on the treatment for ~ 4 months to kick it. Quite long as antibiotics go> and now I have a stomach ache [sic] a lot of the time c/o the antibiotics LOL.   <I can only imagine!> (not to mention that now I'm wicked creeped out thinking maybe I have bugs/parasites in my fingers - just kidding,  that's just my bacteria imagination kicking in I guess LOL ) <ha!> The infectious dis. Dr. told me that they may not work at all and we may have to switch to a different type of antibiotics.   <correct... 'tis what I recall from friends> I may give a call back to him but was trying to be patient/optimistic.  To make a long email even longer.....I got Mr. Fenner's book, CMA, yesterday and I LOVE it. I believe I've already read it from cover to cover! <outstanding... and do share your wisdom in kind> Today I am going to order the Reef I. book as well. <did get your order... kind thanks!> (I really admire both Anthony and Bob not only for their wealth of knowledge-and humor- but for donating their time to help us all out on this great site (as all the crew on WWM does!)   <its a labor of love> Does the RI book cover sump design/ideas - I wouldn't have thought it to but I think I read a reply here that stated there were like 100+ pages designated to that subject?   <roughly 20-30 for sumps/refugiums... the balance to components like plants, algae, live sand. And yes... indeed described refugium styles> As I said in my last email,  I've only had my 55g tank for about 3 months  so I'm still doing a lot of adding/upgrading to it.  I want to add a protein skimmer ASAP but wanted to install a sump first to house all the equipment and free up the space in the main tank (think I'll put the sump in my basement where I have lots of extra room and plumb it up)   I have no idea on how this is done so I'll have lots of reading up on it ahead of me!  (change topic) Any thoughts on compact fluorescent lights... I'm off to order the custom SeaLife 260W - 2 10k, 2 actinic - with 4 moonlights for my tank which will be home to fish/inverts and some *easy* cor

Sore Fingers... Just an Update/Reply Crew: <Mr./Dr. Allen> Saw the update from the victim of mycobacterium marinum.  Glad to hear there's been some improvement. I hope this recovery continues and is complete--this infection can bee difficult to treat. Sorry to hear of the original doctor's inappropriate dismissiveness. This could in part be due to all of the emphasis on over-prescribing of antibiotics leading to resistance. The annual number of prescriptions for antibiotics is plummeting. This is a good thing if doctors are finally not treating viruses with antibiotics that do not work for viruses. On the other hand, it is not good when they fail to treat bacterial infections with meds that do work for them. <Yes> I am including some information for the benefit of all-- <Thank you> I have attached a picture of an infected hand and a pdf fact sheet. <Will post with this msg.> I thought people might be interested in some good links on the topic of Mycobacterium marinum: <Oh yes!> Fore health care providers (but of interest to aquarists): http://www.emedicine.com/derm/topic281.htm http://www.emedicine.com/med/topic1538.htm http://archinte.ama-assn.org/cgi/content/abstract/162/15/1746 For general public: http://www.medicinenet.com/Mycobacterium_Marinum/article.htm http://edcp.org/factsheets/mycobacterium.html http://www.aquatouch.com/Granuloma.htm http://www.dermnetnz.org/pre/dna.tb/atypical-mycobacteria.html Hope this is useful info.   Steve Allen, MD <Does indeed. Again, thank you. Bob Fenner>

A Doctors Input on Fish TB - 8/22/03 <Cheers, Doc :) > Glad to see on today's post that Jan got to see an infectious disease specialist as recommended. <yes... whew!> Thanks for advising going easy on the primary care doc. You are right that most of us have never seen this pathogen. <yes... so true. Certainly not fair to blame your doctor about some rare and obscure pathogen. Its unrealistic to expect your doctor, or electronics technician or broker to know every possible thing there is to be known in a given industry. Common sense should compel one to get other opinions if necessary for an intelligent consensus (fortunately this aquarist did)> I only learned about it when I became a marine aquarist. People should never be afraid to question their doc (we're only human) and seek second opinions if they are skeptical of the first one. <true, true... not a bad thing at all. And surely not taken as a slight by good doctors either.> It would be worthwhile to politely inform the first doc of the final diagnosis so that he/she will be aware of this possibility if seeing an aquarist in the future. <Ahhh... good point. I wish I had though to mention it. Will be posting as always.> Steve Allen, MD <kind thanks as always, Anthony>

A Nasty Owee 12/9/2003 Good morning, Yesterday while cleaning my tank I had a small cut on my thumb. <Did you cut yourself before putting your thumb in the aquarium or on something inside?> I accidentally touched the elegance coral and was stung by it. <Ouch!> My thumb is now swollen, red and tender. <Either a toxic reaction or an infection.> Should I go see the doctor or give it some time. <Go to the doctor ASAP. If this redness is spreading, you may have cellulitis, a potentially serious infection requiring antibiotics.>  Also, what is the active ingredient in the poison. <Uncertain. I could not get any specifics on the Internet. Most of these toxins are a mix of noxious things--local irritants, anticoagulants, neurotoxins. Most reactions are localized burning & swelling, but can be more severe depending on type & amount of venom. Allergic reaction can be severe. Some aquarists have had neurological symptoms like numbness & tingling, loss of taste. Check here for more info: http://www.emedicine.com/wild/topic18.htm> Thanks, <You're welcome. I hope this heals quickly, Steve Allen> -Brent <There's a lesson here for all. It is best to wear arm-length gloves when messing around in your reef tank. Here's one source: http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=3871&D=gloves&R=7795&Ntt=gloves&Ntk= All&Dx=mode+matchallany&Ntx=mode+matchallany&Np=1&N=2004&Nty=1   Also, NEVER EVER put your unprotected skin into the water if you have an open wound (scratch, laceration). The tank is a veritable cesspool of potentially infectious agents and broken skin is an easy access point for them to infect you. Intact skin is your primary line of defense against infection.>

Fish germs and other yucky microbes--Eww! (12/08/2003) hello, I got a question here. If we handle a fish which are sick like, body fungus, gill disease, or other disease with hand without glove, will the disease effect us? or is there any side effect to us? thanks. sorry for my bad English. hope u reply a.s.a.p <While many fish diseases can't infect humans, some do, so it pays to be cautious. Bacteria are very good at entering the body through the slightest break in the skin (cut, scratch or scrape) and some (Vibrio, Mycobacteria) can cause nasty infections. Fungus is probably less likely, as are the various parasites. Fish tapeworms have been known to infect humans. If you got tapeworm eggs on your hand and touched your mouth you might get infested. The best bet is to always wear gloves if you need to handle your fish. Latex-free surgical-type gloves from the local store will provide good protection. If you're going to put your hand in the tank, it's best to wear arm-length aquarium gloves. In any case, always wash your hands thoroughly with hot, soapy water or use an alcohol-based skin cleanser after handling anything that's inside your aquarium. Steve Allen>

Mycobacteria marinum Hi Bob- While surfing my favorite fish site I came across your article on Mycobacteria marinum. I too had acquired the infection-twice. The first time I went to the ER I was given some antibiotics that didn't help. By my third visit to the ER I was immediately sent to our local plastic surgeon (the infection was in my right index finger. I was rushed into surgery within 30 minutes and stayed in the hospital for 6 days. It was 4 days before the source of the infection was found. <Lucky just the same...> For this I received massive doses of antibiotics both orally and by I.V. My finger and hand remained swollen for 6 months until my second bout of it. By this time I knew what was coming and got to the Dr. in time to stave off the severity of before. The surgery involves opening the infected site and SCRAPING the infected area, on me it was the ligament sheath, flushing the open wound for 6 days (the wound needs to stay open so the infection does not get trapped inside and the wound has to heal from the inside out) and then to top it off I need physical therapy 3 times a week for 5 weeks to get mobility back, even then it was a bit stiff and swollen. <Yes... very painful, inconvenient, frightening> It's been since Jan 7 of this year since the last bout of this. My finger just now looks to be normal size. Best precaution??? ARM LENGTH VINYL GLOVES & a MAG FLOAT!!! Cause of infection: getting scrapped by live rock while cleaning the inside of the glass. Lesson learned!!!!..............................Lance <Thank you for sharing your harrowing experiences. You have helped many others. Bob Fenner>

More Mycobacteria transzoonoses... It's not "just a scratch" Friend of mine is at the hospital now with an infection he kicked up with a cut in the aquarium. They are telling him he has a form of Tuberculosis and want to operate. I saw an article about an infection or bacteria that can be picked up this way but cant locate it. Can you help. I mentioned this to him a week ago but he laughed it off. Thanks <Not, NOT a "laughing matter". Please have your friend and his health practitioner read here: http://www.wetwebmedia.com/Wound.htm and more importantly, the associated FAQs file (linked, in blue, at top). These "aquarium wounds, infections" can be VERY serious indeed. I wish your friend (and they are fortunate to have friends like you) good health, recovery. Bob Fenner>

Re: Mycobacterium Thank you, my friend has been diagnosed with Mycobacterium marinum and they will operate this week to remove two granulomas. Aquarists need to be made more aware of this hazard. He was told he could have faced amputation if he had ignored it much longer. Thanks for your prompt response. Paul <And you for your input. Will be posted, shared. Bob Fenner>

Cleaning Fish Tank Can Lead to Infections NEW YORK (Reuters Health) - Owners of tropical fish be warned: Cleaning the fish tank without wearing gloves may get you a bacterial skin infection, especially if you have an open cut or abrasion on your hand or a depressed immune system. Writing in the medical journal Clinical Infectious Diseases, Dr. C. Fordham von Reyn and colleagues from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, describe eight adults who developed sores, mostly on the arms, after cleaning their fish tanks. In six of the eight individuals, lab tests showed the culprit to be Mycobacterium marinum, a bacterium first identified in dead aquarium fish in 1926. This bug was found to infect humans in 1951 after being isolated from skin lesions. The use of chlorine in swimming pools has drastically reduced the number of skin infections among swimmers. Today, most reported skin infections linked to the bacterium come from contact with fish tanks. Antibiotic therapy took care of the infection in most cases. But one patient's infection failed to resolve after about two years of drug treatment as well as attempts to cut out the sores. This patient had a depressed immune system. He had psoriasis, melanoma, and was taking steroids. . Fish-tank exposure is the source of "most cases" of M. marinum skin infections, the researchers warn, and may be preventable by using waterproof gloves. SOURCE: Clinical Infectious Diseases, August 1, 2003. <Thanks Miguel... a growing (awareness) concern. Bob F>

Health Concerns (3/17/04)   Hi Crew, <Steve Allen tonight>   I wish to thank you for your help in the past with my evolving for tank into a full blown reef system. <We are always glad to help.> Through browsing your site I came across the sections regarding bacterial and viral infections which could possibly be passed from tank/animals to humans, especially regarding the "various respiratory ailments" mentioned.   Tank specifications are:- 230G marine FOWLR evolving slowly to  reef. (I do siphon water out by mouth for the record) <Many people do. I'd suggest spit & rinse right away after, maybe even with Listerine, but I'm paranoid.>   I'll try to cut a long story short. 1yr 5 mths ago I had what I though was a minor throat infection, the symptoms being a very dry throat and later in the weeks that followed, the feeling of a golf ball sized lump in my throat, bellow the "Adams apple" area. All very frightening until one morning at 2am I found I could hardly breath. I asked my wife to drive me to the hospital ER unit which she did. I was sent home with the diagnosis that I had a sore throat !!!........That's another story!   Later that day I went back to the hospital and was immediately admitted and put on antibiotics IV. The resultant diagnosis was "Epiglotitis" (a swelling of the vocal  chords <actually, its the epiglottis, the lid that prevents food from going down the trachea>) which can be very serious indeed. <Scary disease, can be fatal. Many young children used to get this from Haemophilus influenza B (Hib). Thankfully there's been a great vaccine available for more than a decade. As a pediatrician, I have not seen a childhood case in 10 years. It is rare in adults, but can be caused by other pathogens. I almost lost an adult cousin to it.> This all came with hundreds upon hundreds of tiny (but fairly painless) ulcers which completely coated my mouth and throat. <Definitely not Hib.> They tested for cancer and all else but had no idea where this had come from........They were completely at a loss, had no idea. Until, somebody asked "Do you keep any unusual pets"?..............Well the answer was yes and still they were none the wiser.   My question to you my good friends is, have you ever heard of anything even remotely like this before? I am really struggling to get anywhere with this as I am still suffering from the lump in the throat and the very dry throat. This is over a year now and although it comes and goes it is still of some concern. <Understandable. I trust you have seen an ENT specialist and had a laryngoscopy and perhaps an MRI. I am not aware of anything from your tank that would likely cause such a thing, unless you have some known toxic fish or invert in there. With your problem, I would certainly advise not starting siphon by mouth, just to be safer. Since no infectious pathogen was isolated and you are still having problems, I'd suspect it is some sort of allergic/inflammatory reaction to an irritant or toxin that you are inhaling from somewhere. Do you get hives ever? Wheezing or asthma symptoms? Do you work with hazardous materials in your job? It might be worth consulting an allergist or an environmental physician.>   Any help at all you may be able to offer will be very much appreciated With much gratitude. <You're welcome. I hope this helps a bit. I suggest you continue to work with your doctors on this one. I hope this problem is solved for you soon.> Simon

Health Concerns 2 (3/17/04) Many, many thanks for your quick reply. <You're welcome.> Yes I realize the swelling is the epiglottis but for general purposes some people may not know where ones epiglottis is ;-) I have seen the ENT specialist and she had several looks at the state of the epiglottis which was indeed very bad and according to her if I had left it any longer I would not be here now! <Good thing you went in>.> What is really puzzling me is the fact that they cannot decide whether it is bacterial or viral? I would have thought if it were viral then IV antibiotics would not have helped much but they did reduce the swelling a great deal. <Bacterial diseases are diagnosed by culturing bacteria from the infected area. Sometimes we are unable to get anything to grow in culture even when it is there. The fact that antibiotics helped suggest there was some bacterium involved because, as you obviously know, antibiotics are not effective against viruses. Specific viruses are more difficult to diagnose unless there is a specific, unique syndrome such as chicken pox. We often fail to get a definitive diagnosis in viral infections.>   I am not presently suffering from any more of the hundreds of little ulcers, have not had those for a year now so am just concerned about the lump and the dryness in the throat. Never had Hives. I do not work with any hazardous materials. Have had several laryngoscopies. No asthma, no wheezing. <I just noticed you hail from the UK. It sounds like you NHS specialists are being thorough.>   Thank you so much for your prompt reply. This has reiterated my own concerns i.e. the problem could be "environmental" but I do have to get to the bottom of this. <Yes. I hope you do soon.> Again if you hear of or find out anyone else has suffered anything similar would you be kind enough to let me know. <Do consider posting this dilemma on the forum at www.wetwebmedia.com  The forum "Zo's Bar & Grill" is read by a lot of our users and if any o them have any ideas, they'll chime in.> Cheers.........Simon <I hope you are restored to full health soon. Steve Allen.>

Pet-fish owees! Bob: This picture accompanied a brief article about Mycoplasma marinum in a recent issue of the New England Journal of Medicine. This is a teaching slide, so it should be acceptable to post as fair use for education our readers.  Steve <Yowzah. Will post... but not near dinner time. Bob F>

URGENT! Medical question: Aquarium related Human Skin Infection (8/13/04) Greetings crew, And greetings to you as well....Leslie here for the crew this evening> I have a quick and urgent question for you. <Sure I will do what ever I can to help that's what I am here for.> I am in medical school and a fellow classmate of mine has a patient that they are following with a rather serious infection. <Utto, sorry to hear that> My colleague--knowing of my avid passion for marine aquariums-- requested my help. It seems their patient cut his arm on some rock (assumed live rock) in their marine aquarium 5 days ago.  It is now a very serious sub-dermal infection taking up the majority of their forearm--serious enough for hospital admission.   Lab results and cultures are pending (won't be ready till tomorrow night at least). The patient is currently on broad-spectrum IV antibiotics. <Well it sounds like your friend's patient is in excellent hands, however enlisting the services of a consulting an Infectious Disease Specialist might be appropriate. > My question to you (that was asked of me) is this:  What microbe is most likely to have infected this patient? <Well the first thing that comes to my mind is Mycobacteriosis caused by the organism Mycobacterium marinum. I am not a Physician but I do work in the medical field as a Registered Nurse and I have had personal experience with this particular infection.........my experience is written up in this article which you may find helpful..... Mycobacteriosis: An Infection You Could Acquire From Your Aquarium which was published in FAMA but can be found here as well http://www.syngnathid.org/articles/mycobacteriumInfection.html> What are the most likely characteristics?    <The articles and references listed below will give you a pretty good picture of the characteristics as well as the clinical course, but basically the organism causes a localized nodule/s typically on the upper extremity. These are erythematous ranging from 0.5-3.0 cm in diameter, may be tender and/or actively draining. I can tell you mine was quite painful. As an addendum to my article I experienced what at the time I thought were premature peri menopausal symptoms with "hot flashes". Well since my infection was not diagnosed until it was almost completely resolved .....in retrospect what was actually occurring were mild low grade fevers of 99.9 to 100.3 with associated chills alternating with diaphoresis, on a regular basis, for over a year and long after the lesion on my arm had almost completely resolved. My annual skin test for TB was always negative prior to this infection.  Now is falsely positive and additional evidence that despite not having the lesion cultured that I did in fact have this infection. > Assuming the aquarium was the source, and it came from the rock, I am assuming it is an aerobic organism.  That is about all I can get from my knowledge.  I have no idea if it would be gram positive/negative, motile, coagulase+/-, etc.    < If M. marinum is the culprit then it is a moderate-growing, non motile photochromogenic, acid-fast bacilli which did not come from the rock as it is a water borne pathogen. > Any information you have on this would be most helpful.    Here are several references I have found interesting and informative..... Mycobacterium marinum: The Fish Disease You Could Catch by Steven Pro:   http://reefkeeping.com/issues/2003-07/sp/feature/index.htm Mycobacterium Marinum Infection of the skin: http://www.emedicine.com/derm/topic281.htm Mycobacterium Marinum Main Index: http://www.medicinenet.com/mycobacterium_marinum/index.htm Atypical Mycobacterial Diseases: http://www.emedicine.com/derm/topic930.htm http://www.fpnotebook.com/DER129.htm http://www.medicinenet.com/mycobacterium_marinum/article.htm There is a photo here in the New England Journal of Medicine in Images in Clinical Medicine: http://content.nejm.org/cgi/content/full/350/9/e8 This article lists a few other aquatic organisms that cause human disease:   http://www.freshwater-aquarium-fish.com/articles/human_aquarium_pathogens.htm Thank you and once again, you (the WWM Crew) are a true credit to the hobby and a wonderful resource. <You are most welcome. I hope this information is useful. Please let us know what the results of your friend's patient's work up reveal and thank you for the accolades. Best of luck to you both in your studies and careers, Leslie.> 

Photo Dear Bob, On your site there was a picture (Steve Pro's "owee"...www.wetwebmedia.com/TopicsPIX/Wounds/HandStevePro.jpg) I am writing a medical-biological book on dangerous marine animals and I would like to ask if I can use the picture for the book? With kind regards, John <I am the photographer. Is this book of a commercial nature or more instructional? Bob Fenner>

Re: Photo Hi Bob, Although it is used by a few organizations as a instruction book it is  mainly commercial. It is not supported by the government or something. John <I see. As it is only one image and the topic intended I am inclined to grant its use. Please do credit myself as the photographer and WetWebMedia as the source. Bob Fenner>

Re: Photo The sore was caused by an infection of Mycobacterium marinum.  I wrote  an article about it here http://reefkeeping.com/issues/2003-07/sp/feature/index.htm  If there is  any other information or if you have any questions, feel free to ask me. Sincerely, Steven Pro <Thank you Steven. I do hope/trust that this writer will ask re disclosing your name in association with the photos use. Bob Fenner>

Hand Photo I saw the picture of my hand on the main page of your website. <Yes, though Mike.K doesn't quite agree, thought it was about the best "poster image" for the new "scientific index" for WWM> For your information and that of your viewers, the infection cleared up after three months of three times daily antibiotics. I cannot remember which antibiotic it was because I had to change three times before we found one I could take. At the end of the treatment time, I was cured of the Mycobacterium infection but had a new problem. Being on antibiotics for such a long time wreaks havoc on one's digestive system. It took six months of eating yogurt to be able to have milk and I still have problems with certain fruits (peaches, strawberries, grapes). Since then I have been using Coralife's gloves, but they tend to leak. I am looking into gloves from a vet. I saw some high gloves that were used to help remove a calf during birth. I am trying to find a source for these now. Hope all is well, Steven Pro <Yes my friend. Do read through the article, FAQs especially having to do with this phenomena: http://www.wetwebmedia.com/Wound.htm  Bob Fenner>

Atypical Mycobacterium and Aquariums (5/11/04) I have been diagnosed as having a rare infection, caused by "atypical Mycobacteria". <Sorry to hear.> (There is a photo posted in the FAQ's - http://wetwebmedia.com/woundfaq.htm - but my case is not as serious as the poor guy shown there). <Thank goodness.> My doctor is giving me special antibiotics, called Minocycline. <Should help, but treatment of this infection may take a long time.> My question for you is: Is it possible that my infection came from my aquarium (freshwater, 150 liter, tetras). <There are many types of "atypical"--as in non-TB--Mycobacteria, some from birds and some from fish. Perhaps the doctor can tell you what species.> How can I treat my aquarium? <I would consult a veterinarian with expertise in fish. Perhaps they could culture the tank. This infection is very difficult to eradicate. It usually requires a complete takedown and disinfection of the tank and its contents. The fish need o be treated with antibiotics effective against Mycobacteria, sometimes by injection. I also recommend never putting your hands in your tank without wearing gloves. Shoulder-length aquarium gloves are available online or at many local retailers. Steve Allen.> 

Zebra Danios With TB  12/05/2005 Hi, We have 10 gallon tank and have started the tank 4 months from now. We bought 3 Danios to start with, and they did very well for first 2.5-3 months. We used to do weekly water change. Our local pet store suggested to not to change water for first month to have fully cycled tank. We stopped the water change. I am not sure if this is the cause or something else, but we lost our smallest fish during this time.  Rest two fishes has lived fine for some time and they started slowing down. They used to eat a lot and swim around in whole tank that is filled with natural plants. They stopped eating with that eagerness. They stopped playing. We noticed that their spine is also got curved.  First we were thinking that they are getting old. After reading FAQ section in your website, we are scared about fish TB.  I have been touching the water to clean up the tank. Though I don't have any wounds, but still I am scared and wanted to know what measure we can take to diagnose if we got infected or not. About the fishes, now they both are dull and during the night they lie down on the bottom of tank. Actually till light is off mostly they lie down on the bottom. If light is on, they try to swim. We can see they have hard time swimming. They most stand still at one place. I have also read on internet somewhere that when they are at the end of their life cycle, then also they develop curve in their spine. So how do I know if my fishes have TB or they are just old. In summary these are questions I have. 1) What measures can we take to find out if we have infected ourselves with the fish TB? < Fish TB is very very rare. If people were getting infected and it was a problem I think you would see warnings all over the place. As a precaution I just wash up after having my hands in an aquarium.> <Rare in people, yes....  but I have seen many, many cases in fish lately - many of which were Betta splendens....  -SCF> 2) how do I find out if my fish's spine is getting curved because they are old or they have fish TB? < More than likely your fish are getting old. Usually these little guys don't last more than a couple of years tops and the contouring of the spine is one of the signs of a fish getting older.> 3) In case of fish TB, how do I sterilize the whole tank? Do we have to start from scratch for the new fishes? < I think you fish may have gotten ill due to poor water quality. Check the nitrates. The lower the better. These little guys like clean well oxygenated water.-Chuck>

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