Fishermen Face Potential of
Nasty Infections

by Laurie Schreiber

“Any break of the skin
allows bacteria to enter
and set up shop.”
— Dr. Evangeline Thibodeau,
an infectious disease fellow at
Tufts Medical Center
in Boston, Mass

Fishermen run a grave risk of suffering life- and limb-threatening bacterial infections and wounds during the normal course of operations.

Handling bait can lead to punctures of the skin from bones or sharp fins. Claws and other sharp features of shellfish can cause puncture wounds. Shellfish harbor bacteria that cause serious infections. Large fish with large sharp fins can cause major trauma with bleeding. Fish hook punctures, and punctures from rusty gear, can lead to serious infections and bleeding.

Dr. Evangeline Thibodeau, an infectious disease fellow at Tufts Medical Center in Boston, Mass., spoke to a group of fishermen at the Maine Fishermen’s Forum in March. She said there are first aid techniques to that fishermen can learn to use on the boat, when they are far from any doctor, which can prevent fish-bone poisoning and other infections.

An infectious disease doctor, she said, practices a subspecialty of general internal medicine that deals specifically with infections. “We see the worst of the worst,” she said. “We are a consultant to other doctors regarding severe infections.”

Severe skin infections, she said, can require hospitalization, the use of intravenous antibiotics, and surgical therapy. “Any break of the skin allows bacteria to enter into the unprotected tissues and set up shop,” she said.

Bacteria can come from the individual’s own skin or from outside sources, she said. In the fisherman’s case, she said, sources to consider are fish flesh, shellfish, and rusty nails and hooks.

Infections of the skin can present within hours, days or weeks of the trauma, she said. They can be complicated if the individual also has an illness that impairs the immune system, such as diabetes, hepatitis, or HIV; or is receiving immuno-suppressive drugs.

Fish hook injury to the eye or major artery needs immediate medical attention, she said. Removal is best performed by a trained specialist with sterile techniques to avoid infectious complications, she said. Where there is bleeding, infection is often not the first concern, she said. The priority, she said, is to control the bleeding and minimize damage.

However, she said, if blood or fish flesh come in contact with open skin, bacteria can get inside and “set up shop.”

To prevent infection, she said, fishermen should cover existing wounds and sore with bandages while at work. They can work at preventing trauma from happening in the first place by using “good quality, durable gloves and clothing.”

She also advised fishermen to keep their bait cold and stored in a cooler to prevent the growth of bacteria; and to stay up to date on their tetanus vaccinations, which requires a repeat every 10 years. Boats should be kept clean.

An infection called
Vibrio vulnificus is
the leading cause of
death in the
United States.

In anticipation of injury, she said fishermen should carry on their boats alcohol swabs, first aid bandages, and sterile water. She said they should clean wounds immediately with alcohol and sterile water.

Importantly, she said, wounds should not be soaked in ocean water, since other bacteria could get in and cause infections.

Various infections can cause a range of symptoms. Tetanus symptoms, which typically come on seven to 10 days after the injury, can cause muscle rigidity, neurological weakness, and death.
Tetanus is preventable with vaccine, she said.

Other infections can spread up the limb and may enter the blood stream, requiring intravenous antibiotics, she said. Untreated limb infections, she said, progress with redness, swelling, pain, fevers, shaking, malaise and, if untreated, limb loss and death.

An infection called Vibrio vulnificus is the leading cause of shellfish-associated death in the United States, she said. Filter-feeding shellfish, such as oysters, can concentrate the bacteria, she said.

Another condition, called “bulla,” is a lesioning of the skin that is caused by Mycobacterium marinum, which lives in fresh and salt water worldwide, she said.

Large fish also pose a risk, she said. These include uncontrolled bleeding and eye trauma. Thibodeau said that some bacteria are more aggressive than others, and some individuals have a more robust immune response than others.

She advised that fishermen should be on the lookout for circumstances that may be hard to notice, such as slivers of shell stuck in a finger. Still, she said, fishermen develop a tough skin and callouses that may be less prone to puncture.

And the presence of blood or flesh on the intact skin will not cause infection, she said.

Thibodeau said that, with other fish, he and his crew used to dress their catch on the way back to port. “All night, with our hands with cracks, and the salt, and we didn’t notice nothing. We would just wash our hands,” he said. “We must have developed an immunity.”

Another man said he noticed that some people can’t touch bait, especially when it’s been left to “ripen” for a while.

“They’ll break out all up their arm,” he said. “It’s just in their makeup, I guess.”

Faye Wells of Sebasco said she comes from a fishing family. She used to fish with her father, whose image was featured on the cover of the forum brochure. Then, she said, she joined the army, married in Japan, returned home to Maine, got a boat of her own, and lobstered and tuna-fished. Now, she said, she fishes with her son and his buddy, still on her boat.

“I’ve been bitten by both sharks and tuna,” she told Thibodeau. “I came down with fish poisoning within hours, both times.”

Wells said it took three hours to get back to port, where she was taken to the hospital and given an intravenous antibiotic, through the night and the next morning.

The tuna bite was on the foot, and the shark bite was on the hand, she said.The bites “instantly blew up” with heat and throbbing, she said.

Thibodeau said that, at that point, oral antibiotics likely would have been useless.

“It probably got into your bloodstream,” she told Wells.

Wells said the tuna bite occurred when she and her crew brought the fish aboard; its mouth was open and the teeth came along the outside of her foot.

“It was instant,” she said. “I knew I was in trouble right away. I’d had fish poisoning before, mostly from things around the dock. We used to use pitchforks to pitch bait, and I got a pitchfork one time on my foot. And fishhooks.” She said the shark bite also came about when tuna-fishing, when she was releasing a shark that bit onto her hook.

“If you’re feeling very greedy and want to get your hook back, you’re at risk,” she said. “I did get the hook back. You catch sharks all the time, 4 or 5 or 6 feet long. We release them, but I just wanted the hook back. I was running low on hooks. And that’s when I got my hand bitten by a shark.”

Thibodeau said the bacteria in the mouths of the fish can be virulent. “I’m going to avoid being bit a third time,” said Wells, adding that, although she hadn’t been tuna-fishing for a while, she planned to go again this coming summer.


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