Hey guys, sorry it took me a while to chime in here--I needed to get a UserID. For those of you who don't know me, my name is Chris Williams, I'm a hobbyist-microbiologist-lecturer and my area of expertise is when things go terribly wrong
So I've read through this entire thread, and there are a bunch of things I'd like to address. In general there is a lot of god information here. All in all, Mario, you did exactly the right thing here, which is not not mess around. If there is ANY feeling of "this doesn't seem right" then GO TO THE HOSPITAL. In some cases there may be no problem at all, or something small that can be easily treated. However, sometimes these symptoms mean there is something very bad happening very quickly, and is is just stupid to take a chance and bet that it's nothing.
1. Speed of infection: generally, Mycobacterium infections are slow--slow to start, slow to progress. In this case I'd bet against it as a primary pathogen simply because Mario's hand started hurting really quickly. That of course doesn't mean there isn't ALSO mycobacteria going on there, it just isn't likely to be the big player at this time. Much more likely are some of the more virulent strains of Vibrio, or Streptococcus iniae, or perhaps something else. Vibrio and S. iniae move wicked fast, so it is critical to get to an ER if your hand starts hurting worse within 24 hours and isn't getting better, or if you see red streaks.
2. Red streaks are caused by the infection traveling thgourh the lymphatic system (your lymph is a fluid wich travels through lymph vessels, kind of like blood but without any pump). This is a "get ye to the hospital immediately" sign.
3. Urgent Care vs Emergency Room: Urgent care is a decent enough idea if your local ER is a disaster and you won't be seen. The reason I don't recommend it though, is that local urgent care places tend to see things like colds, flu, simple lacerations, easy stuff. They aren't going to be thinking about crazy weird infections unless you tell them to, and they won't be as experienced. Also, you may need to be evaluated with tools and expertise they don't have--infectious disease specialists, hand surgeons, special culturing techniques, so you'll end up going to the hospital anyway as Mario did. If you suspect an infection from your tank, always ask to be seen by an Infectious Disease Specialist. These are doctors trained in weird tropical diseases and are more likely to recognize your infection for what it is than your typical doc. Remember, the things in your tanks are NOT normal.
(This is by no means a put-down of ER or general practitioners)
4. Culturing bacteria: they may or may not get a positive culture from your wound. This isn't uncommon. If it is Mycobacterium, that takes weeks to grow, in special conditions, so you won't get that result for a long time. Even if it is a vibrio they may not catch it, and here's why: Vibrio likes hands and aquariums because they are cooler than your normal body temperature--(I'm making big generalizations here but bear with me). When docs send off a culture, they incubate it at your normal body temperature, not the tanks'. It may not grow that way. When I run cultures I always do some at human temperature and some at tank temperature--your hospital most likely won't. Also, there's no guarantee that the open wound part of the hand may have the bacteria still. These bacteria like to dissolve tissue and dig down deep into the flesh (hence the pain), so there may not be any more on the surface. This is also why you may not see pus and goo--this infection doesn't necessarily work like a typical one. Myco will form granulomas, Vibrio and Strep probably won't.
5. The reason you were asked to see a hand specialist is that some bacteria like to infect the linings of the bones in the hand. The X-ray and hand person would be able to see if this were in fact happening before it could cause major damage, and they could adjust your antibiotics to make sure you're getting them where they need to be.
6. I'd be hesistant to recommend any sort of Epsom salt treatment for an aquarium-related problem, because even if it is decreasing the swelling (which it might) you'd just be masking a symptom that is telling you you need to get to the doctor. Epsoms salts are great for aches and pains and sprains and the like, but they are NOT antibiotics. They are not going to cure anything, they will just make it feel less ouchy. Same thing with bag balm--there is a little bit of antiseptic in there, but not enough to do anything at all about an infection. You need to be paying attention to the progression of symptoms here when you don't know the cause of them.
If you have any access at all to medical treatment, use it.
If you are going out to sea where you may be exposed to nasties you can't treat, get a friendly doc to write you scripts for antibiotics and bring them (the antibiotics, not the Rx's
.
--Christine
