Cutaneous infections from aquatic environments

The onset of various skin infestations can be observed after exposure to microbial agents present in aquatic environments. Infection by Mycobacterium marinum, that lives in salt- and freshwater, generally follows minor trauma of the hands when carrying out aquarium maintenance activities, and can give rise to a single nodular lesion or sporotrichoid forms, featuring several nodules running along the lymphatic drainage lines. Multiple or disseminated lesions are observed in subjects with an immune deficiency. Infection by Mycobacterium ulcerans most frequently affects children in Africa, South-East Asia, Latin America, and Oceania. The complaint presents with one or more subcutaneous indolent nodules that slowly evolve to ulcers and ultimately to very disabling scars. Some rapidly growing mycobacteria, that can also be present in domestic water, can cause abscesses or nodules that evolve to ulcers. Erysipeloid mainly affects the hands, and is reported in fishermen, butchers and housewives: it presents as a dark, erythematous, raised area with an irregular, centrifugal extension and distinct margins, sometimes together with generalized symptoms. Wounds from any causes may become infected by various microorganisms; in particular, Vibrio vulnificus is highly virulent and can be the cause of gastroenteritis or invasive septicemia after eating raw or undercooked shellfish, as well as necrotizing wound infections following marine injuries. These pose a high risk of fatality. Pseudomonas dermatitis follows after exposure to contaminated water in heated swimming pools, whirlpools, hot tubes, and also during a shower/bath.