Warning - The Dangers of M/M

[MUCHO REEF]

I had breakfast with a new reefer this morning who wanted to talk about his new zoanthid tank. Long story short, he revealed to me his desire to continuously keep his hands in his tank, for reasons I won't go into. He also shared with me how and when he had fragged a few of his polyps. I shared my reasons why he should stay out of his tank, but more importantly, I was concerned about his fragging practices. He's a Carpenter by trade and it was during our conversation that I noticed several minor cuts and abrasions on his hands from working. I ask if he wore protective gloves while in his tank, he laughed and said, "heck no, why?". Even with the numerous reported cases of other possible compounds/toxins secreted by polyps and the numerous reports such as the ones listed at the top of this forum and others throughout RC as I have listed two of them below, he scoffed at my request to wear protection or taking any precautionary measures once he removed his hands from his tank. I'm sure each of you have heard or should have heard about Palytoxins. One of the most dealdy toxins known to mankind. I don't think the first story below was the results of those toxins or he would be dead, but something bad happened here.

http://www.reefcentral.com/forums/sh....php?t=1858696

http://www.reefcentral.com/forums/sh...ight=dog+death

http://archive.reefcentral.com/forum...d.php?t=605364


So instantly, I stopped our conversation and remembered and reverted back to M & M and all the articles I've read here and on line over the years and most recently a story I saw on Inside Edition back in July. For those of you who aren't aware, I'm speaking of Mycobacterium Marinum. It's a very serious aquatically acquired pathogen/bacteria which can cause serious harm if you're infected. Though highly uncommonly in humans, it is possible and there are documented cases worth sharing. Have you ever had or heard of someone aquiring "fish tuberculosis, piscine TB, fish tank granuloma, or possibly swimming pool nodules?". Then please read through each of the links below and share this thread.


WARNING - Some pictures are extremely graphic


http://www.insideedition.com/news/65...nightmare.aspx

http://reefkeeping.com/issues/2003-0...ture/index.php

http://www.reefcentral.com/forums/sh...d.php?t=414029

http://findarticles.com/p/articles/m...6/ai_13736811/

http://www.pe.com/localnews/stories/...7.1fb365c.html


Please consider wearing protective, dedicated reef safe gloves when working in your reef tank. They can be acquired inexpensively at most all of your local and on line fish stores. And remember, always, always wash your hands with soap and warm water after any exposure to your tank water. FYI.

http://premiumaquatics.com/store/mer...Category_Code=

OR

Purchase latex gloves but be sure to buy the POWDER FREE gloves.


Stay safe


MUCHO REEF

PS. Though unrelated, please take these warnings seriously. Below you'll find a link of one of our own members who washed his live rock with hot water. Please read what ultimately happened from the vapors that were released. FYI.


http://blogs.discovermagazine.com/no...tore-near-you/

http://reefcentral.net/forums/showthread.php?t=1083843

[KafudaFish]

Thank you for posting.

[MUCHO REEF]

Thanks.

Just something I feel everyone should know.

Mucho

[SIR PATRICK]

Great source of info- glad you took the time to put it together.

I remember a time I was clueless about these dangers, and you have wrapped up a number, all in one post, with many sources of info.

Thanks Mucho. I am sure there are a number of people that will benefit greatly from this thread.

[Friday Night]

Good read....

Funny people only wear BSI when "fragging or dealing with zoas" when BSI should be worn even when cleaning/putting hands in the tank. Box of waste water.

[MUCHO REEF]

I hear you Friday.

I really hope it helps one person maybe and keeps them out of harm's way.

Mucho

[SoFloReefer]

This has me really concerned. What can I do to protect my fish from the Palythoas?

J/k, good thread.

[MUCHO REEF]

I think the lenght of my post alone is scaring people away, but it has to be said and it's gonna save somebody some heartache for sure.

[SoFloReefer]

Ya its def a good thing to know. I never let me dogs in the room when I'm working in the tank now.

[LiveStrongM3]

My father is a dermatologist and has treated a few of these cases. As for me (a current medical student and avid reefer), I am not worried enough about it to wear gloves in my tank. The main reason is that most people who acquire this disease have a genetic predisposition for being infected. The majority of the population wouldn't get M. marinum even if their tank is full of it since their immune system fights off the infection.

Now if you have had a diagnosed case of M. marinum infection in the past, you need to seriously consider getting out of the hobby or be extremely careful since reinfected is likely. One of my father's retired patients had a half dozen aquariums in his house and had to give up the hobby because of this disease.

Although M. marinum can have some devasting systemic effects, this mostly happens to patients that wait too long to seek treatment. If caught early, M marinum is treated with no residual effects. If you have had an inflammatory skin lesion on your hands/forearms for over a week (see picture below), go see a dermatologist (not a primary care physician) ASAP. Always remember to say that you are an aquarist when they take your history.

The two biggest things you can do to reduce your risk of of developing M. marinum (other than wearing arm length gloves):

1. Wash your hands thoroughly and never put your hand in your tank if you have any open cuts.

2. Make sure your tank has a UV sterilizer. This will dramatically limit the amount of pathogenic bacteria in your tank's water column


Typical M. marinum lesion:

[MUCHO REEF]

Originally Posted by LiveStrongM3

My father is a dermatologist and has treated a few of these cases. As for me (a current medical student and avid reefer), I am not worried enough about it to wear gloves in my tank. The main reason is that most people who acquire this disease have a genetic predisposition for being infected. The majority of the population wouldn't get M. marinum even if their tank is full of it since their immune system fights off the infection.


Thank you for your informative reply, much appreciated, but I have to disagree with you on several points. I think your reply, with good intent, undermines the intent of every author of the links above which is to exercise caution by using protective measures even though your remarks were limited to M. Marinum.

You may very well be brave to place your hands in your tank without fear of M. Marinum or any of the other potential dangers listed above. I feel your comments will surely lead others whom are new to the hobby to do the same and not exercise the use of gloves. Your remarks could very well cause someone to drop their guard while following your lead and I pray that nothing happens to them based upon your reply. So I have to ask you, how many reefers do you truly think are aware that they have a “genetic predisposition for being infected”, as you have stated? How many reefers who have read your remarks are also aware of their strong or their weak immune system to ward off this infection as you spoke of above?


Now if you have had a diagnosed case of M. marinum infection in the past, you need to seriously consider getting out of the hobby or be extremely careful since reinfected is likely. One of my father's retired patients had a half dozen aquariums in his house and had to give up the hobby because of this disease.



It goes without saying that after the fact, sure, one who is infected with M. Marinum would and should mostly likely exit reefing all together or take some very serious measure to wear a NASA suit whenever they are near their tank. However your remarks are reactive and not proactive as the damage, or should I say they infection, has already transpired. This thread seeks to inform the public of said hazards BEFORE the fact.

M. Marinum isn't the only potentially harmful infection/pathogen which might occur in aquaria, however I can assure you there are more.


1. There are several in the genus Vibrio.
2. Also Erysipelothrix insidiosa.
3. Cercarial Dermatitis

According to the link below.

http://www.freshwater-aquarium-fish...._pathogens.htm

http://emedicine.medscape.com/article/232038-overview



Although M. marinum can have some devasting systemic effects, this mostly happens to patients that wait too long to seek treatment. If caught early, M marinum is treated with no residual effects. If you have had an inflammatory skin lesion on your hands/forearms for over a week (see picture below), go see a dermatologist (not a primary care physician) ASAP. Always remember to say that you are an aquarist when they take your history.



Again, you're under the assumption that everyone knows what you and your father knows. This thread was written to enlighten and inform those who are simply unaware of the potential dangers in their systems as well as several others which you didn’t address as a medical student.

You advise the wearing of gloves for protection against M. Marinum, yet you state openly that you won’t wear them yourself is highly conflicting.

To everyone else, please be vigil in knowing that Palytoxins, Vibrio, Erysipelothrix insidiosa and Cercarial Dermatitis etc and more, with potential dangers which possibly exist in your system. This thread was not created to scare anyone, but to inform, enlighten and educate on the possible dangers in this great hobby.

As an avid reefer and med student, I really think you should clarify the seriousness of the (ALL) the dangers listed above and below even if you choose not to use protection, which is your right my friend. That would be a great help to all who read this. Why?

Above there is a guy who could have lost an eye.
A little girl who could have lost her hand/arm because of M. Marinum
A dog whom lost his life because of possible palytoxins.
A guy who lost a nail
A man who’s finger looks like a rainbow
A man who lost a chunk of flesh
A man who boiled some rock and became ill.
And one of the most potent and deadliest neurotoxins known to man potentially in a reef take.


If you are infected, one should also consider seeing someone in Infectious Diease



The two biggest things you can do to reduce your risk of of developing M. marinum (other than wearing arm length gloves):

1. Wash your hands thoroughly and never put your hand in your tank if you have any open cuts.

2. Make sure your tank has a UV sterilizer. This will dramatically limit the amount of pathogenic bacteria in your tank's water column


Typical M. marinum lesion:

I agree as I originally stated with vigorous hand washing. However a UV Sterilizer will indeed kill pathogens but for those with filter feeders in their reef tanks, it can also wipe out their food source. If all we have then is hand washing, I think some protective measures are advised. Don't you agree?

With all due respect, I'm not being argumentative at all, I am just enjoying the exchange/discussion/feedback and thank you for your replie(s) and it is ok to respectfully agree and disagree.


Mucho


Also, please consider seeking out a specialist in Infectious Disease.

http://reefkeeping.com/issues/2003-0...ture/index.php



Please vote everyone. http://www.reefcentral.com/forums/sh....php?t=2063850

[ghostman]

The dangers of MM are very real, and not easily diagnosed by most physicians. I've been battling it for for 6 months+, and still do not have it under control. Since it is rare, there is not a single antibiotic that is favored. I have tried Rifampin, minocycline, bactrim, and clarithromycin. The MM grew during all my courses. Thanks Mucho for helping point out the importance of gloves and eyewear. Here is a link to my local thread.

http://www.reefcentral.com/forums/sh....php?t=2024150

[MUCHO REEF]

You're very welcome.

Ghostman, I am so sorry to hear about this bro. This is truly sad, but I want to thank you for coming here to share your story. I believe it's going to help someone in the short term for sure.

M. Marinum is nothing to play with people and the word needs to continually go out to be vigilant regarding it. Please continue to update us on your recovery Ghost. Take good care of yourself my friend and God's speed to you on your recovery. Keep your chin up man.

People, please share his story and this link with everyone. I am no longer cocerned with how infrequent this may or may not occur, once is too many if we can help it. It was a full 6 weeks post exposure before this reefers or the doctors realized what he had and took corrective measures. This is why it is so important to wear gloves and why I made my reply in post # 11 above.

Please wear eye protection and dedicated reef safe gloves and wash your hands after you remove your gloves. Better still, wash the gloves themselves with hot water after each use and prior to storing them for use later. Make sure you rinse them well as you don't want any dried soap residue on the gloves to enter your system the next time you use them.

Thanks again Ghostman, much respect.

Mucho Reef

PS. If anyone else out there that has been exposed to M. Marinum or otherwise, please share it right here. Thanks.

[buffaqua]

Thanks for taking the time to post that. It is very informal and eye opening on how to be very cautious.

[deacon hemp]

Ive had this it really sucks! Its been over a year since and u can still see scaring from where it started. Im in the wholesaling buisness and have my hands in tank water daily (all day) so i guess the risk is greater for me. I caught it right away and it still sucked.

P.S. if you even think u have the start of MM print out alot of info on MM and bring it to your doctor to help getting the initial I.D. of it the first try,it takes the healing time down significantly the quicker you catch it.

[MUCHO REEF]

Sorry to hear this man and thanks for sharing that Deacon.

How long did it take the doctors to diagnose it?

Mucho

PS. Awesome idea, and I agree that having some literature already printed out on all of the possible issues mentioned above. You can place it in a cabinet or drawer for quick retrieval in the event medical attention is needed. Just knowing the names of these potential dangers will help as the hospital can quickly research them on their medical databases.

[gone fishin]

What an eye opener. Thanks so much for putting it together. I usually wear gloves. but never eye protection. from now on gloves and eye protection all the time. I would hate to find out the hard way if I am genetically predisposed. Thanks again

[ghostman]

I agree with having printed material to show your doctor. Most physicians will not ask if you have a fish tank, or even consider MM until other treatments fail. My diagnosis was in 6 weeks, a short time, only because I'm a physician. The average time to diagnose MM is in months, and the average time of cure is 11 months of antibiotics. I've had 2 biopsies of the lesions, and both have come up negative. The cultures may not appear positive in about 30% of cases.

[MUCHO REEF]

After rereading this link below, I knew Don Tuttle was infected, but forgot to mention the author of this article, Steven Pro, also an accomplished reefer, was also infected by M. Marinum.

http://reefkeeping.com/issues/2003-0...ture/index.php


Mucho

[LiveStrongM3]

Originally Posted by MUCHO REEF

Your remarks could very well cause someone to drop their guard while following your lead and I pray that nothing happens to them based upon your reply.

I'm not trying to downplay the seriousness of M. marinum infection, I'm just being realistic. Of the many millions of people in the US who have aquariums, only a few hundred actually acquire this disease every year. That's pretty good odds if you ask me (a lot better than most life threatening diseases).

The number of aquarists who use arm length gloves every time they interact with their tank (even in this zoanthid subforum) is probably slim and I doubt that even this very informative thread would change that.

Although I've never used full length gloves, many people find even reef specific full arm gloves cumbersome, uncomfortable, and tend to make more a mess with dripping water outside the tank. If you have some suggestions for better glove choices please post the links.

Review of the coralife full arm gloves:
http://blog.captive-aquatics.com/cap...es-review.html

Originally Posted by MUCHO REEF

As an avid reefer and med student, I really think you should clarify the seriousness of the (ALL) the dangers listed above and below even if you choose not to use protection, which is your right my friend. That would be a great help to all who read this. Why?

Above there is a guy who could have lost an eye.
A little girl who could have lost her hand/arm because of M. Marinum
A dog whom lost his life because of possible palytoxins.
A guy who lost a nail
A man who’s finger looks like a rainbow
A man who lost a chunk of flesh
A man who boiled some rock and became ill.
And one of the most potent and deadliest neurotoxins known to man potentially in a reef take.

As far as M. marinum goes, yes there can be some serious systemic effects but with the vast majority of infections are confined to the skin. The treatment many times is complicated and drawn out due to ineffective antibiotics. Good luck Ghostman with being rid of your infection.


Yes, paly toxin is very serious. Some reefers with this information might be so concerned about paly toxin that they might avoid zoas all together (which could be a good idea). As for me, when fragging them I wear gloves, a facemask, eye protection, and do it outdoors. After interacting with my tank, I thoroughly wash my hands immediately and make a point not to touch my eyes with my hands. If one follows those precautions, you don't NEED to wear full length gloves (although it is a good idea).

Originally Posted by MUCHO REEF

I agree as I originally stated with vigorous hand washing. However a UV Sterilizer will indeed kill pathogens but for those with filter feeders in their reef tanks, it can also wipe out their food source. If all we have then is hand washing, I think some protective measures are advised. Don't you agree?

If your serious about reducing your risk of M. marinum infection, it would make sense to have a UV sterilizer in your tank (which should decrease the amount of M. marinum in the water column).

Although I'm sure you know much more about reefing than I do, I have plenty of filter feeders in my aquarium (tube worms, clams, etc) and they are doing just fine with my 16w UV sterilizer.


The main point of this thread is to make reefers aware of this disease so they can seek treatment early if infected and make intelligent decisions based on the risk and severity of M. marinum and palytoxin. For some that might mean stringent handwashing, adding in a UV sterilizer, or wearing full length gloves. Your choice

[LiveStrongM3]

Originally Posted by MUCHO REEF

With all due respect, I'm not being argumentative at all, I am just enjoying the exchange/discussion/feedback and thank you for your replie(s) and it is ok to respectfully agree and disagree.[/B]

[/B]

Right back at ya.

Side note, you have an awesome tank! I love all the ricordea. http://www.reefkeeping.com/issues/20...totm/index.php

[MUCHO REEF]

Hey thanks for the reply my friend,

I hear of some who have used the long Vet gloves.

Thanks for the kind words.

Mucho Reef

[Steven Pro]

As Mucho Reef mentioned, it is not just M. marinum that one has to worry about, although a lot of people have approached me since I wrote that article telling me of their expereince with this disease. You also have Vibrio, Palythoa and Zoanthid toxins, lionfish and rabbitfish envenomation, getting stuck by urchins and forams, sensitivity to coral and anemone stings (I have fragmented so many Euphyllia species over the years with bare hands that I am very sensitive to them now), etc. Slipping on a pair of gloves seems like a simple and reasonable precaution to me.

[MUCHO REEF]

Hey thanks Steven for sharing that. Stay safe my friend and maybe we can chat at the next conference indeed.

I spent the morning doing some cross referencing on line and the accounts were very surprising as far back as 2003.

I also agree, what ever your degree of protection and type of barriers ( gloves ) used, it is a small price to pay for such a serious infection.

Thanks once again for all whom shared something here.


Mucho Reef

[MUCHO REEF]

Originally Posted by ghostman

I agree with having printed material to show your doctor. Most physicians will not ask if you have a fish tank, or even consider MM until other treatments fail. My diagnosis was in 6 weeks, a short time, only because I'm a physician. The average time to diagnose MM is in months, and the average time of cure is 11 months of antibiotics. I've had 2 biopsies of the lesions, and both have come up negative. The cultures may not appear positive in about 30% of cases.

Hey Ghostman, just wondering how you are doing? Was your incident recent or some time ago?

Mooch