Charlie Parks' hand is swollen and painful, but worse than that, he's frustrated.
His right hand is infected with a strain of water-borne bacteria known as Mycobacterium marinum — all the way into the bone, requiring multiple surgeries.
The avid sailor is frustrated because he doesn't know when he can get back on the water again — or exactly when, where and how he got infected.
The bacteria occurs naturally — not from human pollution — in saltwater and freshwater around the world.
"It's everywhere, in all types of water, in the Indian River Lagoon, in the ocean, in Lake Okeechobee and even in your aquarium," said Dr. Michael Romano, inpatient medical director at Martin Health System. "But you can't get an infection by just swimming in the water. You have to have an entry point, a cut or a fish bite to get an infection."
Parks suspects the culprit is the South Fork of the St. Lucie River, where he keeps his sailboat.
"I could have gotten a scratch who knows where on who knows what," he said. "I'm in and out of the water all the time, sailing on the St. Lucie and the lagoon."
Or he could have been infected while working in the fish pond in the backyard of his Stuart home.
"I'm still wondering where I picked it up," Parks said. "I've had cuts and scrapes from barnacles and oyster shells and from handling lines in the water. I don't remember getting a cut there on my hand, but I guess I could have. I may never know."
Many fishermen get a scratch or a cut and don't do anything about it, Parks said. "I don't want anyone to go through what I've had to go through."
Slow-acting
The bacteria acts slowly. Several weeks, even months, can lapse from the time the bacteria enters the body and the symptoms start.
"They show up as bumps on your skin," Romano said. The bumps often open, or ulcerate, and then scab over.
Parks noticed the knuckle at the base of his right index finger "getting puffy" about two to three months ago.
"It kind of stayed right there for a while," he said. "Then it started spreading down my hand and across to my palm."
A series of tests at the Veterans Affairs Hospital in Miami, "all came back negative," the 72-year-old said. Then an MRI about a month ago showed a bone in his right hand had become infected.
"That meant I had to go back to the VA in Miami for some hand surgery," Parks said. "They took a bone sample to find out what was going on."
About that time, Parks lost the use of his right index finger. His entire hand is swathed in bandages, his arm in a sling.
"I'm doing pretty well with my left hand," the right-handed Parks said. "I can't write very well, but at least I can feed myself."
About two weeks ago, Dr. Zubin J. Panthaki, a hand surgery specialist who teaches at the University of Miami and practices at VA hospitals in Miami and West Palm Beach, tested Parks for Mycobacterium marinum.
"The first time, we tested for the most common forms of bacteria," Panthaki said Friday during Parks' follow-up visit to the VA hospital in West Palm Beach. "The second time, we looked for more unlikely suspects, what we call atypical bacteria."
Parks at last knew the source of his pain and frustration.
"It was a long process just to figure out what it is," Parks said. "This thing is hard to find unless you know to test for it. Thank God that Dr. Panthaki was thinking outside the box. He was the one who put two and two together and figured it out."
Under-reported
Martin Health Systems doctors have diagnosed two cases of Mycobacterium marinum in the last six months, said Romano, who oversees infection control there.
Romano had no information about the outcome of the other cases.
A lot of Mycobacterium marinum cases likely go unreported, he said.
"It's rare, so medical personnel don't always look for it," Romano said. "Usually, the infections get treated with antibiotics, they go away and you don't even know you had it."
Panthaki said he sees "probably one case a year," mostly at his practice in Miami. "A lot of people are in the ocean there."
Parks' case is one of the more serious, he said, because the infection got into a bone.
Mycobacterium marinum infections don't have to be reported to the Florida Department of Health like Vibrio vulnificus infections do, said David J. Koerner, environmental health director at the department's St. Lucie County office.
Vibrio vulnificus, another bacteria found naturally in brackish water like the lagoon, acts quickly and can be fatal, especially to men in their 50s with underlying medical conditions. Two Treasure Coast men died within three days of being infected.
No deaths directly related to Mycobacterium marinum have been reported in the U.S., according to Medscape.com, a medical news website for healthcare professionals.
Be cautious, not fearful
"You take the same precautions to prevent a Mycobacterium infection as you do a Vibrio infection," said Gabrielle Barbarite, a researcher at Florida Atlantic University's Harbor Branch Oceanographic Institute in Fort Pierce. "Primarily, stay out of the water if you've got a cut or an open wound."
Healthy people shouldn't be afraid to get in the water, kayak on it or even send their kids to summer camp, Barbarite said. Serious infections from both bacteria are rare. Infections in children are extremely rare.
Once a Mycobacterium marinum infection is properly diagnosed, a regimen of antibiotics for two to four months is "usually the end of the story."
Parks will be taking antibacterial medications for the next eight months to a year and will need more surgery to repair or replace the tendon in his right index finger.
"I'm cautiously optimistic we can get rid of the infection with antibiotics now, no more surgery," Panthaki said Friday.
Back on the water
The infection won't keep Parks out of the water, but taught him to take precautions.
"I just want people to know — especially people who are around the water, in the river or the lagoon — that if you get a cut, take care of it right away," Parks said. "Clean it out real well. And if it doesn't get better, see a doctor."
Romano agreed.
"It's out there, so don't ignore it," Romano said. "If you get bumps on your skin, even a couple or several weeks after you're in the water, you need to see your doc."
Neither bacteria is caused, or enhanced, by pollution or Lake Okeechobee discharges. So inlet-flushed waters are just as susceptible to the bacteria as stagnant waters.
"It's not related to the algae blooms we've had in the river," Romano said. "In fact, the algae growth would probably suppress the bacteria growth."
There's no time frame for when Parks can get back to sailing.
"That's what's aggravating," he said. "I know I've still got some aggravation to go through. But when I get these bandages off and get healed up, I'll get back out on the water.
"Once a sailor, always a sailor," Parks said. "That bug is tough, but I'm tougher than it is."
Mycobacterium marinum
- Infections can occur when an open wound is exposed to contaminated water.
- Many species of fish and turtles carry the bacteria, so people can get infections from fin pricks or bites.
- Cases are rare: About 880 adults in U.S. are treated for the infection each year.
- The bacteria doesn't discriminate according to race, gender or age, although cases among children are extremely rare.
- Infections usually don't spread; but if they do, they spread very slowly.
- In serious cases, the infection can spread to the bone marrow and internal organs.
- The first signs of infection include a reddish or tan skin bump called a granuloma or a string or batch of small reddish bumps a few weeks after exposure to contaminated water.
- 90 percent of the cases involve arms and hands.
- Diagnosis and treatment are often delayed because the bacteria is much rarer than the more common staph infections.
- Infections are usually treated with oral antibiotics taken anywhere from three to 18 months; surgery is rare but used in more complicated cases.
- No deaths directly related to infections have been reported.
- The infection is not contagious or transmitted in hospitals like other common bacteria.
Sources: MedicineNet.com, MedScape.com